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Uniwersytet Medyczny w Łodzi
Medical University of Lodz
https://publicum.umed.lodz.pl
Nutrition and malnutrition in chronic pancreatitis,
Publikacja / Publication
Plewka Magdalena, Rysz Jacek, Kujawski Krzysztof
DOI wersji wydawcy / Published version DOI http://dx.doi.org/10.25177/JFST.3.5.4
Adres publikacji w Repozytorium URL / Publication address in Repository https://publicum.umed.lodz.pl/info/article/AMLd8a2c5614f784481829a1812489fc336/
Data opublikowania w Repozytorium / Deposited in Repository on Oct 5, 2020
Rodzaj licencji / Type of licence Attribution (CC BY)
Plewka Magdalena, Rysz Jacek, Kujawski Krzysztof: Nutrition and malnutrition in
Cytuj tę wersję / Cite this version chronic pancreatitis, Journal of Food Science & Technology, Sift Desk Publishers, vol.
3, no. 5, 2018, pp. 431-439, DOI:10.25177/JFST.3.5.4
SIFT DESK Jacek Rysz et al.
SDRP Journal of Food Science & Technology (ISSN: 2472-6419)
Nutrition and malnutrition in chronic pancreatitis
DOI: 10.25177/JFST.3.5.4 Review
th
Received Date: 07 Jul 2018
Copy rights: © This is an Open access article distributed under the terms of
Accepted Date: 01st Aug 2018 International License.
th
Published Date:07 Aug 2018
1 1 1,2
Magdalena Plewka , Jacek Rysz , Krzysztof Kujawski
1
Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromski-
ego 113, 90-549 Lodz, Poland
2
Gastrointestinal Endoscopy Department, WAM Teaching Hospital of Lodz, Zeromskiego 113, 90-549
Lodz, Poland
CORRESPONDENCE AUTHOR
Jacek Rysz,
Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromski-
ego 113, Lodz, Poland,
E-mail: jacek.rysz@umed.lodz.pl
CITATION
Jacek Rysz, Nutrition and malnutrition in chronic pancreatitis (2018)SDRP Journal of Food Science &
Technology 3(5)
ABSTRACT person’s intake of energy and/or nutrients. The
term malnutrition covers 2 broad groups of con-
Patients with chronic pancreatitis are at risk of
ditions. One is ‘undernutrition’— which includes
malnutrition and nutrient deficiencies. ddMalnu-
stunting (low height for age), wasting (low
trition is a huge problem in population, especial-
weight for height), underweight (low weight for
ly in hospitalised patients. Routine assessment
age) and micronutrient deficiencies or insuffi-
and regular monitoring of nutrition status is es-
ciencies (a lack of important vitamins and miner-
sential. It is associated with increased rates of als). [1] Malnutrition is a common, under-
morbidity and mortality in hospital patients and
recognised and undertreated problem facing pa-
significantly increases healthcare costs. The pan-
tients and clinicians. It is both a cause and conse-
creas is a major player in digestion. Normal pan-
quence of disease and exists in institutional care
creatic function ensures effective digestion and
and the community. It concerns a very large pop-
absorption of nutrients. Chronic pancreatitis re-
fers to a syndrome of long-standing pancreatic ulation of developing countries, but it can also be
a problem in developed countries, including Po-
injury and because of its role in digestion, chron- land.
ic pancreatitis is responsible for malnutrition.
Generally about 20%-50% (depends on what
INTRODUCTION criteria are taken) of all patients in hospital are
found at risk of undernutrition. A large part of
According to WHO definition, malnutrition re-
these patients are at nutritional risk when admit-
fers to deficiencies, excesses or imbalances in a
ted to hospital and in the majority of these, un-
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SIFT DESK Jacek Rysz et al.
dernutrition develops negatively during hospital stay. • increased energy expenditure, in specific disease
It is really important to prevent this undernutrition, processes, for instance patients with major trau-
because this can cause difficulties with treating main ma, injuries or burns, energy expenditure may be
diseases that are responsible for admitting to hospital. considerably higher, although only for a short
[2] period of time. [5]
There are several factors that can have influence on
failure in nutrition.
Malnutrition, which is often overlooked by clinicians,
Table 1. Factors contributing to malnutrition in acute is common and has wide-ranging effects on physio-
care patients (published by Elsevier, 2007). [3] logical function. It is associated with increased rates
of morbidity and mortality in hospital patients and
Personal Organisational significantly increases healthcare costs. Implementa-
Age Failure to recognise tion of a simple screening tool identifies patients at
malnutrition risk and allows appropriate treatment to be instituted;
Apathy/depression Lack of nutritional screen- this can significantly improve clinical outcomes and
ing or assessment reduce healthcare expenditure. Every doctor should
know that proper nutritional care is essencial to good
Disease (e.g., cancer, diabe- Lack of nutritional training clinical practice.
tes, cardiac, gastrointestinal)
Inability to buy, cook or con- Confusion regarding There are several tools to identify patients with mal-
sume food nutritional responsibility nutrition. [3]
Inability to chew or swallow Failure to record height 1.MUST is a simple, rapid only three-question tool to
and weight
Limited mobility Failure to record patient screen patients and has been proven to be reliable and
intake valid. It aims to identify those at risk by incorporat-
Sensory loss (taste, smell) Lack of adequate intake ing:
• current weight (BMI)
Treatment (ventilation, sur- Lack of staff to assist with
gery, drain tubes) feeding • history of recent unintentional weight loss
Drug therapy Importance of nutrition • likelihood of future weight loss
unrecognised
It allows indicate whether nutrition intervention is
necessary. Although is limited by the fact it has not
Most adult malnutrition is associated with disease and been validated in children or renal patients.
may arise due to:
2.The Mini Nutrition Assessment (MNA) was devel-
• reduced dietary intake, it occurs due to reductions
oped specifically for use among elderly patients (≥65
in appetite sensation as a result of changes in cy-
tokines, glucocorticoids, insulin and insulin-like years) in hospitals and nursing homes. The original
form considers: anthropometrical, medical, lifestyle,
growth factors. The problem may be compounded
dietary and psychosocial factors in an 18 item assess-
in hospital patients by failure to provide regular ment, using a points-based scoring system to deter-
nutritious meals, because of routine clinical activ-
mine if a patient is at risk of, or suffering from mal-
ities, and lack of help and support with feeding nutrition.
when required.
• reduced absorption of macro- and micronutrients 2.Nutritional Risk Screening (NRS-2002) uses recent
weight loss, decreased BMI and reduced dietary in-
especially in those after abdominal surgical resec-
tion take, combined with a subjective assessment of dis-
• increased losses or altered requirements ease severity (based on increased nutrition require-
ments and/or metabolic stress), to generate a nutrition
risk score.
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SIFT DESK Jacek Rysz et al.
3.The four item Short Nutrition Assessment Ques- longed period of time the body draws on functional
tionnaire (SNAQ) was developed to diagnose malnu- reserves in tissues such as muscle, adipose tissue and
trition in hospitalised patients and provides an indica- bone leading to changes in body composition. With
tion for dietetic referrals as well as outlining a nutri- time, there are direct consequences for tissue func-
tion treatment plan. It has been validated for hospital tion, leading to loss of functional capacity and a brit-
inpatient and outpatient use, as well as residential tle, but stable, metabolic state. [6,20]
patients and does not require calculation of BMI.
4.Subjective Global Assessment (SGA) as dr • Cardio-respiratory function
Khursheed Jeejeebhoy says „is a simple bedside
Reduction in cardiac muscle mass is recognised in
method of assessing the risk of malnutrition and iden-
malnourished individuals. The resulting decrease in
tifying those who would benefit from nutritional sup-
cardiac output has a corresponding impact on renal
port. Its validity for this purpose has been demonstrat-
function by reducing renal perfusion and glomerular
ed in a variety of conditions including surgical pa-
filtration rate. Micronutrient and electrolyte deficien-
tients, those with cancer, on renal dialysis and in the
ICU.” cies (eg thiamine) may also affect cardiac function,
SGA is one of the most commonly used nutrition particularly during refeeding. Poor diaphragmatic and
respiratory muscle function reduces cough pressure
assessment tools, and assesses nutrition status via
and expectoration of secretions, delaying recovery
completion of a questionnaire which includes data on from respiratory tract infections.
weight change, dietary intake change, gastrointestinal
symptoms, changes in functional capacity in relation
• Gastrointestinal function
to malnutrition as well as assessment of fat and mus-
cle stores and the presence of oedema and ascites [4].
Adequate nutrition is important for preserving GI
This tool allows for malnutrition diagnosis, and clas-
function: chronic malnutrition results in changes in
sifies patients as either: A—well-nourished; B—
pancreatic exocrine function, intestinal blood flow,
mildly/moderately malnourished; or C—severely
villous architecture and intestinal permeability. The
malnourished.
colon loses its ability to reabsorb water and electro-
SGA has been found to be an appealing method of lytes, and secretion of ions and fluid occurs in the
small and large bowel. This may result in diarrhoea,
assessing nutritional status, as its subjective nature
which is associated with a high mortality rate in se-
allows clinicians to capture subtle patterns of change
verely malnourished patients.
in clinical variables (e.g., weight loss patterns rather
than absolute weight loss). A high degree of inter-
rater reproducibility has been shown for SGA, with • Immunity and wound healing
91% of surgical patients classified by SGA having
two clinicians agreeing on SGA classification [4]. Immune function is also affected, increasing the risk
of infection due to impaired cell-mediated immunity
and cytokine, complement and phagocyte function.
Consequences of malnutrition
Delayed wound healing is also well described in mal-
nourished surgical patients.
• Malnutrition affects the function and recovery of
every organ system.
It can decrease muscle function due to depletion of fat • Psychosocial effects
and muscle mass. Muscle function declines before
In addition to these physical consequences, malnutri-
changes in muscle mass occur, suggesting that altered
tion also results in psychosocial effects such as apa-
nutrient intake has an important impact independent thy, depression, anxiety and self-neglect. [20]
of the effects on muscle mass. If, dietary intake is
insufficient to meet requirements over a more pro-
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