Pancreatic function in children with non-alcoholic fatty pancreas disease

Authors

  • Yu. M. Stepanov State Institution “Institute of Gastroenterology of National Academy of Medical Sciences of Ukraine”, Dnipro,
  • O. Yu. Lukianenko SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”, Dnipro,
  • N. Yu. Zavhorodnia SI “Institute of Gastroenterology of the National Academy of Sciences of Ukraine”, Dnipro,
  • O. M. Tatarchuk SI “Institute of Gastroenterology of the National Academy of Sciences of Ukraine”, Dnipro.,
  • N. H. Hravirovska SI “Institute of Gastroenterology of the National Academy of Sciences of Ukraine”, Dnipro,
  • I. A. Klenina SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”, Dnipro,

DOI:

https://doi.org/10.14739/2310-1210.2019.1.155816

Keywords:

pancreatic diseases, exocrine pancreas, steatometry, elastography, obesity, children

Abstract


Objective. To study the features of pancreatic function in children with pancreatic steatosis.

Materials and methods. We examined 77 children; the average age of patients was (11.59 ± 2.82) years. Pancreatic steatosis was diagnosed by ultrasound examination. In addition, shear wave elastography of the pancreas was performed using UltimaPAExpert apparatus («Radmir»,Ukraine).

Children were divided into groups according to the obesity/overweight and pancreatic steatosis presence as follows: the group 1–- 47 children with pancreatic steatosis and obesity / overweight; the group 2 – 20 children with obesity / overweight without signs of pancreatic steatosis; the group 3 – 10 children with normal weight who had no signs of steatosis. Examination of the exocrine pancreas function with determination of serum amylase, lipase and trypsin levels, urine amylase, fecal elastase was carried out.

Results. Serum lipase level was significantly lower in the group of children with steatosis (0.83 [0.64, 0.99] nmol/s·l) compared to children with normal weight (1.05 [0.99; 1.13] nmol/s·l) (P < 0.05). The level of trypsin did not reveal any significant differences between the groups, while serum amylase level in the patient group 1 tended to be lower compared to children of the group 2. The level of fecal elastase (FE) was significantly lower in patients with steatosis (176.7 [65.8, 251.8] μg/g) compared to children with normal weight (311.40 [213.3, 363. 0] μg/g) (P < 0.05). The level of FE negatively correlated with the degree of pancreatic steatosis in the general group (r = -0,28; P < 0.05) as well as with the pancreatic parenchyma stiffness in children without obesity (r=-0,40; P < 0.05).

Conclusions. Pancreatic steatosis in children can be accompanied by exocrine pancreatic insufficiency development.

References

Singh, R. G., Yoon, H. D., Wu, L. M., Lu, J., Plank, L. D., & Petrov, M. S. (2017). Ectopic fat accumulation in the pancreas and its clinical relevance: A systematic review, meta-analysis, and meta-regression. Metabolism-Clinical and Experimental, 69, 1–13. doi: 10.1016/j.metabol.2016.12.012.

Khatua, B., El-Kurdi, B., & Singh, V. P. (2017). Obesity and pancreatitis. Current opinion in gastroenterology, 33(5), 374–382. doi: 10.1097/MOG.0000000000000386.

Tajima, Y., Kawabata, Y., & Hirahara, N. (2017). Preoperative imaging evaluation of pancreatic pathologies for the objective prediction of pancreatic fistula after pancreaticoduodenectomy. Surgery today, 48(2), 140–150. doi: 10.1007/s00595-017-1529-3.

Khoury, T., Asombang, A. W., Berzin, T. M., Cohen, J., Pleskow, D. K., & Mizrahi, M. (2017). The clinical implications of fatty pancreas: a concise review. Digestive diseases and sciences, 62(10), 2658–2667. doi: 10.1007/s10620-017-4700-1.

Guglielmi, V., & Sbraccia, P. (2017). Type 2 diabetes: Does pancreatic fat really matter? Diabetes/Metabolism Research and Reviews, 34(2), e2955. doi: 10.1002/dmrr.2955.

Pacifico, L., Di Martino, M., Anania, C., Andreoli, G. M., Bezzi, M., Catalano, C., & Chiesa, C. (2015). Pancreatic fat and β-cell function in overweight/obese children with nonalcoholic fatty liver disease. World Journal of Gastroenterology, 21(15), 4688. doi: 10.3748/wjg.v21.i15.4688.

Staaf, J., Labmayr, V., Paulmichl, K., Manell, H., Cen, J., Ciba, I., et al. (2017). Pancreatic fat is associated with metabolic syndrome and visceral fat but not beta-cell function or body mass index in pediatric obesity. Pancreas, 46(3), 358. doi: 10.1097/MPA.0000000000000771.

Taylor, C. J., Chen, K., Horvath, K., Hughes, D., Lowe, M. E., Mehta, D., et al. (2015). ESPGHAN and NASPGHAN report on the assessment of exocrine pancreatic function and pancreatitis in children. Journal of pediatric gastroenterology and nutrition, 61(1), 144–153. doi: 10.1097/MPG.0000000000000830.

(2007) World Health Organization: Growth reference 5-19 years. BMI-for-age (5-19 years). Retrieved from: http://www.who.int/growthref/who2007_bmi_for_age/en/

Fernández, J. R., Redden, D. T., Pietrobelli, A., & Allison, D. B. (2004) Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J. Pediatr, 145(4), 439–44. doi: 10.1016/j.jpeds.2004.06.044.

Lee, J. S., Kim, S. H., Jun, D. W., Han, J. H., Jang, E. C., Park, J. Y., et al. (2009) Clinical implications of fatty pancreas: correlations between fatty pancreas and metabolic syndrome. World Journal of Gastroenterology, 15(15), 1869–1875. doi: 10.3748/wjg.15.1869.

Kamyshnikov, V. S. (2002). Spravochnik po kliniko-biokhimicheskoj laboratornoj diagnostike [Reference book on clinical and biochemical laboratory diagnostics]. (Vol. 2). Minsk. [in Russian].

Goriachkovskyi, O. M. (1998) Klinichna biokhimiia. Dovidkovyi posibnyk [Clinical Biochemistry: Reference Guide]. Odessa: Astroprynt. [in Ukrainian].

Saisho, Y. (2016). Pancreas volume and fat deposition in diabetes and normal physiology: consideration of the interplay between endocrine and exocrine pancreas. The review of diabetic studies, 13(2–3), 132. doi: 10.1900/RDS.2016.13.132.

Saisho, Y., Butler, A. E., Meier, J. J., Monchamp, T., Allen‐Auerbach, M., Rizza, R. A., & Butler, P. C. (2007). Pancreas volumes in humans from birth to age one hundred taking into account sex, obesity, and presence of type‐2 diabetes. Clinical anatomy, 20(8), 933–942. doi: 10.1002/ca.20543.

Nakajima, K., Oshida, H., Muneyuki, T., Saito, M., Hori, Y., Fuchigami, H., et al. (2013). Independent association between low serum amylase and non-alcoholic fatty liver disease in asymptomatic adults: a cross-sectional observational study. BMJ open, 3(1), e002235. doi: 10.1136/bmjopen-2012-002235.

Nakajima, K. (2016). Low serum amylase and obesity, diabetes and metabolic syndrome: A novel interpretation. World journal of diabetes, 7(6), 112. doi: 10.4239/wjd.v7.i6.112.

Abu-El-Haija, M., Kumar, S., Quiros, J. A., Balakrishnan, K., Barth, B., Bitton, S., et al. (2018). Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. Journal of pediatric gastroenterology and nutrition, 66(1), 159–176. doi: 10.1097/MPG.0000000000001715.

Danino, H., Peri-Naor, R., Fogel, C., Ben-Harosh, Y., Kadir, R., Salem, H., & Birk, R. (2016). PPARγ regulates exocrine pancreas lipase. Biochimica et Biophysica Acta (BBA)-Molecular and Cell Biology of Lipids, 1861(12), 1921–1928. doi: 10.1016/j.bbalip.2016.09.010.

Kühn, J. P., Berthold, F., Mayerle, J., Völzke, H., Reeder, S. B., Rathmann, W., et al. (2015). Pancreatic steatosis demonstrated at MR imaging in the general population: clinical relevance. Radiology, 276(1), 129–136. doi: 10.1148/radiol.15140446.

Bharmal, S. H., Pendharkar, S. A., Singh, R. G., Goodarzi, M. O., Pandol, S. J., & Petrov, M. S. (2017). Relationship between circulating levels of pancreatic proteolytic enzymes and pancreatic hormones. Pancreatology, 17(6), 876–883. doi: 10.1016/j.pan.2017.09.007.

Carroccio, A., Verghi, F., Santini, B., Lucidi, V., Iacono, G., Cavataio, F., et al. (2001). Diagnostic accuracy of fecal elastase 1 assay in patients with pancreatic maldigestion or intestinal malabsorption. Digestive diseases and sciences, 46(6), 1335–1342. doi: 10.1023/A:1010687918252.

Teichmann, J., Riemann, J. F., & Lange, U. (2011). Prevalence of exocrine pancreatic insufficiency in women with obesity syndrome: assessment by pancreatic fecal elastase 1. ISRN gastroenterology, 2011, 951686. doi: 10.5402/2011/951686.

Grinevich, V. B., Sas, E. I., Kravchuk, Yu. A., & Matyushenko, K.V. (2012). Steatoz podzheludochnoj zhelezy. Podkhody k terapii [Pancreatic steatosis. Approaches to therapy]. Gastroe'nterologiya Sankt-Peterburga, 2–3, 6–9. [in Russian].

Samsonova, N. G., & Zvenigorodskaya, L. A. (2012). Kliniko-funkcional'noe sostoyaniye podzheludochnoj zhelezy pri metabolicheskom sindrome [Clinical and functional state of pancreas in metabolic syndrome]. E'ksperimental'naya i klinicheskaya gastroe'nterologiya, 11, 96–100 [in Russian].

Vendrik, K. E., Tonneijck, L., Muskiet, M. H., Kramer, M. H., Pouwels, P. J., Pieters-van den Bos, I. C., et al. (2017). Pancreatic Steatosis Is Not Associated With Exocrine Pancreatic Function in Overweight Type 2 Diabetes Patients. Pancreas, 46(9), e75–e76. doi: 10.1097/MPA.0000000000000893.

Aleshina, E. I., Novikova, V. P., Gur'eva, V. A., Burnysheva, I. A., & Usychenko, E. A. (2014). Hepatic steatosis and fatty pancreas--2 targets of metabolic syndrome in children. Eksperimental'naia i klinicheskaia gastroenterologiia = Experimental & clinical gastroenterology, 8, 16–20.

Rathmann, W., Haastert, B., Oscarsson, J., Berglind, N., & Wareham, N. J. (2015). Inverse association of HbA1c with faecal elastase 1 in people without diabetes. Pancreatology, 15(6), 620–625. doi: 10.1016/j.pan.2015.09.014.

Kong, M., Zhu, L., Bai, L., Zhang, X., Chen, Y., Liu, S., et al. (2014). Vitamin D deficiency promotes nonalcoholic steatohepatitis through impaired enterohepatic circulation in animal model. American Journal of Physiology-Gastrointestinal and Liver Physiology, 307(9), G883–G893. doi: 10.1152/ajpgi.00427.2013

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1.
Stepanov YM, Lukianenko OY, Zavhorodnia NY, Tatarchuk OM, Hravirovska NH, Klenina IA. Pancreatic function in children with non-alcoholic fatty pancreas disease. Zaporozhye Medical Journal [Internet]. 2019Feb.8 [cited 2024Nov.22];(1). Available from: http://zmj.zsmu.edu.ua/article/view/155816

Issue

No. 1 (2019)

Section

Original research

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