Both Exocrine Pancreatic Insufficiency and Signs of Pancreatic Inflammation Are Prevalent in Children with Complicated Severe Acute Malnutrition: An Observational Study

Bartels, Rosalie H.; Meyer, Sophie; Stehmann, Tijs A.; Bourdon, Céline; Bandsma, Robert; Voskuijl, Wieger

doi:10.1016/j.jpeds.2016.04.013

Cited by 24 publications

(42 citation statements)

References 44 publications

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“…Diarrhea in SAM is multifactorial; infectious causes and intestinal inflammation as well as impaired digestion of fat and protein related to exocrine pancreas and hepatobiliary dysfunction likely impact the overall nutrient absorptive capacity, and these pathways would not be directly ameliorated by our intervention [12,35,36]. Most cases of diarrhea were osmotic in nature rather than secretory, suggesting that bacterial infections such as enterotoxin-producing Escherichia coli or rotavirus were likely not contributing substantially to the diarrhea at day 3.…”

Section: Discussionmentioning

confidence: 99%

A reduced-carbohydrate and lactose-free formulation for stabilization among hospitalized children with severe acute malnutrition: A double-blind, randomized controlled trial

et al. 2019

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Background Children with medically complicated severe acute malnutrition (SAM) have high risk of inpatient mortality. Diarrhea, carbohydrate malabsorption, and refeeding syndrome may contribute to early mortality and delayed recovery. We tested the hypothesis that a lactose-free, low-carbohydrate F75 milk would serve to limit these risks, thereby reducing the number of days in the stabilization phase. Methods and findings In a multicenter double-blind trial, hospitalized severely malnourished children were randomized to receive standard formula (F75) or isocaloric modified F75 (mF75) without lactose and with reduced carbohydrate. The primary endpoint was time to stabilization, as defined by the World Health Organization (WHO), with intention-to-treat analysis. Secondary outcomes included in-hospital mortality, diarrhea, and biochemical features of malabsorption and refeeding syndrome. The trial was registered at clinicaltrials.gov (NCT02246296). Four hundred eighteen and 425 severely malnourished children were randomized to F75 and mF75, respectively, with 516 (61%) enrolled in Kenya and 327 (39%) in Malawi. Children with a median age of 16 months were enrolled between 4 December 2014 and 24 December 2015. One hundred ninety-four (46%) children assigned to F75 and 188 (44%) to mF75 had diarrhea at admission. Median time to stabilization was 3 days (IQR 2–5 days), which was similar between randomized groups (0.23 [95% CI −0.13 to 0.60], P = 0.59). There was no evidence of effect modification by diarrhea at admission, age, edema, or HIV status. Thirty-six and 39 children died before stabilization in the F75 and in mF75 arm, respectively ( P = 0.84). Cumulative days with diarrhea ( P = 0.27), enteral ( P = 0.42) or intravenous fluids ( P = 0.19), other serious adverse events before stabilization, and serum and stool biochemistry at day 3 did not differ between groups. The main limitation was that the primary outcome of clinical stabilization was based on WHO guidelines, comprising clinical evidence of recovery from acute illness as well as metabolic stabilization evidenced by recovery of appetite. Conclusions Empirically treating hospitalized severely malnourished children during the stabilization phase with lactose-free, reduced-carbohydrate milk formula did not improve clinical outcomes. The biochemical analyses suggest that the lactose-free formulae may still exceed a carbohydrate load threshold for intestinal absorption, which may limit their usefulness in the context of complicated SAM. Trial registration ClinicalTrials.gov NCT02246296 .

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Section: Discussionmentioning

confidence: 99%

A reduced-carbohydrate and lactose-free formulation for stabilization among hospitalized children with severe acute malnutrition: A double-blind, randomized controlled trial

et al. 2019

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“…There can be false positive results if the test is performed on a watery stool specimen; therefore, all FE-1 testing should be performed on a formed or semi-formed stool specimen. Individuals with severe malnutrition may also have false positive FE-1 [31], although in the case of a patient with CF the PI is the likely cause of the malnutrition. In non-CF patients, testing should be repeated after nutritional repletion.…”

Section: Indirect Testsmentioning

confidence: 99%

Pancreatic insufficiency in Cystic Fibrosis

Singh

Schwarzenberg

2017

Journal of Cystic Fibrosis

139

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“…Current management strategies are 'blanket approaches' that disregard the different presentations of SAM and their associated clinical risk [4]. In general, edematous SAM is linked to higher morbidity and mortality [4,9], but the prevalence of underlying pathologies such as Human Immunodeficiency Virus (HIV) has changed the risk profiles associated with the different SAM phenotypes. Recent studies have shown children with non-edematous SAM to be more vulnerable in certain contexts (e.g., children with HIV and severe wasting have the highest mortality risk) [10,11].…”

Section: Introductionmentioning

confidence: 99%

The clinical use of longitudinal bio-electrical impedance vector analysis in assessing stabilization of children with severe acute malnutrition

et al. 2021

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Both Exocrine Pancreatic Insufficiency and Signs of Pancreatic Inflammation Are Prevalent in Children with Complicated Severe Acute Malnutrition: An Observational Study

Cited by 24 publications

References 44 publications

A reduced-carbohydrate and lactose-free formulation for stabilization among hospitalized children with severe acute malnutrition: A double-blind, randomized controlled trial

A reduced-carbohydrate and lactose-free formulation for stabilization among hospitalized children with severe acute malnutrition: A double-blind, randomized controlled trial

Pancreatic insufficiency in Cystic Fibrosis

The clinical use of longitudinal bio-electrical impedance vector analysis in assessing stabilization of children with severe acute malnutrition

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