Pancreatic Malnutrition in Children

Abstract

Exocrine pancreatic insufficiency in children can lead to lifelong complications related to malnutrition and poor growth. The clinical presentation can be subtle in the early stages of insufficiency as the large functional capacity of the pancreas is gradually lost. The pediatrician plays a crucial role in the early identification of these children to ensure a timely referral so that a diagnosis can be made and therapy initiated. Early nutritional therapy allows for prevention and correction of deficiencies, which leads to improved outcomes and survival. When insufficiency is suspected, the workup should start with an indirect test of exocrine pancreatic function, such as fecal elastase, to establish the diagnosis. Once a diagnosis is established, further testing to delineate the etiology should be pursued, with cystic fibrosis being high on the differential list and assessed for with a sweat test. Assessment of anthropometry at every visit is key, as is monitoring of laboratory parameters and physical examination findings that are suggestive of malabsorption and malnutrition. The mainstay of management is administration of exogenous pancreatic enzymes to facilitate digestion and absorption. [ Pediatr Ann. 2019;48(11):e441–e447.]

Profile of Human Milk Phospholipids at Different Lactation Stages with UPLC/Q-TOF-MS: Characterization, Distribution, and Differences

“…The total average content is higher than published research because previous studies identified fewer phospholipid molecular species . The steady content of total phospholipids at various phases (colostrum, transitional milk, and mature milk) of lactation was important to provide normal fat digestion and absorption for the neonates, whose secretion of the pancreas might be defective . However, the studies of Ma et al and Zhao et al revealed that the content of total phospholipids from colostrum to mature milk declined, which was not steady like this research.…”

“…19 The steady content of total phospholipids at various phases (colostrum, transitional milk, and mature milk) of lactation was important to provide normal fat digestion and absorption for the neonates, whose secretion of the pancreas might be defective. 28 However, the studies of Ma et al 29 and Zhao et al 20 revealed that the content of total phospholipids from colostrum to mature milk declined, which was not steady like this research. Zhao et al 20 used the reverse-phase liquid chromatography (RPLC) approach to analyze SM, and the content of SM in colostrum was 11.56−153.92 mg/L.…”