Pancreatic exocrine function and morphology following prior malnutrition in Asian and African cohorts: a multi-cohort study

BACKGROUND: Studies of survivors of large 20th-century famines suggest persistent after effects on metabolism and nutrient handling, including abnormal endocrine and exocrine pancreatic functions, which play key roles in nutrient digestion and absorption. OBJECTIVES: We tested the hypothesis that severe wasting malnutrition in childhood or adulthood leads to long-term exocrine pancreatic insufficiency and/or structural abnormalities. METHODS: We followed up participants from 6 cohorts of previously malnourished (PM) and not previously malnourished (NPM) adults and children in India, the Philippines, Tanzania, and Zambia. Fecal elastase (FE-1), circulating trypsinogen, amylase, and lipase assays were performed. Ultrasound scans (USS) were conducted in all cohorts, and a subset of adults underwent computed tomography scan (CT) to estimate pancreatic volume. Statistical analyses included Kruskal-Wallis tests and logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: A total of 2165 participants had assessments of pancreatic structure or exocrine function: 1799 (83%) had FE-1 measured, 1761 (81%) underwent USS, and 329 (15%) had CT. Low FE-1 (