Abstract
Pancreatic enzyme replacement therapy (PERT) and fat predigestion are key in ensuring the optimal growth of patients with cystic fibrosis. Our study attempted to highlight differences between fat predigestion and conventional PERT on body composition of young pigs with exocrine pancreatic insufficiency (EPI). EPI and healthy pigs were fed with high-fat diet for six weeks. During the last two weeks of the study, all pigs received additional nocturnal alimentation with Peptamen AF (PAF) and were divided into three groups: H—healthy pigs receiving PAF; P—EPI pigs receiving PAF+PERT; and L—EPI pigs receiving PAF predigested with an immobilized microbial lipase. Additional nocturnal alimentation increased the body weight gain of EPI pigs with better efficacy in P pigs. Humerus length and area in pigs in groups L and P were lower than that observed in pigs in group H (p value 0.005-0.088). However, bone mineral density and strength were significantly higher in P and L as compared to that of H pigs (p value 0.0026-0.0739). The gut structure was improved in P pigs. The levels of neurospecific proteins measured in the brain were mainly affected in P and less in L pigs as compared to H pigs. The beneficial effects of the nocturnal feeding with the semielemental diet in the prevention of EPI pigs' growth/development retardation are differently modified by PERT or fat predigestion in terms of growth, bone properties, neurospecific protein distribution, and gut structure.
Highlights
Diseases that are associated with loss or block of the pancreatic parenchyma function (e.g., cystic fibrosis (CF), obstruction of the main pancreatic duct, extensive necrotizing acute pancreatitis, pancreatic cancer, and ShwachmanDiamond syndrome) may lead to exocrine pancreatic insufficiency (EPI), which results in the malabsorption of nutrients, vitamin deficiencies, poor growth, delayed puberty, weight loss, and an increased risk of death [1]
After introduction of the additional nocturnal alimentation, the total body weight gain increased to up to 64% and 49% in pigs in groups P and L, respectively, and of that of group H pigs, with the increase in body weight gain being lower in L compared to P pigs
We conclude that the benefits of feeding EPI pigs with semielemental diet can be improved, differently, by pancreatic enzyme replacement therapy (PERT) supplementation or diet predigestion with lipase
Summary
CF patients usually exhibit general and skeletal growth retardation [2]. Oral pancreatic enzyme replacement therapy (PERT) is recommended to EPI patients [4]. Do not respond well to enzyme supplementation. The poor response of some patients to PERT may be due to the autoinactivation of the enteric-coated enzymes, directly after reaching the gut [5]. For this reason, alternate strategies of replacement therapy are being examined, including predigestion using immobilized lipase to improve fat digestion and absorption, in order to obtain satisfactory clinical responses [6]
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