Abstract
BackgroundStructural changes occur in the pancreas as a part of the natural aging process. With aging, also the incidence of maldigestive symptoms and malnutrition increases, raising the possibility that these might be caused at least in part by inadequate pancreatic enzyme secretion due to degenerative processes and damage of the gland. Fecal elastase-1 is a good marker of pancreatic exocrine secretion. The aim of this study was to investigate the fecal elastase-1 levels among over 60 years old Finnish and Polish healthy individuals without any special diet, known gastrointestinal disease, surgery or diabetes mellitus.MethodsA total of 159 patients participated in this cross-sectional study. 106 older individuals (aged 60-92 years) were recruited from outpatient clinics and elderly homes. They were divided to three age groups: 60-69 years old (n = 31); 70-79 years old (n = 38) and over 80 years old (n = 37). 53 young subjects (20-28 years old) were investigated as controls. Inclusion criteria were age over 60 years, normal status and competence. Exclusion criteria were any special diet, diabetes mellitus, any known gastrointestinal disease or prior gastrointestinal surgery. Fecal elastase-1 concentration was measured from stool samples with an ELISA that uses two monoclonal antibodies against different epitopes of human elastase-1.ResultsFecal elastase-1 concentrations correlated negatively with age (Pearson r = -0,3531, P < 0.001) and were significantly lower among subjects over 70 years old compared to controls (controls vs. 70-79 years old and controls vs. over 80 years old, both P < 0.001). Among the over 60 years old subjects, the fecal elastase-1 concentrations were below the cut off level of 200 μg/g in 23 of 106 (21.7%) individuals [mean 112 (86-138) μg/g] indicating pancreatic exocrine insufficiency. Of those, 9 subjects had fecal elastase-1 level below 100 μg/g as a marker of severe pancreatic insufficiency.ConclusionIn our study one fifth of healthy older individuals without any gastrointestinal disorder, surgery or diabetes mellitus suffer from pancreatic exocrine insufficiency and might benefit from enzyme supplementation therapy.
Highlights
Structural changes occur in the pancreas as a part of the natural aging process
The aim of our study was to evaluate the pancreatic exocrine secretion in older people with no known gastrointestinal disease, surgery or diabetes mellitus with a simple fecal elastase-1 test to estimate the possible need for exogenous pancreatic enzyme replacement therapy in the older population
The fecal elastase1 concentration was significantly lower in individuals over 70 years old compared to controls
Summary
Structural changes occur in the pancreas as a part of the natural aging process. With aging, the incidence of maldigestive symptoms and malnutrition increases, raising the possibility that these might be caused at least in part by inadequate pancreatic enzyme secretion due to degenerative processes and damage of the gland. The aim of this study was to investigate the fecal elastase-1 levels among over 60 years old Finnish and Polish healthy individuals without any special diet, known gastrointestinal disease, surgery or diabetes mellitus. A large-scale, population based, cohort study evaluated pancreatic exocrine secretion in 50 to 75 years old subjects [10]. In this cohort 11.5% showed signs of exocrine pancreatic insufficiency (elastase level < 200 μg/g stool) and 5.1% severe insufficiency (elastase level < 100 μg/g stool). 11.4% of the study population had a history of diabetes mellitus [10] These studies suggest that pancreatic enzyme secretion may be reduced even in normal, healthy older people with no gastrointestinal diseases due to atrophy, fibrosis, sclerosis and lipomatosis of the organ
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