Abstract
Pancreatic exocrine insufficiency (PEI) is a disease of diverse aetiology—e.g., majority of patients suffering from cystic fibrosis (CF) show PEI congenitally. Malnutrition and malabsorption of nutrients impair growth and nutritional status. As reduced fat digestion leads to a deficiency of fat-soluble vitamins the supplementation is standard, but absorption is a critical point in PEI-patients. The pancreatic duct ligated (PL) pig is an established model for PEI in humans and has been proven to be a suitable model to compare different vitamin additives for supplementation. In a former study, PEI caused distinct growth retardation in young piglets, but did not affect growth in older ones. Our study hypothesised that this age-dependent effect is caused by exhausted body reserves of fat-soluble vitamins and, therefore, extra supply reduces growth retardation. PEI was induced by PL at the age of seven (PL-7) or 16 weeks (PL-16). Controls (C) underwent a sham surgery. Some PL-7 pigs (PL-7 + Vit) were fed a special vitamin additive. PEI reduced the mean final body weight (kg) at 26 weeks of age significantly with lower effect in PL-16-pigs (C:117; PL-7:49.5; PL-7 + Vit:77.1; PL-16:96.4). Extra vitamin supply resulted in an increased growth and normalised serum concentration of alpha-tocopherol, underlining the importance of special supplementation in PEI-patients.
Highlights
Pancreatic exocrine insufficiency (PEI) is a disease occurring in humans, as well as veterinary patients, resulting in maldigestion and malabsorption of nutrients, especially of fat [1]
The objective of the present study was to investigate whether an extra supply of fat-soluble vitamins in a water-soluble form, which was proven to be absorbable in juvenile pancreatic duct ligated (PL) pigs treated with pancreatic enzymes [36], reduces growth retardation in these pigs used as a model for children
Vitamin additive (PL-7 + Vit) resulted in a significantly increased (p < 0.05) growth compared to PL-7, but caused no complete normalisation
Summary
Pancreatic exocrine insufficiency (PEI) is a disease occurring in humans, as well as veterinary patients, resulting in maldigestion and malabsorption of nutrients, especially of fat [1]. Patients suffering from PEI are at high risk of developing a deficiency of fat-soluble vitamins [2,3,4,5]. As most patients (~90%) with cystic fibrosis (CF) suffer from PEI [8,9], mostly congenitally, fat-soluble vitamin status is of special interest in these patients. A fat-soluble vitamin deficiency can occur even if patients are treated with pancreatic enzyme replacement therapy [10]. Due to routine pancreatic enzyme replacement therapy and vitamin supplementation clinical manifestation of vitamin deficiency is uncommon nowadays [15]. Today there is a general recommendation to routinely supplement fat-soluble vitamins [17,18,19] and to check blood status on a regular basis (at least annually) [20]
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