Serum alpha Amylase, Serum Lipase and Stool Fat as A Measure of Exocrine Pancreatic Function in Sudanese Children with Protein Energy Malnutrition
Serum alpha Amylase, Serum Lipase and Stool Fat as A Measure of Exocrine Pancreatic Function in Sudanese Children with Protein Energy Malnutrition
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Date
2015-04-12
Authors
IBRAHIM, SUZAN
Journal Title
Journal ISSN
Volume Title
Publisher
UOFK
Abstract
Pancreatic exocrine dysfunction in PEM has been a
frequent observation in many past records. The enzyme
synthesis by the pancreas is affected by the nutritional
deprivation.
This study was designed to determine the pancreatic
exocrine function, namely serum amylase, lipase and stool fat
in PEM and its types. An important aim was to correlate the
defect present to some clinical and biochemical data with
special emphasis on the effect of nutritional rehabilitation. The
study was a prospective hospital based case and control study.
Fifty children with severe Protein Energy Malnutrition (PEM)
and fifteen healthy age and sex matched group were enrolled
in the study.
The cases, including 21 with marasmus, 19 with
kwashiorkor (KWO) and10 with marasmic kwashiorkor
(MKWO) were recruited from Gaafar Ibn Auf Specialized
Children Hospital. Full history and thorough clinical
examination including anthropometric measurements were
performed in all cases and controls.
Serum amylase, lipase and stool fat were estimated
together with other biochemical investigations namely serum
albumin and globulin and hemoglobin, on presentation and
two weeks later. The mean age of presentation in cases was
18.88+6.6 months with slight female preponderance (52%).
The bulk of cases were from Western states (58%).
v
Illiteracy, inappropriate weaning practices and
inadequate nutrition were the major risk factors. The most
frequent presenting symptoms were diarrhoea in 88% and
vomiting in 78% with hair depigmentation (98%), sparsity
(90%) and pallor (94%) as major clinical signs.
All anthropometric measurements were significantly
lower in cases when compared to controls.
Regarding pancreatic exocrine function, serum amylase
and lipase levels were low in all subtypes of malnutrition,
being remarkably low in oedematous cases. The indices
improved after nutritional rehabilitation. Hypoalbuminaemia,
frequent diarrhoea and oedema were the major determining
factors for pancreatic enzyme level. Non survivors had even
more declining indices especially for serum amylase. The
presence of stool fat in cases augmented pancreatic
dysfunction but still could be due to other pathologies.
In conclusion, pancreatic exocrine dysfunction in PEM
may be an overlooked factor contributing to ongoing
malnutrition in Sudanese children. Estimation of PEF level is
recommended as part of the evaluation of patients with PEM.
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Keywords
Serum, alpha, Amylase, Lipase, Stool,Fat , Measure , Exocrine ,Pancreatic,Energy Malnutrition