Serum alpha Amylase, Serum Lipase and Stool Fat as A Measure of Exocrine Pancreatic Function in Sudanese Children with Protein Energy Malnutrition

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.