Original ArticleSarcopenia is closely associated with pancreatic exocrine insufficiency in patients with pancreatic disease
Introduction
Frailty has been proposed as a global metric of patient physiological reserve and overall health status [1]. Sarcopenia has been reported to be an accurate and quantitative marker of frailty [1], [2], [3]. Sarcopenia is defined as depletion of skeletal muscle mass with a risk of adverse outcomes, such as physical disability, poor quality of life, and death [4], [5], and can be assessed by measurement of skeletal muscle (SM) mass by computed tomography (CT). Sarcopenia has been proposed as a poor prognostic factor in patients with colorectal liver metastases, melanoma, liver cirrhosis, liver transplantation, and pancreatic cancer [1], [3], [6], [7], [8]. Prognosis is multifactorial and related not only to tumor specific factors but also to individual patient characteristics, such as frailty. The current literature suggests that decreased SM mass (sarcopenia), sarcopenic obesity (obesity with depleted muscle mass), and loss of visceral adipose tissue (VAT) are associated with a poor prognosis in patients with pancreatic cancer [9]. It has been reported that pancreatic exocrine insufficiency (PEI) in patients with chronic pancreatitis is associated with low body fat mass and with low serum nutritional markers such as albumin, prealbumin, retinol binding protein, and magnesium [10], [11]. However, there has been no report on the correlation between body composition including sarcopenia and exocrine function in patients with pancreatic disease. We wondered whether body components such as SM mass, VAT, subcutaneous adipose tissue (SAT), intramuscular adipose tissue content (IMAC) and serum nutritional markers are associated with pancreatic exocrine function. IMAC was used as a marker for muscle steatosis, and was measured by CT. High IMAC was regarded as a proxy for low muscle quality. CT allows accurate quantification of body composition, including not only SM mass but also SAT and VAT. IMAC is also measured by CT [12]. Pancreatic exocrine function was evaluated using a13C-labeled mixed triglyceride breath test. The usefulness of this method for evaluating pancreatic exocrine function was previously described [13], [14], [15], [16].
Our hypothesis was that sarcopenia is associated with PEI in patients with pancreatic disease due to pancreatic disorders. The aim of the study was to determine whether body components such as SM, SAT, VAT, IMAC and serum nutritional markers are associated with pancreatic exocrine function in patients with pancreatic disease.
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Patients and data collection
This was a prospective review of the medical records of patients with pancreatic disease who underwent pancreatic surgery in the authors' institution between 2010 and 2013. The patients underwent CT within routine preoperative assessment and had a13C-labeled mixed triglyceride breath test for assessing pancreatic exocrine function the day before the surgery, if we were able to get the informed consent of the breath test. No patient took pancreatic enzyme supplements before the surgery. In all
Patient demographics
A total of 221 patients with pancreatic disease underwent pancreatic surgery at our institution between 2010 and 2013. A total of 132 patients who underwent the 13C-labeled mixed triglyceride breath test, CT and the blood test for serum nutritional markers before the pancreatic surgery were enrolled in this study. Of 221 patients, 89 (40%) were excluded because 64 patients (29%) refused to participate and 25 patients (11%) were not able to tolerate a normal solid diets before the surgery. The
Discussion
Our study has demonstrated a clear relationship between sarcopenia and PEI in patients with pancreatic disease. However, there was no correlation between PEI and other measures of body composition or nutritional makers.
Sarcopenia has recently been identified as a poor prognostic factor after digestive surgery [1], [2], [3], [6]. As for patients with pancreatic cancer, several reports have revealed that sarcopenia was an independent risk factor for poor prognosis after pancreatic resection [6],
Conflict of interest
The authors declare no conflict interest.
Acknowledgments
None.
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