Prevalence of exocrine pancreatic insufficiency in women with obesity syndrome: assessment by pancreatic fecal elastase 1.

Background. Previous research on the combined association of 25-hydroxyvitamin D [25(OH)D] and exocrine pancreas insufficiency may have been limited by restricted age variability and a lack of representation of both body weight and body mass index. There are still too few conclusive reports about conspicuous vitamin D metabolism according to pancreatic fecal elastase 1 (FE1) in obese patients. Methods. Between May 2004 and July 2008, we investigated in 125 female patients with obesity syndrome at an average age of approximately 52.9 years as well as in age-matched 80 healthy female controls the prevalence of pancreas insufficiency. Serum levels of PTH, total calcium, and D(3) vitamins calcitriol and calcifediol, as well as the concentration of fecal elastase 1 (FE1) were determined in patients and controls. Results. In 75 female nondiabetic patients with obesity syndrome (BMI 35 ≤ 40 kg/m(2)), calcifediol was markedly decreased (25.0 ± 4.9 ng/mL) compared to controls (50.2 ± 14.7 nmol/L; P < 0.01). FE1 level was significantly decreased in obese subjects compared to controls ( P < 0.01). Calcifediol was significantly lower in patients with morbid obesity (for calcifediol,  P < 0.05). Conclusion. In obese females, pancreatic FE1 in feces confirms the extent of vitamin D supply, and thus shows a vitamin D(3) deficiency, depending on the loss of stool content. There seems to be a connection between the loss of exocrine function and the increasing body mass index. Pancreas insufficiency, as detected by low FE1 concentrations, is frequent in obese patients. However, the BMI is an additional factor for lowered fecal excretion of FE1.