Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
CLINTEC, Karolinska Institutet, Stockholm, Sweden.
J Intern Med. 2018 May;283(5):446-460. doi: 10.1111/joim.12745. Epub 2018 Mar 23.
Senior people constitute the fastest growing segment of the population. The elderly are at risk for malnutrition, thought to be caused by reduced food intake or involution of the physiological capacity of the GI tract. Age-related changes are well known in other secretory organs such as liver, kidney and intestine. The pancreas, representing a metabolically active organ with uptake and breakdown of essential nutritional components, changes its morphology and function with age. During childhood, the volume of the pancreas increases, reaching a plateau between 20 and 60 years, and declines thereafter. This decline involves the pancreatic parenchyma and is associated with decreased perfusion, fibrosis and atrophy. As a consequence of these changes, pancreatic exocrine function is impaired in healthy older individuals without any gastrointestinal disease. Five per cent of people older than 70 years and ten per cent older than 80 years have pancreatic exocrine insufficiency (PEI) with a faecal elastase-1 below 200 μg g stool, and 5% have severe PEI with faecal elastase-1 below 100 μg g stool. This may lead to maldigestion and malnutrition. Patients may have few symptoms, for example steatorrhoea, diarrhoea, abdominal pain and weight loss. Malnutrition consists of deficits of fat-soluble vitamins and is affecting both patients with PEI and the elderly. Secondary consequences may include decreased bone mineral density and results from impaired absorption of fat-soluble vitamin D due to impaired pancreatic exocrine function. The unanswered question is whether this age-related decrease in pancreatic function warrants therapy. Therapeutic intervention, which may consist of supplementation of pancreatic enzymes and/or vitamins in aged individuals with proven exocrine pancreas insufficiency, could contribute to healthy ageing.
老年人是人口中增长最快的群体。老年人存在营养不良的风险，据认为这是由于食物摄入量减少或胃肠道生理功能退化所致。与年龄相关的变化在其他分泌器官中也很明显，如肝脏、肾脏和肠道。胰腺是一个代谢活跃的器官，负责摄取和分解重要的营养成分，其形态和功能会随着年龄的增长而发生变化。在儿童期，胰腺体积增加，在 20 至 60 岁之间达到峰值，此后逐渐下降。这种下降涉及胰腺实质，并伴有灌注减少、纤维化和萎缩。由于这些变化，健康的老年人即使没有胃肠道疾病，其胰腺外分泌功能也会受损。5%的 70 岁以上人群和 10%的 80 岁以上人群存在胰腺外分泌功能不全（PEI），粪便弹性蛋白酶-1 低于 200μg/g 粪便，5%的人群存在严重的 PEI，粪便弹性蛋白酶-1低于 100μg/g 粪便。这可能导致消化不良和营养不良。患者可能很少有症状，例如脂肪泻、腹泻、腹痛和体重减轻。营养不良包括脂溶性维生素缺乏，影响 PEI 患者和老年人。继发性后果可能包括骨密度降低，以及由于胰腺外分泌功能受损导致脂溶性维生素 D 吸收不良。尚未解决的问题是，这种与年龄相关的胰腺功能下降是否需要治疗。在已证实存在外分泌胰腺功能不全的老年个体中，补充胰腺酶和/或维生素等治疗干预措施可能有助于健康老龄化。
