Ferdous Farzana, Filteau Suzanne, Schwartz Nanna Buhl, Gumede-Moyo Sehlulekile, Cox Sharon Elizabeth
School of Tropical Medicine and Global Health, Nagasaki University, Sakamoto Campus, Nagasaki, Japan.
Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Br J Nutr. 2022 May 4;129(4):1-34. doi: 10.1017/S0007114522001404.
Severe acute malnutrition may lead both concurrently and subsequently to malabsorption and impaired glucose metabolism from pancreatic dysfunction. We conducted a systematic review to investigate the associations of current and prior postnatal wasting malnutrition with pancreatic endocrine and exocrine functions in humans. We searched PubMed, Google Scholar, Web of Science and reference lists of retrieved articles, limited to articles in English published before 1 February 2022. We included sixty-eight articles, mostly cross-sectional or cohort studies from twenty-nine countries including 592 530 participants, of which 325 998 were from a single study. Many were small clinical studies from decades ago and rated poor quality. Exocrine pancreas function, indicated by duodenal fluid or serum enzymes, or faecal elastase, was generally impaired in malnutrition. Insulin production was usually low in malnourished children and adults. Glucose disappearance during oral and intravenous glucose tolerance tests was variable. Upon treatment of malnutrition, most abnormalities improved but frequently not to control levels. Famine survivors studied decades later showed ongoing impaired glucose tolerance with some evidence of sex differences. The similar findings from anorexia nervosa, famine survivors and poverty- or infection-associated malnutrition in low- and middle-income countries (LMIC) lend credence to results being due to malnutrition itself. Research using large, well-documented cohorts and considering sexes separately, is needed to improve prevention and treatment of exocrine and endocrine pancreas abnormalities in LMIC with a high burden of malnutrition and diabetes.
严重急性营养不良可能会同时并随后导致吸收不良以及胰腺功能障碍引起的葡萄糖代谢受损。我们进行了一项系统综述，以研究当前和既往出生后消瘦型营养不良与人类胰腺内分泌和外分泌功能之间的关联。我们检索了PubMed、谷歌学术、科学网以及检索文章的参考文献列表，仅限于2022年2月1日前发表的英文文章。我们纳入了68篇文章，大多是来自29个国家的横断面研究或队列研究，包括592530名参与者，其中325998名来自一项研究。许多是几十年前的小型临床研究，质量评级较差。以外十二指肠液或血清酶或粪便弹性蛋白酶为指标的外分泌胰腺功能在营养不良时通常受损。营养不良的儿童和成人胰岛素分泌通常较低。口服和静脉葡萄糖耐量试验期间的葡萄糖消失情况各不相同。营养不良得到治疗后，大多数异常情况有所改善，但通常未恢复到正常水平。几十年后对饥荒幸存者的研究显示，葡萄糖耐量持续受损，并有一些性别差异的证据。神经性厌食症患者、饥荒幸存者以及低收入和中等收入国家（LMIC）中与贫困或感染相关的营养不良的类似发现，支持了这些结果是由营养不良本身导致的观点。需要开展使用大型、记录完善的队列并分别考虑性别的研究，以改善对营养不良和糖尿病负担较重的低收入和中等收入国家外分泌和内分泌胰腺异常的预防和治疗。
