Troubles pancréatiques et thérapie
Libre accès

Abstrait

L'insuffisance pancréatique exocrine affecte non seulement la digestibilité des nutriments et la croissance, mais aussi la composition corporelle et les paramètres endocrinologiques - Étude sur les porcelets utilisés comme modèle pour les enfants

Anne Mößeler, Teresa Schwarzmaier, Peter Colin Gregory, Marion Piechotta, Martin Beyerbach and Josef Kamphues

The pancreatic duct ligated (PL) piglet is a model for pancreatic exocrine insufficiency (PEI) in children. PEI is very common in children suffering from cystic fibrosis and is of highest relevance as the nutritional status affects survival rate of these patients. This study aimed comparing growth and body weight development of PL-piglets with (PL+enz) or without (PL-0) pancreatic enzyme replacement therapy (PERT) with those of controls. Growth, proportion of gastrointestinal tract (GIT; including digesta) and digestibility of nutrients was measured in young PL-pigs. The body weight (kg) at dissection differed significantly (p<0.005) between controls (79.7), PL-0 (51.3) and PL+enz (62.9). GIT mass accounted for 8.17% of body weight in controls, 21.1% in PL-0, whereas in PL+enz the relative weight of GIT was 12.0% differing significantly (p<0.01) from both other groups. Faecal digestibility of nutrients was markedly reduced for fat and protein in PL-0, while starch digestibility reached values of controls (p>0.05). PERT increased digestibility of fat and protein but reached no normalisation. Samples of ileal digesta taken during dissection indicated a significant reduction (p<0.005) in praecaecal starch digestibility in PL-0 (33.4%) compared to the controls (79.7%). This study demonstrates that PEI impaired growth, with improvement, but no complete normalisation, by PERT. The massive increase (p<0.0005) in GIT mass (21.1% of body weight in PL-0 compared to 8.17% in controls) is noteworthy, resulting in an overestimation of growth and nutritional condition in PL-0. Endocrinological parameters like leptin and IGF 1 were also impaired in the PL-pigs (p<0.05) and are supposed to be useful parameters to evaluate nutritional status in these PEI patients. As weight and BMI might result in an overestimation of nutritional status in PEI patients due to increased gut fill, there is need to implement further parameters to estimate nutritional status. Leptin seems to be a promising parameter to characterize nutritional status, even in juveniles – allowing an indirect quantification of the body fat content. Without need for any technical equipment on-site this parameter can be measured continuously during routine consultation, allowing an early detection of malnutrition and early therapeutic intervention.