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Observational Study
. 2023 Sep;27(9):1893-1902.
doi: 10.1007/s11605-023-05770-1. Epub 2023 Jul 13.

Nutritional Risks in Patients Undergoing Total Pancreatectomy Islet AutoTransplantation in the POST Consortium

Elissa M Downs  1 , Anne Eaton  2 , Piotr Witkowski  3 , Martin Wijkstrom  4 , Matthew Walsh  5 , Guru Trikudanathan  6 , Vikesh K Singh  7 , Sarah J Schwarzenberg  8 , Timothy L Pruett  9 , Andrew Posselt  10 , Bashoo Naziruddin  11 , Jaimie D Nathan  12 , Sri Prakash Mokshagundam  13 , Katherine Morgan  14 , Luis F Lara  15 , Timothy B Gardner  16 , Martin L Freeman  6 , Kate Ellery  17 , Srinath Chinnakotla  8   9 , Gregory J Beilman  9 , David Adams  14 , Syed Ahmad  18 , Maisam Abu-El-Haija  19 , Melena D Bellin  8   9
Affiliations
Observational Study

Nutritional Risks in Patients Undergoing Total Pancreatectomy Islet AutoTransplantation in the POST Consortium

Elissa M Downs et al. J Gastrointest Surg. 2023 Sep.

Abstract

Background and aims: Total pancreatectomy with islet autotransplantation (TPIAT) can relieve pain for individuals with acute recurrent or chronic pancreatitis. However, TPIAT may increase the risk of poor nutritional status with complete exocrine pancreatic insufficiency, partial duodenectomy, and intestinal reconstruction. Our study's objective was to evaluate nutritional status, anthropometrics, and vitamin levels before and after TPIAT.

Methods: The multicenter Prospective Observational Study of TPIAT (POST) collects measures including vitamins A, D, and E levels, pancreatic enzyme dose, and multivitamin (MVI) administration before and 1-year after TPIAT. Using these data, we studied nutritional and vitamin status before and after TPIAT.

Results: 348 TPIAT recipients were included (68% adult, 37% male, 93% Caucasian). In paired analyses at 1-year follow-up, vitamin A was low in 23% (vs 9% pre-TPIAT, p < 0.001); vitamin E was low in 11% (vs 5% pre-TPIAT, p = 0.066), and 19% had vitamin D deficiency (vs 12% pre-TPIAT, p = 0.035). Taking a fat-soluble multivitamin (pancreatic MVI) was associated with lower risk for vitamin D deficiency (p = 0.002). Adults were less likely to be on a pancreatic MVI at follow-up (34% vs 66% respectively, p < 0.001). Enzyme dosing was adequate. More adults versus children were overweight or underweight pre- and post-TPIAT. Underweight status was associated with vitamin A (p = 0.014) and E (p = 0.02) deficiency at follow-up.

Conclusions: Prevalence of fat-soluble vitamin deficiencies increased after TPIAT, especially if underweight. We strongly advocate that all TPIAT recipients have close post-operative nutritional monitoring, including vitamin levels. Pancreatic MVIs should be given to minimize risk of developing deficiencies.

Keywords: Fat-soluble vitamin deficiencies; Pancreatitis; Supplementation; Underweight.

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Conflict of interest statement

Competing Interest MDB discloses the following: research support from Viacyte and Dexcom; advisory role (DSMB) for Insulet. LFL discloses the following: research support from Abbvie, consultant for Abbvie, speaker for Abbvie and Nestle. SJS discloses funding from Gilead and UpToDate. VKS is a consultant for Abbvie and Nestle, and he receives research support from Orgenesis and Theraly.

All other authors: none declared.

Figures

Fig. 1
Fig. 1
BMI in children and adults before and after TPIAT. P-values are for a test of the difference in weight distribution between children vs adults at each time. Adults were more often underweight or overweight at baseline and at 1 year after TPIAT vs children. Adults (≥ 18 years old), children (< 18 years old). Black columns: Underweight (adults BMI < 18.5 kg/m2, children BMI %ile < 5th). White columns: Normal weight (adults BMI ≥ 18.5 to < 25 kg/m2, children BMI %ile ≥ 5th to < 85th). Gray columns: Overweight (adults BMI ≥ 25 kg/m2, children BMI %ile ≥ 85th). BMI = body mass index. TPIAT = total pancreatectomy and islet autotransplantation
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