Prospective evaluation of the prevalence of fat-soluble vitamin deficiencies and decreased bone mineral density in chronic pancreatitis
E.C.M. Sikkens¹, D.L. Cahen¹, E.J. Kuipers¹, M.J. Bruno¹
¹. Department of Gastroenterology, Erasmus University Medical Center, Rotterdam, the
Netherlands
Malabsorption of fat is frequently seen in patients with chronic pancreatitis (CP), due to the loss of exocrine pancreatic function. Consequently, these patients are at risk to develop deficiencies of the fat-soluble vitamins. Moreover, because of an impaired absorption of vitamin D and a reduced calcium intake, they may develop a decreased bone mineral density
(BMD), resulting in osteopenia and osteoporosis. Although malnutrition is common in CP, there are limited data on the prevalence of fat-soluble vitamin deficiencies and low bone density. Therefore we evaluated this in CP patients, with and without exocrine pancreatic insufficiency.
In a prospective cohort study we included all consenting CP patients who visited the outpatient clinic of the department of Gastroenterology of our tertiary referral center between
March and November 2011.
The pancreatic function was evaluated, both exocrine (by means of a fecal Elastase-1 test; normal value ≥ 0.2 mg/g) and endocrine (presence of diabetes).
S erum concentrations of vitamin A, D, E, and K were determined. Furthermore, a densitometry was performed to assess BMD (osteopenia: T score -1 to 2.5; osteoporosis: T score < -2.5).
Twenty-eight patients were included, of which 57% were male with a median age of
52 (range 22-69). CP was caused by alcohol in 50%, by idiopathic disease in 32%, and by other causes in 18%. Exocrine insufficiency was present in 19 patients (68%), of whom 14

used pancreatic enzymes, and diabetes was observed in 11 cases (39%). Vitamin A deficiency was not observed. A vitamin E, K, and D deficiency were present in respectively 2 (7%), 16
(57%) and 13 (46%) patients. In the subgroup of patients with exocrine insufficiency who did not use enzymes, the prevalence of vitamin deficiencies was even higher; 20% for vitamin E,
60% for vitamin K, and 80% for vitamin D. A decreased BMD was observed in 16 patients
(57%), of whom 12 suffered from osteopenia (43%) and 4 from osteoporosis (14%). Again, the prevalence was even higher in the patients with untreated exocrine insufficiency; osteopenia in 60% and osteoporosis in 20%.
CP patients have an increased risk to develop deficiencies of the vitamins E, D and K, and a decreased BMD, even if they do not have a clinical proven exocrine insufficiency.
Therefore, CP patients should be routinely screened by laboratory testing and bone densitometry at regular intervals. In addition, to prevent complications, it is crucial that EPI patients are treated with an adequate dosage of enzymes, in order to abolish fat malabsorption.