Background and Objectives: Acute pancreatitis (AP) carries the risk of subsequent nutritional deficiencies. The prevalence of these deficiencies following a single episode of AP in children is unknown. We aimed to determine prevalence of anthropometric and laboratory-based measures of nutritional status in children following their index admission for AP.

Methods: Prospective observational cohort study of patients < 21 years of age with first episode of confirmed AP. Anthropometric and laboratory values were obtained at time of AP onset and follow up time points of three- and twelve-months (m) post AP. AP attack was defined as either moderately severe or severe (SAP) or mild.

Results: 182 patients met criteria and were followed prospectively with 52% male and a median age of 13.7 years (IQR 9.3-16.0) and median BMI Z-score of 0.6 (IQR -0.5, 1.6). Most patients had mild AP (141, 77%), with 23% meeting criteria for moderate or severe (n= 41). 6 (3%) had diabetes mellitus (DM) predating AP and were excluded from further analysis.
BMI Z-score remained stable during the follow up period. 13% of patients developed pre-DM or DM at 3m or 12m. Nearly one third of patients had low ferritin at 3m (29%) or 12m (28%). At 12m, 8% of patients had Vitamin A deficiency. 6% of patients had low Vitamin E levels at both 3 and 12m. Over half of patients at both 3m and 12m had Vitamin D insufficiency or deficiency (57% and 55%). Prolonged INR (> 1.3) was seen in 9% of patients at 12m. Very low albumin (<3.5 g/dL) was found in 24% of patients at 3m and 19% at 12m (Table 1). Patients with very low albumin were younger (10.7 vs. 14.2 years, p=0.048), while age, sex, BMI-Z-score and AP severity were not associated with albumin level.
While BMI Z-score did not differ between the groups, those with SAP had a significant decrease in BMI Z-score from first attack compared to mild AP at 3m (-0.42 vs. 0.00, p= 0.0003, Figure 1). At 12m, those with SAP were more likely to have pre-DM or DM compared to mild AP (31% vs. 7%, p=0.002). At 3m, Vitamin E deficiency in SAP versus mild AP was found in 20% vs 2% (p=0.04). There were no other laboratory significant differences at 3m in mild versus SAP groups.
Logistic regression modelling indicated that very low albumin at 3m was significantly associated with very low albumin at 12m (p=0.006) and low ferritin at 3m was significantly associated with low ferritin at 12m (p=0.017).

Conclusions:
After first AP attack patients experience nutritional deficiencies, including ferritin, all fat-soluble vitamins, and low albumin. SAP is associated with a decrease in BMI Z-score, increased prevalence of vitamin E deficiency at 3m, and an increase in pre-diabetes and diabetes at 12m. Serial monitoring of vitamin and mineral values post AP is warranted and further prospective studies are needed.

Figure 1. Change in BMI Z-score post AP.

<b>Table 1</b>. Lab results at 3- and 12-months post AP.

Table 1. Lab results at 3- and 12-months post AP.

Phillip Holovach

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