Yield of testing for micronutrient deficiencies associated with pancreatic exocrine insufficiency in a clinical setting: An observational study

Table 1 Demographics of patients with suspected or proven benign pancreatic disease investigated with Faecal Elastase-1 including documented symptoms at time of investigation

	PEI (FEL-1 < 200 µg/g)	No PEI (FEL-1 > 200 µg/g)
	n = 41, mean ± SD or n (%)	n = 71, mean ± SD or n (%)
Age (yr)	58.2 (13.2)	57.4 (5)
Female	14 (34)	44 (61)
BMI (kg/m2)	26.1 (5.9)	29.9 (7.1)
Type 1 diabetes mellitus	9 (22.0)	11 (15.4)
Type 2 diabetes mellitus	13 (31.7)	26 (36.6)
Alcohol (unit/wk)	17.7 ± (22.9)	12.3 ± (10.5)
Smoking (pack yr)	22.3 ± (21.5)	21.6 ± (20.5)
Morphological changes of CP1	22/41 (53.7)	10/41 (24.3)
Clinical symptoms
Abdominal pain	21	38
Diarrhoea	9	19
Steatorrhoea	2	0
Bloating	5	11
Weight loss	4	3

¹All patients with PEI and 41 patients without PEI but suspected pancreatic disease underwent cross-sectional imaging.

PEI: Pancreatic exocrine insufficiency; FEL-1: Faecal elastase-1; CP: Chronic pancreatitis; BMI: Body mass index.

Table 2 Prevalence of micronutrient deficiency¹ in 112 patients with suspected pancreatic disease.

	PEI	No PEI	P value	CP PEI	CP no PEI	PEI no CP	No CP no PEI
n in group	41	71		22	10	19	61
Micronutrients
Prealbumin	8 (19.5%)	2 (2.8%)	0.005	6 (27.3%)	0	2 (10.5%)	2 (3.2%)
RBP	0	0		0	0	0	0
Selenium	6 (14.6%)	1 (1.4%)	0.01	5 (22.7%)	0	1 (5.3%)	1 (1.6%)
Zinc	0	0		0	0	0	0
Copper	2 (4.9%)	0		1 (4.5%)	0	1 (5.3%)	0
Magnesium	5 (12.2%)	1 (1.4%)	0.02	3 (13.6%)	0	2 (10.5%)	1 (1.6%)
Vitamin E (n = 19)	5/12(41.7%)	1/7 (14.3%)		5/8 (62.5%)	0/5	0/4	1/2(50%)
Total patients with at least 1 deficiency	17(41.5%)	4 (5.6%)	0.0001	13 (59.1%)	0 P = 0.002a	4 (21.1%) P = 0.03b	4 (6.6%)

¹Micronutrient deficiency defied as level below laboratory ranges: Prealbumin 0.2–0.5 g/L; RBP 20-40 mg/L; Copper 11.0–27.2 µmol/L; Zinc 7.2–20.43 µmol/L; Selenium 0.61–1.24 µmol/L; Magnesium 0.7-1.0 mmol/L; Lipid adjusted vitamin E 3.9-5.9 µmol/L.

^aComparing patients with CP and PEI to patients with CP without PEI.

^bComparing patients with CP and PEI to patients with PEI without CP.

PEI: Pancreatic exocrine insufficiency; FEL-1: Faecal Elastase-1; CP: Chronic pancreatitis; RBP: Retinol-binding protein. Grouped according to the presence of PEI (FEL-1 < 200 µg/g) and CP. Significant differences identified are shown if P value ≤ 0.05 (Fisher’s test)

Table 3 Assessment of significant micronutrient deficiency to predict pancreatic exocrine insufficiency (Faecal Elastase-1 < 200 µg/g)

	Prealbumin	Selenium	Magnesium
Sensitivity	19.5% [95%CI: 8.8-34.9]	14.6% [95%CI: 6.6-33.7]	9.8 % [95%CI: 3.3-21.4]
Specificity	97.2% [95%CI: 90.2-99.7]	98.5% [95%CI: 92.1-99.7]	98.6% [95%CI: 92.4-100]
PPV	80.0% [95%CI: 47.1-94.7]	85.7% [95%CI: 42.1-99.6]	83.3% [95%CI: 37.6-97.7]
NPV	67.7% [95%CI: 64.2-71]	66.7% [95%CI: 56.8-75.6]	60.3% [95%CI: 58.1-62.2]
Accuracy	68.8% [95%CI: 59.3-77.2]	67.9% [95%CI: 58.4-76.3]	61.5% [95%CI: 52.2-70.1]

PPV: Positive predictive value; NPV: Negative predictive value.