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Deficiencies of micronutrients, altered bowel function, and quality of life during late follow-up after pancreaticoduodenectomy for malignancy

Deficiencies of micronutrients, altered bowel function, and quality of life during late follow-up after pancreaticoduodenectomy for malignancy
Deficiencies of micronutrients, altered bowel function, and quality of life during late follow-up after pancreaticoduodenectomy for malignancy
Background/Aim: a previous study in our unit showed an inadequate dietary intake of fat-soluble vitamins and energy after pancreaticoduodenectomy (PD). This study was designed to determine whether deficiencies in dietary intake of micronutrients lead to nutritional deficiencies and to examine the impact of dietary advice on nutrition, bowel function, and quality of life.
Methods: ten patients who had undergone PD for malignant disease more than 6 months previously were studied at baseline and follow-up 8 weeks apart. Dietary intakes of energy, fat, and micronutrients were assessed by analysis of weighed food diaries, and serum vitamins and trace elements were measured at each visit. Quality of life questionnaires (EORTC QLQ30 and PAN 26) were answered, and a clinical assessment of the bowel function was made. Targeted dietary intervention was given, where indicated, and its impact on the study parameters was assessed at the second clinic visit.
Results: the patients were generally well nourished. Dietary deficiencies of fat-soluble vitamins were detected (vitamin A, n = 2; vitamin D, n = 10; vitamin E, n = 2), but these correlated with serum deficiency only for vitamin A. The selenium intake was borderline or insufficient in 6 patients' diet, with serum deficiencies in 4. Despite normal intakes of iron and zinc, half the patients showed serum deficiency. The bowel function was an important factor in quality of life, and symptoms improved in 3 patients with enzyme supplements and antidiarrhoeal medication.
Conclusions: PD patients appear to be prone to a predictable set of micronutrient deficiencies that may be compounded by insufficient dietary intake. The bowel function is important to these patients, and it should be optimized with aggressive enzyme replacement. Dietary intervention appears to make little short-term impact in the areas studied.
pancreaticoduodenectomy, nutrition, steatorrhoea, quality of life, dietitian
1424-3903
528-534
Armstrong, T.
fe074aba-a53c-4db6-b007-af761cd75235
Walters, E.
611b0826-2e97-494e-a5aa-c46a20847cdf
Varshney, S.
b1b8d045-dec2-4699-a84b-db21c25b0acf
Johnson, C.D.
e50aa9cd-8c61-4fe3-a0b3-f51cc3a6c74a
Armstrong, T.
fe074aba-a53c-4db6-b007-af761cd75235
Walters, E.
611b0826-2e97-494e-a5aa-c46a20847cdf
Varshney, S.
b1b8d045-dec2-4699-a84b-db21c25b0acf
Johnson, C.D.
e50aa9cd-8c61-4fe3-a0b3-f51cc3a6c74a

Armstrong, T., Walters, E., Varshney, S. and Johnson, C.D. (2002) Deficiencies of micronutrients, altered bowel function, and quality of life during late follow-up after pancreaticoduodenectomy for malignancy. Pancreatology, 2 (6), 528-534. (doi:10.1159/000066095).

Record type: Article

Abstract

Background/Aim: a previous study in our unit showed an inadequate dietary intake of fat-soluble vitamins and energy after pancreaticoduodenectomy (PD). This study was designed to determine whether deficiencies in dietary intake of micronutrients lead to nutritional deficiencies and to examine the impact of dietary advice on nutrition, bowel function, and quality of life.
Methods: ten patients who had undergone PD for malignant disease more than 6 months previously were studied at baseline and follow-up 8 weeks apart. Dietary intakes of energy, fat, and micronutrients were assessed by analysis of weighed food diaries, and serum vitamins and trace elements were measured at each visit. Quality of life questionnaires (EORTC QLQ30 and PAN 26) were answered, and a clinical assessment of the bowel function was made. Targeted dietary intervention was given, where indicated, and its impact on the study parameters was assessed at the second clinic visit.
Results: the patients were generally well nourished. Dietary deficiencies of fat-soluble vitamins were detected (vitamin A, n = 2; vitamin D, n = 10; vitamin E, n = 2), but these correlated with serum deficiency only for vitamin A. The selenium intake was borderline or insufficient in 6 patients' diet, with serum deficiencies in 4. Despite normal intakes of iron and zinc, half the patients showed serum deficiency. The bowel function was an important factor in quality of life, and symptoms improved in 3 patients with enzyme supplements and antidiarrhoeal medication.
Conclusions: PD patients appear to be prone to a predictable set of micronutrient deficiencies that may be compounded by insufficient dietary intake. The bowel function is important to these patients, and it should be optimized with aggressive enzyme replacement. Dietary intervention appears to make little short-term impact in the areas studied.

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More information

Published date: 2002
Keywords: pancreaticoduodenectomy, nutrition, steatorrhoea, quality of life, dietitian

Identifiers

Local EPrints ID: 26203
URI: http://eprints.soton.ac.uk/id/eprint/26203
ISSN: 1424-3903
PURE UUID: 75cd4c00-af67-4011-af58-33de96ce5490

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Date deposited: 20 Apr 2006
Last modified: 15 Jul 2019 19:14

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Contributors

Author: T. Armstrong
Author: E. Walters
Author: S. Varshney
Author: C.D. Johnson

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