trypsinogen and Nutrition-Disorders

Many patients with cystic fibrosis are malnourished at the time of diagnosis. Whether newborn screening and early treatment may prevent the development of a nutritional deficiency is not known.. We compared the nutritional status of patients with cystic fibrosis identified by neonatal screening or by standard diagnostic methods. A total of 650,341 newborn infants were screened by measuring immunoreactive trypsinogen on dried blood spots (from April 1985 through June 1991) or by combining the trypsinogen test with DNA analysis (from July 1991 through June 1994). Of 325,171 infants assigned to an early-diagnosis group, cystic fibrosis was diagnosed in 74 infants, including 5 with negative screening tests. Excluding infants with meconium ileus, we evaluated nutritional status for up to 10 years by anthropometric and biochemical methods in 56 of the infants who received an early diagnosis and in 40 of the infants in whom the diagnosis was made by standard methods (the control group). Pancreatic insufficiency was managed with nutritional interventions that included high-calorie diets, pancreatic-enzyme therapy, and fat-soluble vitamin supplements.. The diagnosis of cystic fibrosis was confirmed by a positive sweat test at a younger age in the early-diagnosis group than in the control group (mean age, 12 vs. 72 weeks). At the time of diagnosis, the early-diagnosis group had significantly higher height and weight percentiles and a higher head-circumference percentile (52nd, vs. 32nd in the control group; P=0.003). The early-diagnosis group also had significantly higher anthropometric indexes during the follow-up period, especially the children with pancreatic insufficiency and those who were homozygous for the deltaF508 mutation.. Neonatal screening provides the opportunity to prevent malnutrition in infants with cystic fibrosis.

Topics: Body Height; Body Weight; Cystic Fibrosis; Humans; Infant; Infant, Newborn; Neonatal Screening; Nutrition Disorders; Nutritional Status; Prospective Studies; Trypsinogen

We used a sensitive probe of pancreatic dysfunction, serum immunoreactive cationic trypsinogen, to study 50 infants and children with varying degrees of malnutrition. Patients were classified into subgroups according to the severity of malnutrition. Mean serum trypsinogen concentration was significantly elevated in 25 patients with "severe" malnutrition (77.4 +/- 42.0 ng/ml, P less than 0.001) and in 23 with "moderate" malnutrition (55.2 +/- 16.1 ng/ml, P less than 0.02) compared with the mean value (32.5 +/- 10.4 ng/ml) for well-nourished controls. The level of circulating trypsinogen tended to rise with increasing severity of malnutrition. There was no relationship between serum trypsinogen and other variables such as age, specific diagnosis, or mode of feeling. Elevated serum trypsinogen levels could not be attributed to renal disease or cystic fibrosis. In patients who showed an improvement in nutritional status, serum trypsinogen tended to revert toward normal. Elevated serum trypsinogen values in acutely malnourished infants and children may result from pancreatic acinar cell damage or regurgitation of enzymes from obstructed pancreatic ducts.

Topics: Acute Disease; Cations; Child, Preschool; Creatinine; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Nutrition Disorders; Pancreas; Radioimmunoassay; Trypsinogen

Malnutrition was induced in the immediate postnatal period by expanding newborn litters to 20 rat pups/dam. The reversibility of the effects of malnutrition on the pancreas was evaluated by comparing two different feeding methods. At 21 days of age, pups from the expanded litters exhibited significantly decreased body (P less than 0.0005) and pancreatic (P less than 0.0025) weights as compared to those from control litters (12 pups/dam). Malnourished pups also had less contents of amylase (P less than 0.01), lipase (P less than 0.0005) and trypsinogen (P less than 0.0025) in their pancreases. The concentrations (specific activities) of amylase (P less than 0.05) and lipase (P less than 0.0125) were significantly decreased but trypsinogen (P less than 0.35) was not affected. Subsequent nutritional rehabilitation by an ad libitum (food available 24 h/day) or restricted (food available 2 h/day) feeding regimen failed to allow for "catch-up" in body (P less than 0.025) and pancreatic weight (P less than 0.05) by 56 days of life. With ad libitum feedings, enzyme contents and concentrations of amylase and lipase in malnourished animals attained control values by 7 and 14 days, respectively. Restricted feedings, however, delayed the recovery in amylase by an additional 7 days but lipase remained depressed in both content, (P less than 0.005) and specific activity (P less than 0.0025) for the duration of the experiment (56 days). Changes in pancreatic enzymes in response to malnutrition are readily reversible with ad libitum feedings but changes in somatic and pancreatic weights were not reversed.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Amylases; Animals; Animals, Suckling; Feeding Behavior; Female; Lipase; Nutrition Disorders; Organ Size; Pancreas; Pregnancy; Random Allocation; Rats; Rats, Inbred Strains; Time Factors; Trypsinogen