Low plasma pancreatic lipase as a novel predictor of nutritional target achievement and response to nutritional interventions in malnourished inpatients: Secondary analysis of a randomized clinical trial

Abstract

Background & aims: Pancreatic lipase plays an essential role in digesting dietary fats in the intestine, facilitating nutrient absorption. Plasma lipase serves as a surrogate for pancreatic exocrine function, which decreases with age and potentially leads to inadequate nutrient digestion and gastrointestinal symptoms. We investigated clinical implications of plasma lipase among medical inpatients at nutritional risk.

Methods: This secondary analysis investigated admission plasma lipase concentrations among patients at risk for malnutrition regarding clinical outcomes and treatment response in patients included in the Effect of Early Nutritional Support on Frailty Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a randomized controlled trial comparing individualized nutritional support to usual care.

Results: Of 810 patients with available admission plasma lipase concentrations, 158 (19.5 %) had concentrations below the reference range. Patients with low concentrations had a 1.6-fold higher risk of not reaching energy or protein targets during hospitalization (adjusted odds ratio 1.62 [95 % confidence interval 1.07 to 2.45], p = 0.022 and 1.61 [95 % confidence interval 1.07 to 2.44], p = 0.023, respectively). They also tended to have a more pronounced benefit from nutritional interventions in terms of reduced mortality (adjusted hazard ratio for patients with low lipase 0.48 [95 % confidence interval 0.18 to 1.26] compared to 0.99 [95 % confidence interval 0.60 to 1.63] in patients with normal lipase concentrations, p for interaction = 0.224).

Conclusion: Findings from this multicenter trial indicate that around 20 % of polymorbid older patients had plasma lipase concentrations below the reference range, suggesting exocrine pancreatic insufficiency, which placed them at a greater risk for failing to meet nutritional targets; however, they also demonstrated a pronounced improvement from nutritional support. Further studies should assess the impact of pancreatic enzyme replacement therapy in this population.

Trial registration: ClinicalTrials.gov Identifier: NCT02517476.

Keywords: Disease-related malnutrition; Lipase; Nutritional support; Pancreatic insufficiency; Polymorbid medical inpatient; Treatment response.