The impact of malnutrition on secondary diabetes and calcific pancreatitis: A comprehensive review

Introduction: Malnutrition in low- and middle-income countries significantly impacts the development of secondary diabetes and calcific pancreatitis. Aim and Methods: This review summarizes the prevalence, characteristics, and findings from key studies over the past decade on the link between malnutrition and secondary diabetes, focusing on protein-deficient pancreatic diabetes (PDPD) and fibro-calculous pancreatic diabetes (FCPD). A comprehensive literature search was conducted in PubMed, Scopus, and Google Scholar for articles published between 1995 and 2023. Studies included were peer-reviewed articles focusing on the link between malnutrition and secondary diabetes, conducted in LMICs, and discussing the prevalence, clinical characteristics, and outcomes of PDPD and FCPD. Both observational and interventional studies were considered. Results: The review of studies revealed several key findings: · PDPD is characterized by lower C-peptide levels and varied responses to glibenclamide post-nutritional rehabilitation. · FCPD patients show rapid calcification, diminished exocrine and beta-cell function, and more severe exocrine deficiency compared to PDPD. · Both PDPD and FCPD patients often present with lower BMI and significant renal involvement. · Recent studies indicate improved nutritional status and prognosis of FCPD patients with enhanced medical care. · Insulin-requiring diabetes in Ethiopia is strongly linked with poor education, poverty markers, and childhood malnutrition. · Lean diabetes, linked to childhood malnutrition, is characterized by low-normal BMI, early onset, and rapid beta-cell failure. Discussion: The development of diabetes following early malnutrition can be attributed to several interconnected mechanisms involving metabolic, endocrine, and epigenetic factors. Early nutritional intervention trials are crucial to prevent glucose abnormalities and diabetes later in life. Studies highlight that improving early-life nutrition can enhance beta-cell function, reduce insulin resistance, and mitigate long-term metabolic dysfunction. Lean diabetes, linked to childhood malnutrition, presents unique challenges but can be addressed through targeted nutritional support. Conclusion: The review underscores the significant impact of malnutrition on the development of secondary diabetes and calcific pancreatitis in LMICs. Addressing malnutrition through early nutritional interventions is crucial to mitigate the risk of chronic conditions and improve metabolic health outcomes. Continued research and targeted public health strategies are essential to break the cycle of malnutrition and disease in vulnerable populations.