Features of nutrition in exocrine pancreatic insufficiency and metabolic syndrome

The review presents literature data on the importance of nutritional goals, which include ensuring sufficient intake of macro- and micronutrients, reducing indigestion, the degree of malabsorption, and other risk factors in order to prevent or treat malnutrition associated with exocrine pancreatic insufficiency. Nutritional status and nutritional interventions depend on this. Attention is drawn to the indication of different nutritional options depending on the severity of the course of exocrine insufficiency and the presence of diabetes (10–15% need oral nutritional supplements, 5% — enteral nutrition through a tube, and about 1% — parenteral nutrition). The European Society for Clinical Nutrition and Metabolism (ESPEN) Guidelines for Nutritional Screening are presented. The question of the impact of chronic pancreatitis and exocrine pancreatic insufficiency on digestion with the development of maldigestion and malabsorption and the importance of these factors for the quality of life is discussed. The author reviewed in detail the metabolism of carbohydrates, proteins, and fats in enzyme pancreatic insufficiency and the importance of this knowledge in providing nutritional recommendations. The digestion of lipids in the lumen of the small intestine depends on pancreatic lipase and cofactors such as colipase and bile acids. Lipases of the stomach and salivary glands play a minor role in the digestion of triglycerides and cannot compensate for the insufficient fat digestion. There are no enzyme systems for digesting triglycerides in the brush border membrane. Therefore, lipid digestion is reduced due to insufficient secretion of lipase and a decrease in the concentration of bile acids in the lumen. Attention is paid to research methods that determine the state of fat, lean mass, muscle state, bone health, and resting energy expenditure, provide an opportunity to conduct a detailed assessment of current and usual food consumption, which promotes successful treatment.