European journal of internal medicine · 2026
Assessment of serum micronutrient concentration in chronic pancreatitis: insights from the nationwide COMBO randomised trial.
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Thierens Nde, de Rijk Fem, Bai S, van der Schaar P J, Voermans R P, Kager L M, Tielemans M M, Pauw H S, van Veldhuisen C L, Besselink M G, de Jonge Pjf, van Santvoort H C, van Hooft J E, Bruno M J, Drenth Jph, Verdonk R C, Dutch Pancreatitis Study Group
Аннотация
INTRODUCTION: In patients with chronic pancreatitis (CP), pancreatic exocrine insufficiency (PEI) and poor dietary intake may cause malnutrition. International guidelines recommend monitoring key micronutrients (MN), however clinical implications remain uncertain. This study aims to evaluate the prevalence, risk factors, complications, and longitudinal course of low serum MNs in patients with CP.
METHODS: This is a predefined analysis of the COMBO trial, a nationwide stepped-wedge cluster randomised trial on evidence-based CP management. Nutritional biochemical assessment included vitamins A, D, E, and K, iron, zinc, selenium, calcium, and magnesium during the 35-month study period. PEI symptom severity was assessed using the PEI-Questionnaire.
RESULTS: Among 409 patients with CP, 327 (80%) had PEI. Low serum MNs were present in 184 patients (45%), including 63 (15%) with low levels of multiple MNs. Low vitamin K (59%) and D (38%) were most prevalent. Risk factors of low serum MNs included severe PEI symptoms (aOR 2.54; 95% CI 1.04 - 6.18, p = 0.04), and daily alcohol use (aOR 3.71; 95% CI 1.54 - 8.89, p = 0.003), but not smoking and abnormal BMI. Low vitamin K was not associated with increased INR. Osteoporosis was diagnosed in 47/166 patients (28%), and associated with low calcium, but not with low vitamin D or K. In most patients, low serum MNs normalised over time without targeted supplementation.
CONCLUSION: Low serum MNs are common in CP and associated with severe PEI symptoms, and daily alcohol use, but often not with functional outcomes. These findings support targeted biochemical nutritional assessment in CP, guided by clinical risk factors.
METHODS: This is a predefined analysis of the COMBO trial, a nationwide stepped-wedge cluster randomised trial on evidence-based CP management. Nutritional biochemical assessment included vitamins A, D, E, and K, iron, zinc, selenium, calcium, and magnesium during the 35-month study period. PEI symptom severity was assessed using the PEI-Questionnaire.
RESULTS: Among 409 patients with CP, 327 (80%) had PEI. Low serum MNs were present in 184 patients (45%), including 63 (15%) with low levels of multiple MNs. Low vitamin K (59%) and D (38%) were most prevalent. Risk factors of low serum MNs included severe PEI symptoms (aOR 2.54; 95% CI 1.04 - 6.18, p = 0.04), and daily alcohol use (aOR 3.71; 95% CI 1.54 - 8.89, p = 0.003), but not smoking and abnormal BMI. Low vitamin K was not associated with increased INR. Osteoporosis was diagnosed in 47/166 patients (28%), and associated with low calcium, but not with low vitamin D or K. In most patients, low serum MNs normalised over time without targeted supplementation.
CONCLUSION: Low serum MNs are common in CP and associated with severe PEI symptoms, and daily alcohol use, but often not with functional outcomes. These findings support targeted biochemical nutritional assessment in CP, guided by clinical risk factors.