1. VITAMIN D DEFICIENCY IN PATIENTS AFTER TOTAL PANCREATECTOMY AND
ISLET AUTO-TRANSPLANTATION: EFFECTS ON QUALITY OF LIFE
Glynnis Womack, BS1, ; Maria Nestleroad, RD, LD1, Kelley Martin, MPH, RD, LD1, Diane M. DellaValle, Ph.D., RDN, LD2,
Stefanie Owczarski, PA-C, MPAS3, Elizabeth Shuford, RN, CGRN3, Katherine Morgan, MD3, David Adams, MD3
1Medical University of South Carolina Dietetic Internship
2 Medical University of South Carolina, Department of Medicine, Division of Gastroenterology/Hepatology
2 3Medical University of South Carolina Department of Gastrointestinal and Laparoscopic Surgery
Due to the relatively new status of the total pancreatectomy and islet auto-
transplantation (TP-IAT) procedure, data regarding nutritional status in this
patient population is limited. Additionally, not many studies have been done
that focus on the association between vitamin D status and quality of life
(QoL) have. This study was created to look for an association between
vitamin D status and quality of life measures in TP-IAT patients. The objective
of this study is to create nutrition recommendations and protocol for RDNs to
follow, regarding vitamin D supplementation in the TP-IAT patient population.
ABSTRACT
BACKGROUND & OBJECTIVE
METHODS
SUMMARY & CONCLUSIONS
RESULTS
REFERENCES
Pain severity, impaired gastrointestinal function, nutritional risk and additional
disease-related complications have a negative impact on quality of life (QoL) in
patients with chronic pancreatitis (CP). Chronic pain may decrease after a
patient undergoes a total pancreatectomy and islet auto-transplantation (TP-
IAT) procedure. Vitamin D (VD) deficiency is associated with inflammation,
decreased immune function and depression, all of which affect overall QoL. The
purpose of this study was to assess VD status and relationships with QoL
measures in a cohort of CP patients who had undergone TP-IAT within the past
five years (n=86, 11 males, 75 females). VD levels and QoL measures were
assessed before and six months after surgery. Post-surgery morphine use was
examined as an objective measure and a pain score questionnaire as a
subjective measure of QoL. VD deficiency (VD level <25 ng/mL) was identified
in 53% of the cohort (deficient: 14.91±5.47 vs normal: 35.35±9.40 ng/mL,
p<0.001). Six months after surgery, VD-deficient patients reported two-fold
greater morphine use compared to those with normal levels (359.0±411.1 vs
184.1±178.5 mg/d, p=0.015). VD-deficient patients also reported higher
average pain scores at six months compared to those with normal levels
(p=0.05). It is essential to monitor VD levels in patients undergoing TP-IAT, as
those with low levels appear to have poor QoL due to higher pain levels. RDNs
should monitor QoL measures such as pain medication use and subjective pain
scores as markers of QoL as part of their functional nutrition assessment.
Differences between VD Replete and Deplete patients in Pre-surgery weight
(63.9±13.8 vs 78.4±20.3 kg, p<0.001 for Replete and Deplete, respectively) and
prealbumin (25.6±7.4 vs 22.2±5.6 mg/dL, p=0.02 for Replete and Deplete,
respectively) were controlled for in regression analyses.
Figure 1. Relationship between Vitamin D status and morphine use in post-
surgical chronic pancreatitis patients
* After controlling for pre-surgery weight and prealbumin,
for every ng/mL increase in Vitamin D status at 6-
months, morphine use decreased by 6.4±3.0 mg/d
(*p=0.04 for main effect of Vitamin D status).
180.1±78.7 mg/d
350.9±52.4 mg/d
4.4±0.4
4.9±0.4
*, p<0.001
Figure 2. Relationship between Vitamin D status and body
pain scale score in post-surgical chronic pancreatitis patients
Manifestation of same phenomenon
observed in objective pain assessment
(morphine use), but in a subjective pain
assessment.
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A retrospective chart review was conducted in a cohort of CP patients who
had undergone TP-IAT within the past five years (n=86; 87% female; 85%
white; 41.1±12.3 y; pre-surgery BMI: 26.3±6.3 kg/m2). QoL measures were
assessed before and six months after surgery. Morphine equivalent use (mg/
d) was examined as an objective QoL measure. Narcotic use was self-
reported, then type and dose of narcotic was converted into morphine
equivalents using an online standardized opioid-narcotic conversion calculator
(9). SF12 pain score questionnaire was used as a subjective measure of QoL
(8). VD levels were assessed before and 6-months after surgery. VD
deficiency (VD level <25 ng/mL per MUSC laboratory reference values) was
identified in 53% of the cohort (Deplete: 14.91±5.47 vs Replete: 35.35±9.40
ng/mL, p<0.001). Statistical Analysis: ANOVA was used to examine
differences between Vitamin-D Deplete and Replete Groups before and 6-
months after surgery. Pearson's correlations were used to examine
associations between variables. A p-value <0.05 was considered statistically
significant for main effects.
TP-IAT patients with vitamin D deficiency reported a two-fold greater morphine use than those who were vitamin D replete. While morphine equivalent usewas our objective
measure of QoL in this study, TP-IAT patients with low vitamin D also reported poor QoL in terms of subjective pain when compared to those who were vitamin D replete.
Limitations to this study include the self-reported QoL measures, including narcotic use, and that this study only examined the time interval from baseline to 6-months post-
surgery. Overall, these results imply that it is essential for RDNs to monitor vitamin D status in TP-IAT patients, prior to and after surgery. Additionally, RDNs should monitor
QoL measures, such as pain medication use and subjective pain scores as markers for QoL as part of their functional nutrition assessment. Since increasing QoL is one of the
main goals of a TP-IAT, it is important to look at all possible barriers to attaining that goal.