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TOPLINE:

Approximately 20% of hospitalised older adult patients at risk for malnutrition had plasma pancreatic lipase levels below the reference range, which was associated with an increased risk for adverse outcomes and failure to meet nutritional targets.

METHODOLOGY:

• In a randomised trial conducted at eight Swiss hospitals (2014-2018), adult inpatients at risk for malnutrition were randomly assigned within 48 hours of admission to receive either individualised nutritional support to meet energy and protein goals or usual hospital food.
• Researchers conducted a secondary analysis of the trial, including 810 patients (mean age, 71.5 years; 52% men) with plasma lipase concentrations measured at admission, to assess the prognostic implications of these concentrations for nutritional and clinical outcomes.
• Patients were stratified into two groups on the basis of whether their lipase concentrations were below or above the assay-specific reference value.
• The primary endpoint was all-cause mortality within 30 days.
• Secondary endpoints included adverse clinical outcomes within 30 days, major complications, achievement of energy and protein targets, rehospitalisation, and long-term mortality up to 5 years.

TAKEAWAY:

• Overall, 19.5% of patients had lipase concentrations below the assay-specific threshold. Diagnoses of cancer and infection were associated with reduced lipase concentrations (P = .012 and P = .022, respectively), whereas chronic kidney disease was associated with elevated lipase concentrations (P ≤ .001).
• Low lipase concentrations were not associated with 1-year mortality risk but were significantly associated with an increased risk for adverse outcomes within 30 days of hospital discharge (adjusted odds ratio [aOR], 1.67; P = .009).
• Low lipase concentrations were associated with an increased risk of not meeting individualised energy targets (aOR, 1.62; P = .022) and protein targets (aOR, 1.61; P = .023).
• Compared with patients with normal lipase concentrations, those with low lipase concentrations, particularly those older than 70 years, tended to have a lower risk for 30-day mortality when receiving nutritional interventions.

IN PRACTICE:

"It may be crucial to identify medical inpatients with low lipase concentrations and to initiate further diagnostics and treatment to prevent adverse outcomes," the authors wrote.

"Our results are hypothesis-generating rather than definitive and require validation through prospective studies in an independent sample, using standard diagnostic methods for EPI [exocrine pancreatic insufficiency]," they added.

SOURCE:

This study was led by Selina Randegger and Carla Wunderle, both from Kantonsspital Aarau in Aarau, Switzerland. It was published online on February 25, 2025, in Clinical Nutrition.

LIMITATIONS:

The sample size may have been too small to yield significant findings in some analyses. Missing lipase values at some sites may have introduced selection bias. As lipase concentrations were measured only at admission, the dynamics over time or the effect of nutritional support remained unclear. Furthermore, the concentrations of plasma lipase were used as a proxy for pancreatic exocrine function, without a formal diagnosis of exocrine pancreatic insufficiency according to the gold-standard criteria.

DISCLOSURES:

The trial received support from the Swiss National Science Foundation and the Research Council of Kantonsspital Aarau. Several authors reported receiving grants or consulting fees from sources unrelated to this study. One author reported being employed by Nestlé Health Science.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.