Nutritionally Induced Pancreatic Disease
The pancreas plays a central role in nutrition and metabolism by virtue of the production of digestive enzymes by the exocrine tissue and the secretion of polypeptide hormones by the islets. Pancreatic digestive enzymes include trypsin, chymotrypsin, carboxypeptidase, elastase, lipase, RNase, DNase, and amylase (1). A deficiency of these enzymes in the small intestine results in digestive failure and malabsorption, which can lead to systemic nutritional disturbances affecting the growth and function of other organs and tissues. The effect of diseases of the pancreas on absorption and nutrition has been fully reviewed elsewhere (2), and a discussion of those malabsorption states that are secondary to pancreatic diseases such as cystic fibrosis and chronic pancreatitis will not be included here. Many abnormalities of the pancreas remain clinically "silent" because of the remote internal location of the pancreas and because the organ possesses a large reserve capacity with regard to both exocrine and endocrine functions (3). Secretion by the exocrine pancreas must be reduced by more than 90% before there is clinical evidence of malabsorption, and in subtotal pancreatectomy, preservation of about 10% of the gland prevents diabetes.