Exocrine Pancreatic Insufficiency in Diabetes Mellitus: A Complication of Diabetic Neuropathy or a Different Type of Diabetes?

Pancreatic exocrine insufficiency is a frequently observed phenomenon in type 1 and type 2 diabetes mellitus. Alterations of exocrine pancreatic morphology can also be found frequently in diabetic patients. Several hypotheses try to explain these findings, including lack of insulin as a trophic factor for exocrine tissue, changes in secretion and/or action of other islet hormones, and autoimmunity against common endocrine and exocrine antigens. Another explanation might be that diabetes mellitus could also be a consequence of underlying pancreatic diseases (e.g., chronic pancreatitis). Another pathophysiological concept proposes the functional and morphological alterations as a consequence of diabetic neuropathy. This paper discusses the currently available studies on this subject and tries to provide an overview of the current concepts of exocrine pancreatic insufficiency in diabetes mellitus

Fettsyrasammansättningen i amerikansk vapenfluga : påverkan från födosubstratet

With an increasing world population and meat consumption the black soldier fly (BSF; Hermetia illucens) shows potential as feed for animals, while recycling nutrients from food waste. To produce larvae of high quality as animal feed, further understanding is needed of how the substrate affects the nutritional composition of the larvae. In this project the aim was to investigate how the chemical composition of the substrate affects the one of the larvae, with focus on fatty acids. The chemical composition of BSF larvae (BSFL) reared on six different substrates was investigated: 1)retaken bread, 2) rainbow trout, 3) food waste, 4) fresh mussels, 5) ensiled mussels and 6) rancid mussels. Significant differences were recorded in proximate and fatty acid composition between larvae reared on different substrates, especially in the crude fat and ash content. Linear regression analysis indicated mainly the carbohydrate, crude protein and ash content of the substrate affected the proximate composition of the larvae. The proportion of saturated fatty acids (SFA), especially lauric acid, increased in the larvae with an increased larval weight, while mono- and polyunsaturated fatty acids decreased. The main factor for finding omega-3 fatty acids in the larvae was the concentrations of these fatty acids in the substrate. The analysis of malondialdehyde concentration in the substrates did not produce reliable results for the samples analysed. While the high SFA content in the larvae could be problematic in aquaculture, the use of substrates such as mussels and fish could improve the quality of the BSFL as a feed alternative.I takt med att jordens befolkning ökar och äter allt mer animaliska livsmedel, kan den amerikanska vapenflugan (BSF; Hermetia illucens) komma att bli viktig då den potentiellt kan användas som djurfoder och samtidigt tar vara på livsmedelsavfall. För att kunna producera larver av hög kvalitet behövs dock en vidare förståelse för hur olika avfallsprodukter påverkar den slutgiltiga näringssammansättningen i larverna. Syftet med detta projekt var att undersöka hur näringssammansättningen i olika avfallsprodukter påverkade sammansättningen i BSF-larver, med fokus på fettsyrasammansättningen. Näringssammansättningen analyserades i larver som fötts upp på sex olika substrat: 1) återtaget bröd, 2) regnbågslax, 3) livsmedelsavfall, 4) färska musslor, 5) ensilerade musslor och 6) härskna musslor. Signifikanta skillnader hittades i näringssammansättningen mellan de olika larverna, speciellt i fett- och ask- halten. Regressionsanalys visade på att främst halten kolhydrater, protein och aska i substraten påverkade larvernas näringssammansättning. Mängden mättade fettsyror, främst laurinsyra, ökade i takt med att larverna blev större, medan mängden enkel- och fleromättade fettsyror minskade. Den viktigaste faktorn för att det skulle finnas omega-3 fettsyror i larverna var att dessa fettsyror också återfanns i substratet. Analys av koncentrationen malondialdehyd i proverna gav inga tillförlitliga resultat. Medan den höga andelen mättade fettsyror i larverna kan vara ett problem i fiskodling, visar resultaten från denna studie också att användningen av substrat såsom fisk och musslor kan öka kvalitén i BSF-larverna som fiskfoder

Analysis of short chain fatty acids in faecal samples

Short chain fatty acids (SCFA) are produced by the gut microflora following the intake of complex carbohydrates and have been suggested as a contributor for some of the health benefits associated with dietary fibre (DF) intake. For further research of the mechanisms and effects of SCFA, reliable and accurate methods for analysis of SCFA in different biological samples are needed. In this project the aim was to develop and validate a rapid and ease-of use method for analysis of SCFA content in faecal samples. The contents of acetic, propionic, iso-butyric, n-butyric, iso-valeric, n-valeric and capronic acid were analysed through a method where fecal water was obtained through centrifugation and SCFA were further extracted with propyl formate. Extracts were analysed on a gas chromatograph coupled with a flame-ionization detector (GC-FID). The method was validated including estimation of accuracy and precision which were measured through calculation of recovery, deviation from linearity and by the coefficient of variance (CV), respectively. An exploratory test was also performed to analyse the distribution of SCFA in faecal matter. Moreover, the method was used to analyse SCFA concentrations in faecal samples (n=40) from two Norwegian bowel cancer projects, NORCCAP and BCSN. The results of the validation (recovery, CV and deviation from linearity) varied somewhat between the three batches, and thereby also the limits of quantification (LOQ), which were limited, but in most cases included the physiologically relevant concentrations. Through the exploratory distribution test, a significant difference in SCFA content was found between the in- and outside of the faecal sample, which emphasises the importance of homogenization of samples or consistent sampling from faecal samples. SCFA contents of faecal samples from the NORCCAP and BCSN samples were consistent with those reported by other studies, which indicate that the method produces reliable results. For a higher accuracy and precision, it is suggested that the amount of faecal material analysed is increased, followed by further validation of both lower and higher concentrations. Additionally, the effects of storage with and without buffer should also be investigated for more comparable results.Kortkedjiga fettsyror produceras av tarmfloran efter intag av komplexa kolhydrater och har föreslagits som en bidragande förklaring till några av de hälsofördelar som förknippats med intag av kostfibrer. För vidare studier kring mekanismerna och effekterna av kortkedjiga fettsyror krävs pålitliga och precisa metoder för analys av kortkedjiga fettsyror i olika biologiska prover. I detta projekt var syftet att utveckla och validera en enkel och snabb metod för analys av kortkedjiga fettsyror i avföringsprover. Innehållet av ättik-, propan-, isobutan-, butan-, isovalerian-, valerian- och kapronsyra analyserades genom centrifugering, extrahering med propylformat och analys med gaskromatografi och flamjonisationsdetektor (GC-FID). Metoden validerades genom mätning av noggrannhet och precision som räknades ut i form av utbyte, avvikelse från standardlinje och variationskoefficient (CV). Ett ytterligare test utfördes för att undersöka hur koncentrationen av kortkedjiga fettsyror varierade i olika delar av ett avföringsprov. Dessutom användes metoden för att analysera innehållet av kortkedjiga fettsyror i prover (n=40) från två norska tarmcancerprojekt, NORCCAP och BCSN. Resultaten från valideringen (utbyte, variationskoefficient och avvikelse från standardlinjen) varierade mellan de tre omgångarna och därmed även gränserna för kvantifiering, vilka var begränsade men i de flesta fallen inkluderade de koncentrationer av kortkedjiga fettsyror som är fysiologiskt relevanta. Testet som undersökte variationen av kortkedjiga fettsyror uppvisade signifikanta skillnader mellan in- och utsidan av avföringsprovet, vilket understryker vikten av homogenisering av prover och att vara konsekvent vid provtagning av avföringsprover. De koncentrationer som uppmättes från NORCCAP- och BCSN- proverna stämde väl överens med de som rapporterats i tidigare studier, vilket indikerar att metoden ger tillförlitliga resultat. För att uppnå högre precision och noggrannhet bör mängden avföring som analyseras ökas samt en ytterligare validering på både lägre och högre koncentrationer utföras. Dessutom bör effekterna av lagring med och utan buffert undersökas för mer jämförbara resultat

Mechanisms linking hypertriglyceridemia to acute pancreatitis

Hypertriglyceridemia (HTG) is a metabolic disorder, defined when serum or plasma triglyceride concentration (seTG) is >1.7 mM. HTG can be categorized as mild to very severe groups based on the seTG value. The risk of acute pancreatitis (AP), a serious disease with high mortality and without specific therapy, increases with the degree of HTG. Furthermore, even mild or moderate HTG aggravates AP initiated by other important etiological factors, including alcohol or bile stone. This review briefly summarizes the pathophysiology of HTG, the epidemiology of HTG-induced AP and the clinically observed effects of HTG on the outcomes of AP. Our main focus is to discuss the pathophysiological mechanisms linking HTG to AP. HTG is accompanied by an increased serum fatty acid (FA) concentration, and experimental results have demonstrated that these FAs have the most prominent role in causing the consequences of HTG during AP. FAs inhibit mitochondrial complexes in pancreatic acinar cells, induce pathological elevation of intracellular Ca2+ concentration, cytokine release and tissue injury, and reduce the function of pancreatic ducts. Furthermore, high FA concentrations can induce respiratory, kidney, and cardiovascular failure in AP. All these effects may contribute to the observed increased AP severity and frequent organ failure in patients. Importantly, experimental results suggest that the reduction of FA production by lipase inhibitors can open up new therapeutic options of AP. Overall, investigating the pathophysiology of HTG-induced AP or AP in the presence of HTG and determining possible treatments are needed

Recommendations from the United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis

In collaboration with United European Gastroenterology, the working group on 'Harmonizing diagnosis and treatment of chronic pancreatitis across Europe' (HaPanEU) developed European guidelines for the management of chronic pancreatitis using an evidence-based approach.Recommendations of multidisciplinary review groups based on systematic literature reviews to answer predefined clinical questions are summarised. Recommendations are graded using the Grading of Recommendations Assessment, Development and Evaluation system.Recommendations covered topics related to the clinical management of chronic pancreatitis: aetiology, diagnosis of chronic pancreatitis with imaging, diagnosis of pancreatic exocrine insufficiency, surgical therapy, medical therapy, endoscopic therapy, treatment of pancreatic pseudocysts, pancreatic pain, nutrition and malnutrition, diabetes mellitus and the natural course of the disease and quality of life.The HaPanEU/United European Gastroenterology guidelines provide evidence-based recommendations concerning key aspects of the medical and surgical management of chronic pancreatitis based on current available evidence. These recommendations should serve as a reference standard for existing management of the disease and as a guide for future clinical research. This article summarises the HaPanEU recommendations and statements

Treatment options for severe hypertriglyceridemia (SHTG): the role of apheresis

Hypertriglyceridemia is associated with a number of severe diseases such as acute pancreatitis and coronary artery disease. In severe hypertriglyceridemia (SHTG, triglycerides > 1,000 mg/dL), rapid lowering of plasma triglycerides (TG) has to be achieved. Treatment regimes include nutritional intervention, the use of antihyperlipidemic drugs, and therapeutic apheresis. Apheretic treatment is indicated in medical emergencies such as hypertriglyceridemic pancreatitis

United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU)

Background:There have been substantial improvements in the management of chronic pancreatitis, leading to the publication of several national guidelines during recent years. In collaboration with United European Gastroenterology, the working group on Harmonizing diagnosis and treatment of chronic pancreatitis across Europe' (HaPanEU) developed these European guidelines using an evidence-based approach. Methods: Twelve multidisciplinary review groups performed systematic literature reviews to answer 101 predefined clinical questions. Recommendations were graded using the Grading of Recommendations Assessment, Development and Evaluation system and the answers were assessed by the entire group in a Delphi process online. The review groups presented their recommendations during the 2015 annual meeting of United European Gastroenterology. At this one-day, interactive conference, relevant remarks were voiced and overall agreement on each recommendation was quantified using plenary voting (Test and Evaluation Directorate). After a final round of adjustments based on these comments, a draft version was sent out to external reviewers. Results: The 101 recommendations covered 12 topics related to the clinical management of chronic pancreatitis: aetiology (working party (WP)1), diagnosis of chronic pancreatitis with imaging (WP2 and WP3), diagnosis of pancreatic exocrine insufficiency (WP4), surgery in chronic pancreatitis (WP5), medical therapy (WP6), endoscopic therapy (WP7), treatment of pancreatic pseudocysts (WP8), pancreatic pain (WP9), nutrition and malnutrition (WP10), diabetes mellitus (WP11) and the natural course of the disease and quality of life (WP12). Using the Grading of Recommendations Assessment, Development and Evaluation system, 70 of the 101 (70%) recommendations were rated as strong' and plenary voting revealed strong agreement' for 99 (98%) recommendations. Conclusions:The 2016 HaPanEU/United European Gastroenterology guidelines provide evidence-based recommendations concerning key aspects of the medical and surgical management of chronic pancreatitis based on current available evidence. These recommendations should serve as a reference standard for existing management of the disease and as a guide for future clinical research

Biological Earth observation with animal sensors

Space-based tracking technology using low-cost miniature tags is now delivering data on fine-scale animal movement at near-global scale. Linked with remotely sensed environmental data, this offers a biological lens on habitat integrity and connectivity for conservation and human health; a global network of animal sentinels of environmen-tal change