Prevalence and determinants of exocrine pancreatic insufficiency among older adults:: Results of a population-based study

Objective. The prevalence and main determinants of exocrine pancreatic insufficiency were investigated in a large population- based sample of older adults by measuring pancreatic elastase-1 in stool. Material and methods. The study comprised 914 participants aged 50 to 75 years recruited by their general practitioner during a general health examination. All participants and their physicians were asked to fill out a standardized questionnaire which contained information on socio-demographic and lifestyle factors as well as medical history. Native stool was examined for pancreatic elastase-1 with a commercially available ELISA ( ScheBo(R) Tech, Giessen, Germany). Results. Overall, 524 women and 390 men aged 50 to 75 years ( mean age 61.9 years) were included in the analysis. In total, 105 (11.5%) of the 914 subjects showed signs of exocrine pancreatic insufficiency (EPI) with <= 200 mu g elastase-1/g stool, and 47 (5.1%) subjects showed signs of a severe exocrine pancreatic insufficiency (SEPI, < 100 mu g elastase-1/g stool). There was a clear increase in EPI with age. Patients taking angiotensin-converting enzyme ( ACE) inhibitors had a lower prevalence than subjects without this medication; these associations persisted after adjustment for covariates. Conclusions. Prevalence of EPI increases with age and seems to be tentatively higher in men than in women. However, smoking seems to be an independent risk factor for EPI and SEPI whereas ACE-inhibitor intake might be a protective factor. The latter finding may even point to new options in the treatment of chronic pancreatitis.