Assessment of serum micronutrient concentration in chronic pancreatitis: insights from the nationwide COMBO randomised trial
In brief
Nearly half of chronic pancreatitis patients had low micronutrient levels
In a nationwide study of 409 patients, 45% had at least one low micronutrient level and 15% had multiple deficiencies; low vitamins K and D were most common. Severe pancreatic insufficiency symptoms and daily alcohol use were linked to low levels, which often normalized without targeted supplements and were usually not tied to measured complications. Risk-guided testing may help identify patients who need closer nutritional assessment.
- Journal
- European journal of internal medicine (Q1)
- Published
- 17 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Nde Thierens, Fem de Rijk, S Bai, P J van der Schaar, R P Voermans, L M Kager, et al.
- PMID
- 42892572
- DOI
- 10.1016/j.ejim.2026.107233
Why clinicians should know about it
- Picked for Biochemistry (medical) (paper of the day, 20 October 2026): Micronutrient deficiencies common in chronic pancreatitis with PEI
Abstract
INTRODUCTION: In patients with chronic pancreatitis (CP), pancreatic exocrine insufficiency (PEI) and poor dietary intake may cause malnutrition. International guidelines recommend monitoring key micronutrients (MN), however clinical implications remain uncertain. This study aims to evaluate the prevalence, risk factors, complications, and longitudinal course of low serum MNs in patients with CP. METHODS: This is a predefined analysis of the COMBO trial, a nationwide stepped-wedge cluster randomised trial on evidence-based CP management. Nutritional biochemical assessment included vitamins A, D, E, and K, iron, zinc, selenium, calcium, and magnesium during the 35-month study period. PEI symptom severity was assessed using the PEI-Questionnaire. RESULTS: Among 409 patients with CP, 327 (80%) had PEI. Low serum MNs were present in 184 patients (45%), including 63 (15%) with low levels of multiple MNs. Low vitamin K (59%) and D (38%) were most prevalent. Risk factors of low serum MNs included severe PEI symptoms (aOR 2.54; 95% CI 1.04 - 6.18, p = 0.04), and daily alcohol use (aOR 3.71; 95% CI 1.54 - 8.89, p = 0.003), but not smoking and abnormal BMI. Low vitamin K was not associated with increased INR. Osteoporosis was diagnosed in 47/166 patients (28%), and associated with low calcium, but not with low vitamin D or K. In most patients, low serum MNs normalised over time without targeted supplementation. CONCLUSION: Low serum MNs are common in CP and associated with severe PEI symptoms, and daily alcohol use, but often not with functional outcomes. These findings support targeted biochemical nutritional assessment in CP, guided by clinical risk factors.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.