Negative impact of reduced exocrine pancreatic function on sarcopenia risk in the asymptomatic general population

Background In patients with pancreatic disease, exocrine insufficiency facilitates sarcopenia. Here, we investigated whether impaired exocrine function in the asymptomatic general population is also associated with sarcopenia. Methods We pooled data from two independent cohorts of 5,598 participants without history of pancreatic disease enrolled in the Study of Health in Pomerania. The association between impaired exocrine pancreatic function (fecal elastase ≤ 200 μg/g) and sarcopenia was determined by cross-sectional, univariable and multivariable regression analyses. The relation between baseline fecal elastase levels and incident sarcopenia was tested in a subgroup of 1,587 persons with available 5-years follow-up data. Results We found a baseline prevalence of 4.1% and 9.1% for sarcopenia and impaired exocrine pancreatic function, respectively. While there was no association in persons with age ≥ 65 years, impaired exocrine pancreatic function was associated with the risk of sarcopenia only in younger subjects (OR [95% CI]: 2.52 [1.40; 4.54]). These crude results remained robust in the multivariable models (OR [95% CI]: 2.41 [1.26; 4.61]). Longitudinal analyses did not show an association between exocrine pancreatic function and incident sarcopenia. However, reduced fecal elastase concentration at baseline was associated with muscle mass decline during follow-up. This relation was age-dependent with a significant inverse association only among younger (β [95% CI]: −0.23 [−0.39; −0.08]) but not older study participants (β [95% CI]: 0.04 [−0.31; 0.39]). Conclusion Impaired exocrine pancreatic function is associated with sarcopenia in younger individuals of the general population. Studies are called for testing the effect of pancreatic enzyme replacement therapy in asymptomatic patients with impaired exocrine pancreatic function.