From the Guidelines
Elevated GGT and amylase levels in malnutrition are primarily a result of the body's stress response to inadequate nutrition, affecting the liver and pancreas, and can be managed through careful nutritional rehabilitation. Malnutrition causes stress on multiple organ systems, particularly affecting the liver and pancreas. When the body is severely undernourished, the liver may develop fatty infiltration or inflammation, leading to increased GGT levels as this enzyme is released from damaged liver cells 1. Similarly, pancreatic stress during malnutrition can cause elevated amylase levels. The pancreas may become inflamed or damaged when trying to function with inadequate nutritional resources.
Some key factors to consider in malnutrition include:
- Inadequate spontaneous nutrient intake
- Metabolic acidosis
- Insulin resistance
- Chronic inflammation
- Intestinal microbiota alterations (intestinal dysbiosis)
- Infection and oxidative stress, all of which can contribute to the development of malnutrition 1
- Malnutrition is characterized by loss of protein and energy stores associated with multiple metabolic derangements, most of which are peculiar to the syndrome 1
Treatment focuses on careful nutritional rehabilitation with gradual refeeding to prevent refeeding syndrome. Protein intake should be slowly increased while monitoring electrolytes, particularly phosphate, potassium, and magnesium. Vitamin supplementation, especially thiamine, should precede carbohydrate administration 1. Enzyme levels typically normalize with proper nutritional rehabilitation, though this may take weeks depending on the severity of malnutrition. Regular monitoring of liver and pancreatic function during refeeding is essential to track improvement and adjust the nutritional plan accordingly.
It is also important to note that older persons are at increased risk of malnutrition and dehydration, with serious health consequences, and that supporting adequate nutrition is an important public health concern 1. The prevalence of malnutrition generally increases with deteriorating functional and health status, and reported prevalence rates greatly depend on the definition used, but are generally below 10% in independently living older persons and increase up to two thirds of older patients in acute care and rehabilitation hospitals 1.
From the Research
Elevated GGT and Amylase in Malnutrition
- GGT (gamma-glutamyl transferase) and amylase are enzymes that can be elevated in various conditions, including pancreatic diseases and malnutrition.
- Malnutrition can be a complication of pancreatic diseases, such as chronic pancreatitis, due to exocrine pancreatic insufficiency (EPI) and maldigestion 2.
- EPI can lead to fat malabsorption, weight loss, and malnutrition, which can be associated with elevated GGT and amylase levels 3, 4.
- A study found that 84.6% of patients with chronic pancreatitis had EPI, and 31.5% had a medium or higher risk for malnutrition 5.
- Malnutrition in chronic pancreatitis is associated with osteoporosis, sarcopenia, poor quality of life, and increased mortality 2.
- Pancreatic enzyme replacement therapy and nutritional support can help manage malnutrition and EPI in patients with pancreatic diseases 6, 3, 4.
- Elevated GGT and amylase levels can be indicative of pancreatic damage or disease, and malnutrition can exacerbate these conditions 5.