Prevalence and impact of sarcopenia in chronic pancreatitis: A systematic review and meta-analysis

BACKGROUND: Chronic pancreatitis (CP) is a progressive inflammatory disease leading to irreversible pancreatic damage, resulting in exocrine and endocrine insufficiency. While surgical and endoscopic interventions can address morphological complications of CP, they may not directly address the systemic impacts of malnutrition, frailty, and sarcopenia-key contributors to morbidity and mortality in these patients. This systematic review and meta-analysis aimed to evaluate the prevalence of sarcopenia in CP patients. METHODS: A systematic search of MEDLINE and Embase databases (via Ovid, from inception to November 2024) was conducted following PRISMA guidelines. Studies reporting sarcopenia prevalence in CP, assessed by various diagnostic modalities, were included. Random-effects pooled proportion meta-analysis using the Freeman-Tukey double arcsine transformation were applied. Heterogeneity was assessed using the I² statistic. RESULTS: Fifteen studies with 1365 CP patients were included. Most patients were male (68 %), with about half having a history of alcohol misuse and smoking (48 %, 52.5 %, respectively). About 47 % had pancreatic exocrine insufficiency, with 41 % being on pancreatic enzyme replacement therapy. Mortality was assessed in a single study and reported at 16 %. The pooled prevalence of sarcopenia was 40.9 % [95 % CI: 28.4 %-58.9 %]. The pooled mean difference for BMI between sarcopenic and non-sarcopenic patients was -2.62 (95 % CI: 3.22 to -2.01, p < 0.01). CONCLUSION: This highlights that approximately 41 % of patients with CP have sarcopenia, and that this seems to be associated with a low BMI. Given the known adverse impact of sarcopenia on overall health, future studies should focus on standardizing sarcopenia screening, assessment and exploring its interplay with outcomes in CP patients. PROSPERO: CRD42024611097.