Table 2

Evaluation of the need for PERT dose escalation: nutritional and symptom assessments

  • Weight changes in relation to nutritional intake (unexplained weight loss / failure to gain weight)

  • Functional changes (grip strength, sit-to-stand times, 6 min walk)

  • Micronutrient status (iron, ferritin, B12 and folate, fat-soluble vitamins, selenium, zinc, magnesium, copper, clotting)

  • Glycaemic control (HbA1c and random glucose)

  • Inflammatory markers for assessment of accuracy of micronutrients (CRP)

  • Stool frequency, texture, colour, appearance, presence of oil, floating/difficult to flush,

  • Flatulence, bloating, abdominal pain

  • Medication that may mask symptoms (opioids, ondansetron, iron supplements, etc)

  • 24-hour dietary recall with relevant PERT dose to assess adherence and ratio of PERT with nutrition

  • Food avoidance due to abdominal symptoms

  • Avoidance of fat-containing products

  • Nutritional adequacy of diet

  • CRP, C reactive protein; HbA1c, haemoglobin A1c; PERT, pancreatic enzyme replacement therapy.