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Normal bone mineral density and lean body mass, but increased fat mass, in young adult patients with congenital adrenal hyperplasia.
Patients with congenital adrenal hyperplasia attributable to 21-hydroxylase deficiency are treated with glucocorticoids. Glucocorticoid administration, even in substitution doses, may cause decreased bone mineral density (BMD) and obesity. The purpose of this study was to determine BMD, lean mass, and fat mass in young adult male (M, n = 15) and female (F, n = 15) patients with 21-hydroxylase deficiency, who had been treated with currently recommended low doses of glucocorticoids. Measurements were performed with dual-x-ray absorptiometry. In addition, calcaneal ultrasound measurements were performed (broadband ultrasound attenuation and speed of sound). Results were compared with those in age- and sex-matched controls; to adjust for height, lean and fat mass were divided by (height)(2). M and F patients [M, 21.7 +/- 2.4; F, 20.6 +/- 2.9 yr old (mean +/- SD)] were shorter than the controls (M, P < 0.001; F, P < 0.003) and their body mass indices were higher [M patients (25.0 +/- 3.6) vs. controls (22.3 +/- 1.9 kg/m(2)) (P < 0.02); F patients (25.5 +/- 4.5) vs. controls (21.9 +/- 2.3 kg/m(2)) (P < 0.02)]. BMD values (lumbar spine L1-L4, femoral neck, and total body) were not different from controls. Calcaneal ultrasound measurements showed that M patients had higher speed of sound values [M patients (1564 +/- 38) vs. controls (1529 +/- 29 m/sec) (P < 0.01)]. Lean mass in M and F patients was not different from controls when adjusted for height. Fat mass was higher in M and F patients when adjusted for height [M patients 5.6 +/- 2.9 vs. controls 2.7 median (1.7-7.0 min-max) kg/m(2) (P < 0.04); F patients 8.7 +/- 2.8 vs. controls 5.8 (4.3-10.7) kg/m(2) (P < 0.02)]. Relative fat mass (fat mass as a percentage of the total body mass) was higher in patients, compared with controls [M patients 22.0 +/- 9.1 vs. controls 12.8 (8.5-27.0)% (P < 0.04); F patients 34.1 +/- 5.0 vs. controls 29.0 +/- 5.1% (P < 0.02)]; this resulted from increased fat mass, not from decreased lean mass. Fat distribution over the body was not different in patients and controls. No significant correlations were found between cumulative glucocorticoid doses in the last 0.5, 2, or 5 yr or mean salivary morning levels of 17-hydroxyprogesterone and androstenedione in the last 5 yr on one hand and bone parameters, lean mass, or fat mass on the other hand. We conclude that, at prevailing low-dose glucocorticoid regimens, young adult patients with 21-hydroxylase deficiency have normal BMD. Their lean mass is in accordance with height, but fat mass is increased, with a normal distribution over the body. This results in a higher fat percentage of the total body and a higher body mass index than in healthy peers. Because overweight and increased fat mass are associated with the metabolic syndrome and increased cardiovascular risk, weight management should have appropriate attention in the follow-up of congenital adrenal hyperplasia patients, to prevent overweight-associated morbidity.
Fat emulsions as an ideal nonprotein energy source under surgical stress for diabetic patients.
We studied the possibility of fat emulsions being a major calorie source, and if possible, a new infusion protocol without glucose for diabetic patients undergoing surgery. High dosages of fat emulsions and amino acids (HFHA infusions) were investigated as a substitute for conventional glucose-based infusions for 7 days after surgery. Without insulin and glucose, blood glucose was kept within the normal range, in spite of the fact that patients were recovering from major surgeries. Blood triglyceride and fatty free acids (FFA) increased after the start of the HFHA infusions but remained within normal range. Liver function tests and nutritional states estimated by nitrogen balance or rapid turnover proteins were no different from those of the conventional glucose-based infusion, but the significance of the HFHA infusion lies in the fact that it was applied to patients in whom it was impossible to administer enough calories by using the conventional glucose-based infusion, even if insulin was used. This HFHA infusion, which enables easy blood glucose control, sufficient calorie supply without complications, and is also nutritionally equivalent to the conventional glucose-based infusion, can be a new nutritional option for postoperative patients with impaired glucose tolerance.
Joint analysis of the influence of CYP11B1 and DGAT1 genetic variation on milk production, somatic cell score, conformation, reproduction, and productive lifespan in German Holstein cattle.
Recent publications indicate genetic variation in milk production traits on proximal BTA14, which cannot be explained solely with genetic variation in the DGAT1 gene. To elucidate these QTL effects, animals from a German Holstein granddaughter design (18 families, 1,291 sons) were genotyped for CYP11B1 (V30A) and DGAT1 (K232A) polymorphisms. Frequencies of alleles of maternal descent were estimated for CYP11B1(V) (0.776) and DGAT1(K) (0.549). Allele substitution effects (alpha/2) were first calculated for both alleles in separate models and then in a joint model. From the joint analysis, CYP11B1(V) effects on fat content (+0.04%) and protein content (+0.01%) were positive. Effects on milk yield (-82 kg), fat yield (-0.5 kg), and protein yield (-1.9 kg) were negative. Compared with the individual analysis, DGAT1(K) effects on fat content (+0.28%), protein content (+0.06%), and milk yield (-258 kg) were reduced; fat yield (+10.8 kg) was enhanced; and protein yield (-3.8 kg) was reduced. In the joint analysis, allele substitution effects of CYP11B1(V) and DGAT1(K) together explained more of the variation in milk production traits than DGAT1(K) alone. Further significant effects were found for CYP11B1(V) and DGAT1(K) among 6 reproduction traits and 14 conformational traits. These observations indicate a possible negative influence of DGAT1(K) on maternal nonreturn rate, and thus, on length of productive life.
Diets enriched in unsaturated fatty acids enhance apolipoprotein A-I catabolism but do not affect either its production or hepatic mRNA abundance in cynomolgus monkeys.
To determine the mechanisms whereby dietary fatty acids influence high density lipoprotein (HDL) cholesterol and apolipoprotein (apo) A-I concentrations, ten cynomolgus monkeys were fed each of three experimental diets enriched in saturated (SAT), monounsaturated (MONO), or polyunsaturated (POLY) fatty acids in a crossover design consisting of three 13-week periods, with each animal serving as its own control. Each diet contained 30% of energy as fat with 0.22 mg cholesterol/kcal and differed solely by the isocaloric substitution of fatty acids as 18% of total energy calories. The replacement of dietary saturated fatty acids with either monounsaturated or polyunsaturated fatty acids, respectively, resulted in significant reductions of plasma total cholesterol (-17%; -30%), HDL cholesterol (-32%; -41%), and apo A-I (-37%; -44%) concentrations, while no significant differences were noted in plasma lipid or apo A-I concentrations when the MONO and POLY phases were compared. Although the MONO and POLY diets were similar in their effects on plasma lipids and apolipoproteins, the HDL of monkeys fed the POLY diet, as compared with either the SAT or the MONO diets, contained more cholesteryl ester and phospholipid but less total protein, resulting in a significantly lower total lipid to protein constituent ratio. Metabolic experiments revealed that the significantly lower plasma apo A-I concentrations observed during both the MONO and POLY phases relative to SAT were directly attributable to enhanced HDL apo A-I catabolism. Conversely, neither HDL apo A-I production rates nor hepatic apo A-I mRNA concentrations were significantly affected by dietary fatty acid perturbation in this study. Taken together, these data indicate that fractional catabolic rate is the predominant mechanism by which dietary fatty acids differentially modulate circulating concentrations of HDL apo A-I in this species when all other dietary variables are held constant.
Diurnal variation in milk and plasma urea nitrogen in Holstein and Jersey cows in response to degradable dietary protein and added fat.
Four Holstein and four Jersey cows fitted with ruminal and duodenal cannulas were used in two 4 x 4 Latin squares to investigate the effects of varying protein degradability and supplemental fat on diurnal changes in plasma and milk urea N. Dietary dry matter contained 16.2% crude protein with two concentrations of ruminally undegradable protein (RUP) that were obtained by substituting blood meal for a portion of soybean meal. Treatments were 1) 29% RUP and 0% added fat, 2) 29% RUP and 2.7% added fat (Ca soaps of fatty acids), 3) 41% RUP and 0% added fat, and 4) 41% RUP and 2.7% added fat. Dry matter of the total mixed diet fed at 1000 and 1400 h consisted of 30% corn silage, 29% alfalfa haylage, and 41% concentrate. Ruminal ammonia, plasma urea N, and milk urea N were measured every 4 h over a 24-h period. Dry matter intake was depressed 6.7% by added fat. Ruminal ammonia was 25 to 45% lower when the 41% RUP diets were fed. Overall, the concentration of plasma urea N and milk components were not influenced by diet. However, milk urea N was higher in Holsteins than in Jerseys. Both plasma and milk urea N increased within 2 h after the 1000-h feeding followed by a decline at 6 h after the 1400-h feeding. In this short-term study, fat supplementation had no effect on milk production or yields of milk components. The inclusion of blood meal, however, increased the yields of milk components. Plasma and milk urea N did not differ among dietary treatments but varied throughout the day in relation to the time of feeding.
Storage stability of cooked sausages containing vegetable oils.
Comminuted cooked sausages were produced using standard industrial practices, by substituting corn oil, sunflower oil, cotton seed oil, soybean oil and hydrogenated vegetable fat for animal fat. When processed, products were assessed for their stability with respect to autoxidation and change in organoleptic properties during vacuum-packed storage in a domestic refrigerator at 4 degrees C. Data obtained indicated that changes in thiobarbituric acid (TBA) values and organoleptic properties of products produced using corn oil, sunflower oil and hydrogenated vegetable fat were similar to those observed for reference material produced using lard. In the case of samples produced using soybean and cotton seed oil, TBA value changes were more pronounced, but did not exceed acceptable limits. A more rapid deterioration of organoleptic characteristics was also observed for the same samples, which showed flavour problems after 3 months of storage at 4 degrees C. Substitution of plant oils for lard considerably reduced the cholesterol content and increased the ratio of unsaturated to saturated fatty acids of cooked sausages.
Filled milk and artificial milk substitutes.
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Fatty acid composition and total lipid of cream and cream substitutes.
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Palm olein in the fat blend of infant formulas: effect on the intestinal absorption of calcium and fat, and bone mineralization.
OBJECTIVE: To evaluate the published clinical data on the physiologic effects of using palm oil and its low melting fraction, palm olein (PO) as a dominant lipid source in the fat blend in infant formulas. DESIGN: A systematic search of Medline and the Cochrane Database of Systematic Reviews was performed to retrieve studies comparing infants who received infant formulas containing PO with those who received infant formulas without PO or which contained synthetic triacylglyceride as a source of palmitic acid. Outcomes of interest include intestinal fractional absorption of fat, palmitic acid and calcium; and bone mass. The effect size for each dependent variable in each published study was obtained by standardizing based on the difference in means between non-PO and PO group with respect to the standard deviation of the PO group. Trend analysis of the outcome of interest was performed when 3 or more between group comparisons were available. The comparison of effect size across different studies was based on all available data and includes results that showed no significant difference between infants fed PO or non-PO study formulas in the outcomes of interest. RESULTS: Nine publications were identified with non-PO and PO comparison groups. The gestational ages of infants in the published studies were between 28 to 42 weeks and postnatal ages were birth to 192 days at study onset. Within each published study, there was some variability in the effect size between non-PO and PO groups. The standardized results were consistently significantly (p < 0.05) positive in favor of the feeding with non-PO formulas with respect to increased intestinal fractional absorption of fat, palmitic acid and calcium. The latter two variables were significantly different by at least 0.6 SD. Bone mass measured as total body bone mineral content was significantly higher in the non-PO group by at least 0.3 SD. CONCLUSION: The use of PO in infant formulas to match the human milk content of palmitic acid has unintended physiological consequences including diminished intestinal absorption of fat, palmitic acid and calcium and lower bone mass. The avoidance of PO or its substitution with synthetic triacylglyceride in infant formulas can prevent this detrimental effect.
[Facial localized cosmetic filling by multiple injections of fat stored at -30 degrees C. Techniques, clinial follow-up of 99 patients and histological examination of 10 patients].
At the end of the 1980's and at the beginning of the 1990's, free fat autografts were abandoned because of the poor long-term results. Two theories supported by hystological studies (the host replacement theory or the cell survival theory) have now been proposed to explain survival of fat tissue. They demonstrate that, when harvested by a correct technique, fat tissue presents the ideal characteristics to be grafted, providing a good soft-tissue substitute with a minimum follow-up of four years up to 6 years. The authors present a multiple stage lipofilling technique in 99 cases of facial rejuvenation by means of lipolayering. Injections are performed every 20 days and fat is stored fat at -30 degrees C with good aesthetic results and minimal morbidity with clinical follow-up at 4 and 6 years. Histological examination of fat stored for 20 days and for 8 months was also performed in 10 patients. Microscopic and ultrastructural examination demonstrated that stored adipocytes retain their anatomical features and, when injected in multiple stages, are adequate to obtain good clinical results. Our histological study combined with the clinical outcomes, suggests the advantage of several stage injection of stored fat (-30 degrees C).
Physical properties of ice cream containing milk protein concentrates.
Two milk protein concentrates (MPC, 56 and 85%) were studied as substitutes for 20 and 50% of the protein content in ice cream mix. The basic mix formula had 12% fat, 11% nonfat milk solids, 15% sweetener, and 0.3% stabilizer/emulsifier blend. Protein levels remained constant, and total solids were compensated for in MPC mixes by the addition of polydextrose. Physical properties investigated included apparent viscosity, fat globule size, melting rate, shape retention, and freezing behavior using differential scanning calorimetry. Milk protein concentrate formulations had higher mix viscosity, larger amount of fat destabilization, narrower ice melting curves, and greater shape retention compared with the control. Milk protein concentrates did not offer significant modifications of ice cream physical properties on a constant protein basis when substituted for up to 50% of the protein supplied by nonfat dry milk. Milk protein concentrates may offer ice cream manufacturers an alternative source of milk solids non-fat, especially in mixes reduced in lactose or fat, where higher milk solids nonfat are needed to compensate other losses of total solids.
Iatrogenic kwashiorkor in infants.
Four children experienced kwashiorkor six weeks to six months following the introduction of a low-protein, high-fat, nondairy creamer into their diets. In all cases, the milk substitute eventually became their sole nutritional source and resulted in hypoproteinemia, edema, and hepatic abnormalities. All patients had been given the milk substitute in an attempt to control suspected milk protein sensitivity. Only one of the four patients was subsequently shown to have cow's milk sensitivity. All had complete resolution of symptoms within six weeks following institution of a nutritionally adequate diet.
Suction lipectomy--a review of 200 patients over a six-year period and a study of the technique in cadavers.
Suction lipectomy is designed to reduce subcutaneous fat. It is strictly a procedure for the removal of localized fat and body contouring in selected patients and is not a substitute for weight reduction. The technique and the complications associated with the procedure were reviewed in more than 200 patients. Suction lipectomy was performed on fresh cadavers to study the nature of the fibrous tissue and to better understand why the procedure has proved safe.
Fate of pancreatic enzymes in the human intestinal lumen in health and pancreatic insufficiency.
The activities of pancreatic enzymes decrease during their passage from the duodenum to the terminal ileum, but degradation rates of individual enzymes are different. Whereas lipase activity is lost most rapidly, proteases and amylase are more stable. The mechanism by which lipase activity is destroyed is proteolysis, mainly by the action of chymotrypsin. This mechanism is also operative in patients with chronic exocrine pancreatic insufficiency. It explains why fat malabsorption develops earlier compared with protein or starch malabsorption. The substitution of lipase is also more difficult than that of other enzymes, because it is more rapidly destroyed by proteases. Conversely, inactivation of proteases improves intraluminal activity of lipase not only in healthy individuals but also in patients with chronic pancreatitis. Other factors that contribute to problems in lipase substitution therapy include acid-peptic destruction of unprotected enzyme preparations and unphysiological particle sizes of enteric-coated capsules or pellets. Recent data suggest that the adaptation of the diameter of enteric-coated pancreatin micropellets into the range that permits gastric emptying in synchronicity with the meal improves their digestive efficacy.
[Detection of genetically modified soy (Roundup-Ready) in processed food products].
In this study, the application of a qualitative and a quantitative method of analysis to detect genetically modified RR-Soy (Roundup-Ready Soy) in processed foods is described. A total of 179 various products containing soy such as baby food and diet products, soy drinks and desserts, tofu and tofu products, soy based meat substitutes, soy protein, breads, flour, granules, cereals, noodles, soy bean sprouts, fats and oils as well as condiments were investigated following the pattern of the section 35 LMBG-method L 23.01.22-1. The DNA was extracted from the samples and analysed using a soybean specific lectin gene PCR as well as a PCR, specific for the genetic modification. Additional, by means of PCR in combination with fluorescence-detection (TaqMan 5'-Nuclease Assay), suspicious samples were subjected to a real-time quantification of the percentage of genetically modified RR-Soy. The methods of analysis proved to be extremely sensitive and specific in regard to the food groups checked. The fats and oils, as well as the condiments were the exceptions in which amplifiable soy DNA could not be detected. The genetic modification of RR-Soy was detected in 34 samples. Eight of these samples contained more than 1% of RR-Soy. It is necessary to determine the percentage of transgenic soy in order to assess whether genetically modified ingredients were deliberately added, or whether they were caused by technically unavoidable contamination (for example during transportation and processing).
NTP toxicology and carcinogenesis studies of decalin (CAS No. 91-17-8) in F344/N rats and B6C3F(1) mice and a toxicology study of decalin in male NBR rats (inhalation studies).
Decalin is used as an industrial solvent for naphthalene, fats, resins, oils, and waxes. It is also used as a substitute for turpentine in lacquers, paints, and varnishes; as a solvent and stabilizer for shoe polishes and floor waxes; and as a constituent of motor fuels and lubricants. Other applications include use as a paint thinner and remover, a patent fuel in stoves, a high-density fuel in submarine-launched cruise missile systems, and in stain removal and cleaning machinery. Decalin was nominated for study by the National Cancer Institute because of its chemical structure, its potential for consumer exposure, and a lack of adequate testing of the chemical. Male and female F344/N rats and B6C3F(1) mice were exposed to decalin (greater than 99% pure) by inhalation for 2 weeks, 3 months, or 2 years. Groups of male NBR rats were exposed to decalin for 2 weeks. Male NBR rats do not produce alpha2u-globulin; the NBR rats were included to study the relationship of alpha2u-globulin and renal lesion induction. Genetic toxicology studies were conducted in Salmonella typhimurium and mouse peripheral blood erythrocytes. 2-WEEK STUDIES IN RATS: Groups of five male and five female F344/N rats and five male NBR rats were exposed to 0, 25, 50, 100, 200, or 400 ppm decalin vapor 6 hours per day, 5 days per week for 16 days. All rats survived to the end of the study, and mean body weights of exposed groups were similar to those of the chamber controls. Renal toxicity studies were performed in male F344/N and NBR rats. The numbers of labeled cells and the labeling indices in the left kidney of 200 and 400 ppm F344/N male rats were significantly greater than those in the chamber controls. The alpha2u-globulin/soluble protein ratios were significantly increased in all exposed groups of F344/N rats. Liver weights of male F344/N and NBR rats exposed to 100 ppm or greater were significantly increased, as were those of all exposed groups of females. Kidney weights of male F344/N rats exposed to 50 ppm or greater were significantly increased. Exposure-related hyaline droplet accumulation, degeneration and regeneration of renal cortical tubules, and granular casts occurred in the kidney of exposed F344/N male rats. 2-WEEK STUDIES IN MICE: Groups of five male and five female B6C3F(1) mice were exposed to 0, 25, 50, 100, 200, or 400 ppm decalin vapor 6 hours per day, 5 days per week for 17 days. All mice survived to the end of the study, and mean body weights of exposed groups were similar to those of the chamber control groups. Liver weights of 200 and 400 ppm males and females and 100 ppm females were significantly increased. 3-MONTH STUDY IN RATS: Groups of 25 male and 20 female F344/N rats were exposed to 0, 25, 50, 100, 200, or 400 ppm decalin vapor 6 hours per day, 5 days per week for 2 (five male renal toxicity rats), 6 (10 male and 10 female clinical pathology rats), or 14 (10 core study rats) weeks. All rats survived to the end of the study, and mean body weights of exposed groups were similar to those of the chamber control groups. Urinalysis results indicated that decalin exposure caused increases in urine glucose and protein concentrations and enzyme activities that were consistent with the renal lesions observed microscopically. Renal toxicity studies were performed on rats sacrificed at 2 and 6 weeks and at the end of the study. In kidney tissue examined for cell proliferation, the numbers of PCNA-labeled cells and labeling indices were generally significantly greater than those of the chamber controls in exposed groups of rats at all three time points. Concentrations of alpha2u-globulin in the kidney as well as the alpha2u-globulin/soluble protein ratios were significantly increased at week 2 in all exposed groups and in the 200 and 400 ppm groups at week 6 and at the end of the study. Absolute and/or relative kidney and liver weights of male rats exposed to 50 ppm or greater were increased. Incidences of renal tubule regeneration and granular casts in the medulla of the kidney in exposed male rats were increased, and the severities of hyaline droplets generally increased with increasing exposure concentration. 3-MONTH STUDY IN MICE: Groups of 10 male and 10 female B6C3F(1) mice were exposed to 0, 25, 50, 100, 200, or 400 ppm decalin vapor 6 hours per day, 5 days per week for 14 weeks. All mice survived to the end of the study, and mean body weights of exposed groups were similar to those of the chamber control groups. Liver weights of 200 and 400 ppm males and females were significantly increased. There was a significant exposure concentration-related decrease in the absolute spermatid head count and a significant decrease in absolute head count of the 400 ppm group compared to the chamber controls. Incidences of centrilobular cytomegaly of the liver were increased in exposed male mice. 2-YEAR STUDY IN RATS: Groups of 50 male and 50 female F344/N rats were exposed to 0, 25, 50 (male rats only), 100, or 400 ppm (female rats only) decalin vapor 6 hours per day, 5 days per week for 105 weeks. A group of 20 male rats was exposed to 400 ppm. Survival of exposed groups was similar to that of the chamber control groups. Mean body weights of 400 ppm males were slightly less than those of the chamber controls during the second year of the study. Incidences of renal tubule adenoma and adenoma or carcinoma (combined) and of benign or malignant pheochromocytoma (combined) of the adrenal medulla in 100 and 400 ppm males were significantly increased. There was a significant association between nephropathy severity and adrenal pheochromocytoma incidence. Nonneoplastic lesions related to decalin exposure occurred in the kidney of male rats. 2-YEAR STUDY IN MICE: Groups of 50 male and 50 female B6C3F(1) mice were exposed to 0, 25, 100, or 400 ppm decalin vapor 6 hours per day, 5 days per week for 105 weeks. Survival of exposed mice was similar to that of the chamber controls. Mean body weights of exposed groups were generally similar to those of the chamber control groups throughout the study. Increased incidences of hepatocellular neoplasms occurred in 25 and 400 ppm female mice, and the incidences of centrilobular hypertrophy, necrosis, syncytial alteration, and erythrophagocytosis of the liver in 400 ppm males were significantly increased. The incidences of uterine stromal polyp and stromal polyp or stromal sarcoma (combined) occurred with positive trends in female mice. PHARMACOKINETIC MODEL: The rate of metabolism of decalin was the same for males and females in rats and mice. Also in rats and mice, decalin metabolism was saturated at less than 400 ppm. Increased labeling indices in male rats were likely due to changes related to alpha2u-globulin. GENETIC TOXICOLOGY: Decalin was not mutagenic in S. typhimurium strains TA97, TA98, TA100, or TA1535, with or without induced hamster or rat liver S9 enzymes. A small but significant increase in the frequency of micronucleated normochromatic erythrocytes was noted in male mice exposed to decalin for 3 months; however, no induction of micronuclei was observed in female mice. CONCLUSIONS: Under the conditions of these studies, there was clear evidence of carcinogenic activity of decalin in male F344/N rats based on increased incidences of renal tubule neoplasms. The increased incidences of benign or malignant pheochromocytoma (combined) of the adrenal medulla in male rats were also considered to be exposure related. There was no evidence of carcinogenic activity of decalin in female F344/N rats exposed to 25, 100, or 400 ppm. There was no evidence of carcinogenic activity of decalin in male B6C3F(1) mice exposed to 25, 100, or 400 ppm. There was equivocal evidence of carcinogenic activity of decalin in female B6C3F(1) mice based on marginally increased incidences of hepatocellular and uterine neoplasms. Exposure of male rats to decalin resulted in nonneoplastic lesions of the kidney characteristic of alpha2u-globulin accumulation. Nonneoplastic lesions of the liver were observed in male mice exposed to decalin.
[Chronic pancreatitis: nutrition and pain therapy].
Therapy of chronic pancreatitis rests on five arms: Avoidance of alcohol, treatment of pain, replacement therapy for exocrine and endocrine insufficiency and adequate nutrition. Alcohol withdrawal improves pain and the patient's compliance. It also seems to retard the chronic inflammatory process. Therapy of pain depends on the pathomechanism of pain. There is a lack of prospective, controlled studies comparing various treatment regimens. Thus, treatment options are partly dependent on the experience of the physician taking care of the patient and include i.e. for pseudocysts: surgical vs percutaneous or endoscopic drainage; for stenosis of the main pancreatic duct close to the papilla: surgical vs endoscopic drainage (stents); for distal bile duct stenosis: endoscopic stents vs biliodigestive anastomosis vs pancreatic head resection; for pancreatic stones: extracorporal shock wave lithotripsy followed by endoscopic stone extraction vs surgery (pancreaticojejunostomy), finally for inflammatory tumor of the pancreatic head combined with pain with or without compression of the distal bile duct or duodenum: duodenum-preserving pancreatic head resection vs Whipple resection. Patients with pain resistant to medical treatment may be candidates for a transcutaneous blockade of the plexus coeliacus or for epidural nerve blockade before one choses a surgical procedure. Application of pancreatic enzymes does not seem to have a major beneficial effect on pancreatic pain. Modification of nutrition has become less restrictive. Thanks to improved substitution with acid resistant porcine pancreatic extracts with high lipase activity, fat restriction is no longer of paramount importance. However, supply with sufficient calories is still difficult due to pain, inadequate compliance and hypermetabolism.