Introduction:
Acute pancreatitis (AP) is a pancreatic inflammatory disorder that causes organ failure, infection, systemic inflammation, morbidity, and death. The incidence of acute pancreatitis is rising worldwide and it is a common reason for emergency visits to the hospital. Malnutrition begins early and has been linked with a poor prognosis for acute pancreatitis.
The key elements of acute pancreatitis management include early nutrition, appropriate analgesia, multiple organ supports, fluid resuscitation, handling of local complications, and patient rehabilitation. Nutritional therapy has shown some advantages in the management of acute pancreatitis. Therefore, nutritional management has become the foundation of acute pancreatitis management and must be promoted daily for better outcomes.
What Are the Causes of Malnutrition in Acute Pancreatitis?
Malnutrition is widespread and progresses quickly, particularly in necrotizing acute pancreatitis. The possible causes are,
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Reduced oral intake because of pain, nausea, and vomiting from gastric outlet obstruction, gastroparesis, intraabdominal hypertension (IAH), and improper fasting.
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Alcoholism.
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Higher levels of catabolism are associated with sepsis and severe acute pancreatitis.
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Endocrine and exocrine dysfunction during acute pancreatitis.
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Intestinal failure from enteric or ileus fistulas.
What Is the Preferred Route of Administration?
Food administration in acute pancreatitis is based on the severity of the disease.
Enteral Nutrition (EN):
An oral diet is recommended for individuals who can take it orally. EN feeding is preferable over PN for individuals incapable of eating themselves. EN benefits the gastrointestinal tract, immune system, and metabolism by meeting nutritional requirements. EN can enhance splanchnic circulation, reduce bacterial translocation, maintain the integrity of the gut mucosa, and improve gut barrier dysfunction.
The suggested nutritional support mode for acute pancreatitis is EN. EN is more beneficial in cases of severe acute pancreatitis than PN in terms of reducing systemic infections, hospital stays death, multiorgan failure, and the necessity for surgical procedures.
Diets that are polymeric, elemental, or semi-elemental can supply EN. Elemental diets are commercial formulas that are predigested and contain the simplest forms of nutrients. They are low in fat and have medium-chain triglycerides, simple carbs, and individual amino acids. Whereas polymeric formulations contain macronutrient components such as complex carbohydrates, long-chain triglycerides, and whole proteins, semi-elemental formulations are commercially available feeds with partially predigested enteral formulations such as simple carbohydrates, medium-chain triglycerides, and oligopeptides of varying length.
Paraenteral Nutrition (PN):
The following are the indications for PN over EN,
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Contraindication to EN.
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Complete intolerance to EN.
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Inability to meet nutritional requirements with EN alone.
Intermittent Bolus Feeding:
Intermittent bolus feeding has theoretical and physiological benefits. However, certain studies show an increased prevalence of diarrhea in intermittent feeding. Therefore, continuous feeding is recommended over intermittent bolus feeding.
What Are the Low Fat Diet Tips?
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Consume four to six small meals during the day.
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Divide the daily consumption of fat for the whole day.
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Use cooking oils, butter, and margarine in minimal quantities.
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Prepare foods by baking, steaming, grilling, and roasting. Avoid frying or stirring foods.
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Consume fruits, whole grains, vegetables, and dairy products with little or no fat daily.
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Include protein in every meal and snack, such as fish, lean beef, low or nonfat dairy, egg whites, chicken without skin, soy, and beans.
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Avoid alcohol and alcohol-based foods.
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Check the labels of food items. Select items with the labels "light," "low fat," "nonfat," and "fat-free."
What Is Medium Chain Triglycerides (MCT) Oil?
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Medium Chain Triglycerides (MCTs) are a kind of fat that enters the bloodstream directly and does not require the breakdown of pancreatic enzymes.
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It is present in palm kernel and coconut oils.
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Include MCT oil in meals. Use one to three tablespoons of MCT oil for the entire day.
What Are the Nutritional Supplements to Consider?
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Consume high-calorie, protein-rich, fat-free juice nutritional supplements, like Resource Juice Breeze or Ensure Clear, at least twice daily.
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There are several dietary supplements containing MCT, including Peptamen or Vital.
What Is the Kitchen-Based Diet for Acute Pancreatitis?
The kitchen-based diet for acute pancreatitis is,
Meats, Fish, Poultry and Eggs:
Foods Recommended: Suggested foods include lean meats, chicken (without skin), fish, low-fat or non-fat deli meat slices, eggs, and egg whites. Foods should be steamed, grilled, baked, or broiled.
Foods to Avoid: Foods like fried eggs, fried, fatty, or highly marbled meats (with skin), duck, canned tuna in oil, bacon, and organ meats like liver, salami, hot dogs, and sausages.
Dairy:
Foods Recommended: Low-fat or non-fat dairy products, such as cheese, milk, cultured yogurt, frozen yogurt, cottage cheese, ice cream, and sour cream, are advised foods.
Foods to Avoid: Fried cheese, cream, creamy or cheesy sauces, whole-fat dairy products, and milkshakes.
Meat and Dairy Alternatives:
Foods Recommended: Suggested foods include tofu, lentils, beans, soy products, and almond or rice milk and its derivatives.
Foods to Avoid: Foods such as fried tofu, refried beans, coconut milk, nuts, and nut butter.
Fruits:
Foods Recommended: Suggested foods include canned, frozen, and fresh fruits.
Foods to Avoid: Avoid eating avocado and fried fruits.
Vegetables:
Foods Recommended: Cooked, frozen, and fresh vegetables.
Foods to Avoid: Avoid eating fried or stir-fried vegetables.
Grains:
Foods Recommended: Whole grains, such as bran, bread, bagels, buns, couscous, hot and cold cereals, low-fat crackers, popcorn with light butter, pancakes, noodles, pasta, waffles, English muffins, corn, rice, or flour tortillas.
Foods to Avoid: Fried rice, fried potato or corn chips, french fries, muffins, croissants, sweet rolls, biscuits, and granola.
Beverages:
Foods Recommended: Tea, coffee, hot chocolate, fruit and vegetable juices, and sports drinks.
Foods to Avoid: Sodas, drinks with witty cream, and eggnog.
Desserts:
Foods Recommended: Applesauce, puddings, sorbet, sherbet, popsicles, gelatin, angel food cake, fruit ice, and a little chocolate.
Foods to Avoid: Cake, brownies, doughnuts, cookies, pies, pastries, candies, coconut, custard, and fried sweets.
Seasonings and Condiments:
Foods Recommended: Honey, maple syrup, sugar, salt, low-fat or light salad dressings, mustard, cooking oils (in small quantities), butter, jam, non-dairy creamer, spices, and herbs (as permitted), mayonnaise, margarine, and broth.
Foods to Avoid: Shortening, tahini paste, olives, seeds, traditional mayonnaise, lard, and animal drippings.
Conclusion:
Nutritional supplementation is essential for improving acute pancreatitis patients' prognoses. The optimal approach is to start the oral or EN, route immediately. Patients with mild acute pancreatitis may begin an oral diet when they feel pain-free and hungry. Tube feeding may be started in MSAP (moderately severe acute pancreatitis) and SAP (severe acute pancreatitis) if oral feeding is not tolerated. Still, certain patients could need PN. Probiotics and immuno-nutrition have no proven benefits and should not be recommended.
