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NORMAL FAT VERSUS LOW-FAT DIETS IN PATIENTS WITH ACUTE PANCREATITIS: A RANDOMIZED CONTROLLED STUDY (NOURISH-AP STUDY)
Date
May 21, 2024
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OBJECTIVES
Current guidelines recommend a solid low-fat diet (LFD) in patients with acute pancreatitis (AP)1,2; however, the recommendation is based on limited evidence. Routine use of LFD may result in unpalatability, inadequate energy and protein intake, and impaired quality of life (QoL). The aim of this study is to evaluate the efficacy and safety of a solid normal fat diet (NFD) versus LFD in patients with mild to moderately severe AP.
MATERIALS AND METHODS
This is a double-blind randomized controlled study. Patients diagnosed with mild to moderately severe AP were enrolled. All patients were randomized to either receive NFD (fat 30% of total calories) or LFD (fat 15% of total calories). The primary outcome was energy intake per day (kcal/kg/day), evaluated by photographic food record and analyzed by a dietitian. The secondary outcomes included nutrition-related outcomes, clinical outcomes, QoL (SF-36), and length of hospital stay (LOS). Target energy and protein were defined as 30 kcal/kg/day and 1.2 g/kg/day, respectively.
RESULTS
Sixty-five patients were enrolled, with 33 patients in the NFD group and 32 in the LFD group. The average age (SD) was 60.4 (18.9) years. The leading cause of AP was gallstone pancreatitis (66.2%), followed by alcoholic pancreatitis (15.4%). Malnutrition was found in 10.8-21.6% of patients. The NFD group demonstrated a trend toward higher energy intake (18.9 kcal/kg/day vs. 16.5 kcal/kg/day, p = 0.087) and lower energy deficit (-700 kcal/day vs. -915 kcal/day, p = 0.055). The difference was significant in subgroup analysis in malnourished patients (23.2 kcal/kg/day vs. 15.6 kcal/kg/day, p = 0.024). Additionally, NFD was associated with significantly higher QoL scores across various aspects including "Physical functioning" (73.3 vs. 62, p = 0.041), “Physical role functioning” (53.9 vs. 39.4, p = 0.019), “Emotional role functioning” (63.8 vs. 38.2, p < 0.001), and "General mental health" (55.9 vs. 40.7, p = 0.004). Body weight and body mass index changes, abdominal pain, nausea and vomiting, LOS, and 30-day readmission rate were similar between two groups.
CONCLUSION
In conclusion, NFD may be more effective than LFD for patients with AP, especially in malnourished individuals. NFD led to higher energy intake and improved QoL without negative impacts on clinical outcomes. These results suggest a reevaluation of current dietary guidelines for AP.
Reference
1 ACG Clinical Guideline: Management of Acute Pancreatitis. Am J Gastroenterol 2013; 108:1400–1415.
2 ESPEN guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr. 2020;39(3):612-631.
Current guidelines recommend a solid low-fat diet (LFD) in patients with acute pancreatitis (AP)1,2; however, the recommendation is based on limited evidence. Routine use of LFD may result in unpalatability, inadequate energy and protein intake, and impaired quality of life (QoL). The aim of this study is to evaluate the efficacy and safety of a solid normal fat diet (NFD) versus LFD in patients with mild to moderately severe AP.
MATERIALS AND METHODS
This is a double-blind randomized controlled study. Patients diagnosed with mild to moderately severe AP were enrolled. All patients were randomized to either receive NFD (fat 30% of total calories) or LFD (fat 15% of total calories). The primary outcome was energy intake per day (kcal/kg/day), evaluated by photographic food record and analyzed by a dietitian. The secondary outcomes included nutrition-related outcomes, clinical outcomes, QoL (SF-36), and length of hospital stay (LOS). Target energy and protein were defined as 30 kcal/kg/day and 1.2 g/kg/day, respectively.
RESULTS
Sixty-five patients were enrolled, with 33 patients in the NFD group and 32 in the LFD group. The average age (SD) was 60.4 (18.9) years. The leading cause of AP was gallstone pancreatitis (66.2%), followed by alcoholic pancreatitis (15.4%). Malnutrition was found in 10.8-21.6% of patients. The NFD group demonstrated a trend toward higher energy intake (18.9 kcal/kg/day vs. 16.5 kcal/kg/day, p = 0.087) and lower energy deficit (-700 kcal/day vs. -915 kcal/day, p = 0.055). The difference was significant in subgroup analysis in malnourished patients (23.2 kcal/kg/day vs. 15.6 kcal/kg/day, p = 0.024). Additionally, NFD was associated with significantly higher QoL scores across various aspects including "Physical functioning" (73.3 vs. 62, p = 0.041), “Physical role functioning” (53.9 vs. 39.4, p = 0.019), “Emotional role functioning” (63.8 vs. 38.2, p < 0.001), and "General mental health" (55.9 vs. 40.7, p = 0.004). Body weight and body mass index changes, abdominal pain, nausea and vomiting, LOS, and 30-day readmission rate were similar between two groups.
CONCLUSION
In conclusion, NFD may be more effective than LFD for patients with AP, especially in malnourished individuals. NFD led to higher energy intake and improved QoL without negative impacts on clinical outcomes. These results suggest a reevaluation of current dietary guidelines for AP.
Reference
1 ACG Clinical Guideline: Management of Acute Pancreatitis. Am J Gastroenterol 2013; 108:1400–1415.
2 ESPEN guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr. 2020;39(3):612-631.
Table 1: Baseline characteristics of the participants.
Table 2: Outcomes compared between patients receiving solid normal fat and low-fat diets.
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