Nutrition in chronic pancreatitis

Abstract

The pancreas is a major player in nutrient digestion. In chronic pancreatitis both exocrine and endocrine insufficiency may develop leading to malnutrition over time. Maldigestion is often a late complication of chronic pancreatic and depends on the severity of the underlying disease. The severity of malnutrition is correlated with two major factors: (1) malabsorption and depletion of nutrients (e.g., alcoholism and pain) causes impaired nutritional status; and (2) increased metabolic activity due to the severity of the disease. Nutritional deficiencies negatively affect outcome if they are not treated. Nutritional assessment and the clinical severity of the disease are important for planning any nutritional intervention. Good nutritional practice includes screening to identify patients at risk, followed by a thoroughly nutritional assessment and nutrition plan for risk patients. Treatment should be multidisciplinary and the mainstay of treatment is abstinence from alcohol, pain treatment, dietary modifications and pancreatic enzyme supplementation. To achieve energy-end protein requirements, oral supplementation might be beneficial. Enteral nutrition may be used when patients do not have sufficient calorie intake as in pylero-duodenal-stenosis, inflammation or prior to surgery and can be necessary if weight loss continues. Parenteral nutrition is very seldom used in patients with chronic pancreatitis and should only be used in case of GI-tract obstruction or as a supplement to enteral nutrition.

Keywords: Chronic pancreatitis; Malabsorption; Malnutrition; Metabolism; Nutrition therapy; Nutritional assessment; Nutritional risk; Nutritional risk screening.

Figure 1

The nutritional care process including screening, plan and monitoring according to the European Society for Clinical Nutrition and Metabolism guideline[6]. REQ: Requirement.

Figure 2

Nutrition risk screening 2002[9]. BMI: Body mass index.

Figure 3

Nutritional assessment in patients with chronic pancreatitis. AMC: Arm muscle circumference; TSF: Triceps skin fold; HGS: Hand grip strength; BIA: Bioimpedance; REE: Resting energy expenditure; GGT: γ-glutamyl transferase; ALP: Alkaline phosphatase; PTH: Parathyroid hormone; DXA: Dexa scan.