The Dietary Intake of Patients with Chronic Pancreatitis

Abstract

Chronic pancreatitis is a chronic inflammatory disorder that results in destruction of the endocrine and exocrine function of the pancreas. Due to loss of function, most patient suffer from malabsorption and malnutrition. Malnutrition is further exacerbated by poor dietary intake, excess alcohol (for some), heavy smoking, pancreatitis-related complications, and ongoing abdominal symptoms. Adverse digestive symptoms are common in chronic pancreatitis, including severe abdominal pain, bloating, wind, flatulence, nausea and vomiting. Treatment options are limited in chronic pancreatitis, and management is mainly reactive and aimed at managing symptoms. Pancreatic enzyme replacement therapy and dietary intervention are the cornerstones of nutritional treatment. Despite the risk of malnutrition and nutrient deficiency in chronic pancreatitis, little is known about dietary intake in this group. To address this research gap, I designed three interlinked studies: a systematic review and meta-analysis of dietary intake in chronic pancreatitis; an analysis of current (short-term) dietary intake of patients with chronic pancreatitis using 3-day food diaries and dietary analysis software; and analysis of habitual (longer-term) intake of patients with chronic pancreatitis using an online-administered food frequency questionnaire. Forty patients and 40 controls were recruited for the dietary analysis studies. The systematic review showed that whilst patients with pancreatitis consumed a similar amount of calories compared to controls, they consumed significantly fewer non-alcohol calories. The review also identified paucity of recent, well designed studies. The second study on current dietary intake found that patients consumed a broadly similar diet to healthy controls with the exception of a lower consumption of fibre and iron. Importantly, patients with an alcohol-related aetiology, those who currently smoke, those reporting pain, and those who reporting being inactive, had a lower intake of many macro- and micronutrient intake than their counterparts. The third study on long term, habitual intake showed that compared to controls, patients had a similar Healthy Eating Index scores. However, patients had poor dietary intake overall, including a lower consumption of energy, protein and fibre, as well as several micronutrients including fat-soluble vitamins A and K. Again significant differences were seen in the subgroup analysis. Patients with alcohol-related chronic pancreatitis, those with longer duration of disease, and those who were unemployed (as a consequence of disease) had lower nutrient intakes. This research, which is among the first to be conducted internationally, shows that patients with chronic pancreatitis have poor diets compared to matched healthy controls, particularly in certain subgroups. This will allow for targeted interventions for high-risk groups.