Systematic review of diet in the pathogenesis of acute pancreatitis: A tale of too much or too little?

Abstract

Background/Aim:The role of diet as the cause of acute pancreatitis (AP) has been suggested. The aim of the current review was to determine if there exists sufficient evidence linking nutrition, or the lack of it, to the pathogenesis of AP.Patients and Methods:A systematic search of the scientific literature was carried out using Embase, PubMed, MEDLINE, and the Cochrane Central Register of Controlled Trials for the years 1965 - 2011 to obtain access to studies involving dietary factors and the pathogenesis of AP.Results:A total of 17 studies were identified describing diet and AP. These included 12 human and 5 animal studies. 8 reports were found to link malnutrition and/or refeeding to the pathogenesis of AP. Two studies found an increased consumption of fats and proteins in patients with alcohol-related AP while 1 study noted a lesser intake of carbohydrate in patients. However, none of these differences attained statistical significance. A recent prospective case-control study found a significantly higher risk for AP amongst patients eating par-boiled rice and fresh water fish.Conclusions:Evidence from literature does not appear to support the role of diet as a single bolus meal as a cause for AP. Prolonged consumption of diets rich in proteins and fats may work synergistically with gallstones / alcohol to trigger an attack of AP indicating a possible role of diet as a cofactor in the development of AP possibly by lowering the threshold needed by these other agents to lead to the attack of AP.

Macroscopic and Histopathologic Findings From a Mass Stranding of Rough-Toothed Dolphins (Steno bredanensis) in 2005 on Marathon Key, Florida, USA

“…Factors, which may be causal, that were also found in high prevalence during this investigation include parasitism and anorexia (i.e., zymogen granule depletion) or potentially a combination of these factors. Thomas et al ( 49 ) found no conclusive evidence of a direct causative role for diet in the development of acute pancreatitis in humans; however, there was an indication that diet maybe a cofactor and the reintroduction of feeding after prolonged anorexia especially in malnourished individuals may lead to metabolic disorders and/or nutritional/malnutritional pancreatitis. Low-protein high fat diets, especially in dogs, resulting in hyperlipidemia has been shown to be associated with pancreatitis possibly due to the generation of toxic fatty acids by the activation of lipase ( 50 ).…”

Dietary Factors Reduce Risk of Acute Pancreatitis in a Large Multiethnic Cohort

“…Our results are consistent with findings from the Iowa Women’s Health Study which show that intakes of total and saturated fat were associated with an increased risk of AP 10 . A previous systematic review suggests that in humans, a prolonged exposure to a high-fat diet may work synergistically with gallstones to trigger an AP attack indicating a possible role of diet as a cofactor in the causation of AP 11 . We also found that a high-cholesterol diet was associated with the risk of GS AP.…”

Pancreatic necrosis: Complications and changing trend of treatment

“…Generally, oral nutrition can be given in the absence of nausea, vomiting, and progressively rising pain in the abdomen. Diet low in fat should be used[68]. Studies have shown that enteral nourishment by means of nasojejunal tubes do not lead to stimulation of exocrine secretions in the pancreas[69].…”