Early enteral nutrition inhibits worsening of acute pancreatitis in obese patients

Early enteral nutrition (EEN) is a potential strategy that can prevent acute pancreatitis (AP) from deteriorating in obese patients, a recent study suggests.

“Nutritional support plays a critical role in the treatment of AP,” the authors said. “EEN is considered to be able to protect mucosa of AP patients and alleviate inflammatory reactions.”

Visceral fat obesity (VFO) was associated with worsening AP. However, EEN was able to prevent VFO patients from developing pancreatic necrotic infection. This was potentially driven by inhibiting excessive inflammatory reactions, adjusting the imbalance of inflammatory response and alleviating ischaemia of intestine mucosa.

In a 2017 systematic review and meta-analysis, results showed that EEN within 48 hours was superior to delayed enteral nutrition beyond 48 hours for patients with AP. However, no significant between-group difference was observed in terms of mortality. [Medicine (Baltimore) 2017;96:e8648]

This prospective randomized controlled trial included patients with moderately severe or severe AP, who were then divided into two according to the obesity index VFO. Participants received either “delayed” enteral nutrition (initiated enteral nutrition feeding after the first 48 hours following admission to the hospital; group A: non-VFO patients, n=108; group B: VFO patients, n=88) or EEN (in the VFO subgroup, group C: n=91).

The investigators measured the occurrence of complication, clinical outcomes, plasma levels of cytokines and intestine gut barrier index at different timepoints after admission.

Obesity has been shown to worsen prognosis of patients with AP, according to the investigators.