Table 3

Running head: PANCREATITIS EVIDENCE ABSTRACT1PANCREATITIS EVIDENCE ABSTRACT

2

Pancreatitis (Gastrointestinal) Evidence Abstract

Molly Chaffin

The University of Southern Mississippi

Citation:Sathiaraj, E., Murthy, S., Mansard, M. J., Rao, G. V., Mahukar, S., & Reddy, D. N. (2008). Clinical trial: oral feeding with a soft diet compared with clear liquid diet as initial meal in mild acute pancreatitis. Alimentary Pharmacology and Therapeutics, 28. 777-781. doi:10.1111/j.1365-2036.2008.03794.x.

Study Design:Randomized, controlled trial

Class:A

Quality Rating:0

Research Purpose:To determine if an association exists between the type of diet (clear liquids versus soft diet) and length of hospital stay in patients experiencing acute pancreatitis.

Inclusion Criteria:Patients must be admitted to the Asian Institute of Gastroentology between September 2007 to February 2008 with symptoms of abdominal pain and diagnosis of mild acute pancreatitis. Patients lipase and/or amylase levels must be > three times the normal limit or > twice the upper limit with pancreatic inflammation.

Exclusion Criteria:Patients were excluded if any of the following characteristics were observed: organ dysfunction, neoplasm, pregnancy, infections such as TB or HIV/AIDS, severe acute pancreatitis, and/or recent surgical history. Patients who received enteral or parenteral nutrition or those who were receiving pancreatic enzyme supplementation were excluded from the study.

Description of Study ProtocolPatients who were admitted for acute pancreatitis were initially nil per os (NPO). When abdominal pain and gastrointestinal (GI) symptoms subsided, patients were randomized to receive either a solid diet (SD) or a clear liquid diet (CLD) with advancement to SD as tolerated. The CLD provided 485 kcal and 11 g fat per day, and the SD provided 1040 kcal and 20 g fat per day. The hospital medical team determined patient discharge and dietary advancement.

Data Collection Summary:The clinical dietitian recorded patient outcomes daily which included diet tolerance, daily intake of calories and fat, and pain (using a 10-point Likert scale). The primary outcome observed in the study was the length of hospital stay (LOH), with secondary outcomes observing the frequency of diet discontinuation due to patient intolerance and GI symptoms.

Description of Actual Data Sample:A total of 101 patients from the Asian Institute of Gastroentology were enrolled in the study (52 in the CLD and 49 in the SD). Patient characteristics were similar between the CLD and SD groups with average ages of 39 and 37 and percentage of males of 44% and 39 % respectively. Proportions of the causes of pancreatitis were similar in both groups with the greatest percentage from alcohol, unknown causes, and gallstones.

Summary of ResultsTotal LOH and post-refeeding LOH were significantly lower in subjects in the SD group compared to the CLD group. Average post-refeeding days to discharge were 6.75 days in the CLD group and 4.18 days in the SD group with an average difference of 2.57 days (P < 0.001). Average total LOH was also 2.79 days shorter in the SD group compared to the CLD (P < 0.001). Time between admission and diet initiation was not significantly different between groups (P = 0.462).

Author Conclusion:Initiating dietary intake with a solid diet as opposed to a clear liquid diet significantly shortened length of hospitalization in patients with mild acute pancreatitis. Patients who advance to a SD as opposed to a CLD also had greater energy intake without an increase in GI pain or symptoms.

Review Comments:Strengths of this study included the large sample size (n = 101) and strength of the intervention. Experimenters could directly control or record subjects intake due to inpatient stay.

One limitation of the study was the lack of control over the time of diet advancement and discharge. However, the medical team involved in these decisions were not tied to the studys outcomes, therefore research bias was unlikely.

Nutrition Prescription (The patients/clients individualized recommended dietary intake of energy and/or selected foods or nutrients based on current reference standards and dietary guidelines and the patients/clients health condition and nutrition diagnosis):

Energy needs using MSJ: (10 x 72.9 kg) + (6.25 x 176 cm) (5 x 26 years) 161 = 1538 kcal/day

--Stress factor (1.2) = 1846 kcal/day

--Activity factor (1.3, light active) = 1,999 kcal/day (usual day after discharge)

Protein needs (1.2-1.5 g/kg) = 87.6 109.5 g/day

Fat needs (~25% total kcal) = 51 55.5 g/ day

Fluid needs: 1.8 2.0 L/day

Assess

Interpret data needed to identify nutrition related problems, their causes, and significancePriorityDiagnosis (PES Statement)

______RT______ AEB_______Intervention

What are you going to do to fix the problem?Monitoring

What data do you need to assess your intervention?Evaluation

Quantifiable goal(s)

Anthropometrics:

26YOWF

Ht: 176 cm

Wt: 72.9 kg

BMI: 23.5 kg/m2 (normal)

IBW: 145 lbs (65.9 kg)

--%IBW: 111%

No recent weight changes

Biochemical Data:Labs:

BUN 5 mg/dL L

Glucose 87 mg/dL

Sodium 135 mmol/L L

Calcium 8.4 mg/dL L

Total protein 5.7 g/dL L

Albumin 3.3 gm/dL L

Amylase 2918 unit/L H

Lipase 1483 unit/L H

Clinical:

Medical dx: Acute recurrent pancreatitis; experiencing severe nausea, vomiting

-Admission date 11/2/2014

Hx of prior pancreatitis (5/2014), alcohol abuse

Prior cholescystectomy

Family hx: CAD (father and paternal grandmother)

Medications:

-Clonazepam

-Pantoprazole

-Ondansetron

-Acetaminophen

-Morphine

-Seroquel

-Effexor XR

Herbal/dietary supplements:

None reported

Diet history:

Current diet order: NPO

Regular diet prior to admission

Reported consuming 12 beers/wk + 1-2 glasses wine/day

Cigarette smokers

Eco-social:Employed, nurse

Lives with significant other and children

No household alcohol concerns reported

1Inadequate oral intake RT GI symptoms AEB pancreatitis diagnosis, reported N/V, NPO diet order. -Advance diet order to clear liquid diet or GI soft diet as patient prefers/tolerates

-Encourage adequate intake of meals as soon as possible

-Intake according to patient and nurses reports

-Toleration of diet advancement (according to GI symptoms)

-Weight

-Intake >75% of meals

-Diet advancement to GI soft diet within three days

- Weight maintenance

2Altered GI function RT pancreatitis AEB recurrent GI symptoms (abdominal pain, nausea, vomiting), hx of hospitalization due to pancreatitis (5/14), NPO/lack of appetite, intolerance/malabsorption of fatty foods.-Conduct a 24-hour recall to determine current dietary intake and areas for improvement

-Educate patient on diet to follow for pancreatitis. Promote a healthy, well balanced diet low in concentrated sweets with moderate fat (25% of kcal or