Pancreatitis
Manual of Clinical Nutrition Management III- 92 Copyright © 2013 Compass Group, Inc.
restricted diet will influence the recurrence rate of pancreatitis, except in those patients with severe
hypertriglyceridemia. Pancreatic lipase reserves are large; as much as 80% of pancreatic lipase secretion can
be lost without interfering with fat digestion. A low fat diet is not routinely required, unless symptoms are
poorly controlled on enzyme therapy or if pain persists on both enzyme supplementation and narcotic
analgesia (1). Vegetable fats have been shown to be better tolerated than animal fats (1). Substituting
medium-chain triglyceride oil for long-chain fat has been shown to decrease cholecystokinin (CCK) levels and
pancreatic stimulation and improve persistent pain in patients with chronic pancreatitis (21). One study found
that approximately 5% of those with chronic pancreatitis have severe and ongoing maldigestion and may
enteral feeding support. Providing enteral nutrition using a route that provides feedings beyond the
Ligament of Treiz is recommended over parenteral nutrition (22).
The following table provides a summary of nutrition intervention strategies for patients with acute and
chronic pancreatitis.
Table III-26: Nutrition Intervention Strategies for Pancreatitis
Approach Rationale
First oral feeding NPO with intravenous hydration to support and correct fluid, electrolyte and acide-base
disturbances (17).
Advance to liquids or solids as symptoms subside and laboratory values normalize (18).
Initiating the first oral feeding as clear liquids does not improve tolerance when
compared to advancing to solid feedings. Current evidence suggests a liberalized
approach with diet progression should be considered based on patient tolerance and
response to therapy (17,18,20).
Total energy Refer to Section II: “Estimation of Energy Expenditures” using predictive equations
relevant to patient medical condition
25 kcal/kg to 35 kcal/kg/day for acute pancreatitis (17)
35 kcal/kg/day for chronic pancreatitis (1)
Protein 1.2 to 1.5 g/kg/day with acute pancreatitis (1)
1.0 to 1.5 g/kg/day in chronic phase (1)Fat Patients with exocrine insufficiency should receive pancreatic enzymes (1,17).
A low fat diet is not routinely required, unless symptoms are poorly controlled on
enzyme therapy or if pain persists on both enzyme supplementation and narcotic
analgesia (1,17).
Modifications in fat may be indicated with diabetes, obesity
Note: During measurement of 72-hour (quantitative) fecal fat, patients need to be on a
100 - g fat diet and have actual fat intake calculated.Carbohydrates Normal percentage of carbohydrates.
Fluids Patients may have increased fluid, chloride, sodium, potassium, and calcium needs
secondary to nasogastric suction, diarrhea, or emesis.
Fiber Avoid high-fiber diets in patients with exocrine insufficiency; large amounts of fiber can
increase steatorrhea.
Vitamins For patients with alcoholism or history of alcoholism supplement: Thiamin 100 mg,
folate 1 mg and a general multivitamin by mouth once per day (17).
Patients with fat malabsorption may need supplementation of fat-soluble vitamins (17).
Monitoring If abdominal pain persists pancreatic enzyme supplements may need to be increased to
3 to 4 tablets with meals and at bedtime (1). See typical dose below.
If delayed gastric emptying, consider prokinetic medication if appropriate (1).