Role of Fibre in Nutritional Management of Pancreatic Diseases.

The role of fibre intake in the management of patients with pancreatic disease is still controversial. In acute pancreatitis, a prebiotic enriched diet is associated with low rates of pancreatic necrosis infection, hospital stay, systemic inflammatory response syndrome and multiorgan failure. This protective effect seems to be connected with the ability of fibre to stabilise the disturbed intestinal barrier homeostasis and to reduce the infection rate. On the other hand, in patients with exocrine pancreatic insufficiency, a high content fibre diet is associated with an increased wet fecal weight and fecal fat excretion because of the fibre inhibition of pancreatic enzymes. The mechanism by which dietary fibre reduces the pancreatic enzyme activity is still not clear. It seems likely that pancreatic enzymes are absorbed on the fibre surface or entrapped in pectin, a gel-like substance, and are likely inactivated by anti-nutrient compounds present in some foods. The aim of the present review is to highlight the current knowledge on the role of fibre in the nutritional management of patients with pancreatic disorders.

Raffia palm (Raphia hookeri) wine inhibits glucose diffusion; improves antioxidative activities; and modulates dysregulated pathways and metabolites in oxidative pancreatic injury.

Raffia palm wine is a natural drink from the stem of Raffia palm (Raphia hookeri) tree with nutritional and medicinal properties. The effect of fermentation was investigated on its antidiabetic and antioxidative effects in yeast cells and pancreatic tissues, respectively. Both unfermented and fermented palm wine significantly increased glucose uptake, reduced glutathione level (GSH), superoxide dismutase, and catalase activities. They also inhibited glucose diffusion, myeloperoxidase, and ATPase activities as well as decreased malondialdehyde and nitric oxide levels. They also led to the inactivation of oxidative metabolic pathways in oxidative pancreas with the generation of adenosine, sugar and inositol metabolites, selenium (enzyme co-factor) and vitamin metabolites owing to concomitant activation of vitamins, lipid, steroids, inositol, and sulfate/sulfite metabolic pathways. The results suggest the antidiabetic and antioxidative potentials of unfermented and fermented palm wine and may be attributed to the LC-MS-identified compounds which were mainly polyphenols and its glycosides, vitamins, and amino acids. PRACTICAL APPLICATIONS: Raffia palm wine is among the natural beverages employed for social, nutritional, and medicinal purposes. However, there are limited studies on its medicinal properties. This study reports for the first time, the ability of Raffia palm wine to stimulate glucose uptake, inhibit glucose diffusion, and ameliorate pancreatic oxidative injury, as well as the possible associated metabolic pathways that may be involved. These findings will further contribute in understanding the antidiabetic effect of Raffia palm wine, and the possible metabolic pathways involved.

The nutritional management of type 3c (pancreatogenic) diabetes in chronic pancreatitis.

Type 3c diabetes mellitus (T3cDM), also known as pancreatogenic diabetes, refers to diabetes caused by disease of the exocrine pancreas. T3cDM is not commonly recognised by clinicians and frequently it is misclassified as T1DM, or more commonly, T2DM. T3cDM can be difficult to distinguish from T1DM and T2DM, and it often co-exists with the latter. The aim of this review is to describe T3cDM, along with its complications, diagnosis and management. We focus on the nutritional implications of T3cDM for those with chronic pancreatitis, and provide a practical guide to the nutritional management of this condition.

Preoperative oral immunonutrition versus standard preoperative oral diet in well nourished patients undergoing pancreaticoduodenectomy.

BACKGROUND: Pancreaticoduodenectomy is still associated to high morbility, especially due to pancreatic surgery related and infectious complications: many risk factors have already been advocated. Aim of this study is to evaluate the role of preoperative oral immunonutrition in well nourished patients scheduled for pancreaticoduodenectomy. METHODS: From February 2014 to June 2015, 54 well nourished patients undergoing pancreaticoduodenectomy were enrolled for 5 days preoperative oral immunonutrition. A series of consecutive patients submitted to the same intervention in the same department, with preoperative standard oral diet, was matched 1:1. For analysis demographic, pathological and surgical variables were considered. Mortality rate, overall postoperative morbility, pancreatic fistula, post pancreatectomy haemorrhage, delayed gastric emptying, infectious complications and length of hospital stay were described for each groups. Chi squared test, Fisher's Exact test and Student's T test were used for comparison. Differences were considered statistically significant at p < 0.05. Statistics was performed using a freeware Microsoft Excel (®) based program and SPSS v 10.00. RESULTS: No statistical differences in term of mortality (2.1% in each groups) and overall morbility rate (41.6% vs 47.9%) occurred between the groups as well as for pancreatic surgery related complications. Conversely, statistical differences were found for infectious complications (22.9% vs 43.7%, p = 0.034) and length of hospital stay (18.3 ± 6.8 days vs 21.7 ± 8.3, p = 0.035) in immunonutrition group. CONCLUSION: Preoperative oral immunonutrition is effective for well nourished patients scheduled for pancreaticoduodenectomy; it helps to reduce the risk of postoperative infectious complications and length of hospital stays.

Efficacy of low-fat diet against dyspepsia associated with nonalcoholic mild pancreatic disease diagnosed using the Rosemont criteria.

OBJECTIVES: The objective of this study was to examine the efficacy of low-fat diet against dyspepsia in patients who had endosonographic evidence of nonalcoholic mild pancreatic disease. METHODS: Patients with unknown cause of upper abdominal pain suggesting pancreatic disease without a history of alcohol consumption were prescribed a low-fat diet (<20 g of fat/d) for 4 weeks. Based on endoscopic ultrasonographic findings and the Rosemont criteria, the patients were distributed into those with 5 or more minor features of chronic pancreatitis (suggestive group), those with 3 or 4 (indeterminate group), and those with 2 or less (control group). Patients with major features were excluded. Symptom severity was recorded before and after the diet therapy using a 10-cm visual analog scale. Improvement of symptoms was compared among the 3 groups. RESULTS: Of 45 patients, 14 were in the suggestive group, 18 were in the indeterminate group, and 13 served as controls. Improvement of visual analog scale score was significantly greater in the suggestive group than in the indeterminate group (P < 0.001) and the control group (P < 0.001). CONCLUSIONS: A low-fat diet may be effective in patients with dyspepsia associated with endosonographic evidence of mild pancreatic disease, who do not habitually drink alcohol.

Simposio: enfermedades del páncreas. Apoyo nutricio en pancreatitis aguda grave ¿es útil? / Symposium Diseases of pancreas: nutritional support in severe acute pancreatitis, is it usefull?

Objetivo: Analizar los resultados del apoyo nutricio en pancreatitis aguda grave. Sede: Clínica de hiperalimentación y cirugía, Guadalajara, Jalisco, México. Diseño: Estudio retrospectivo, observacional, sin análisis estadístico ni grupo control. Pacientes y métodos: Se estudiaron 17 pacientes portadores de pancreatitis aguda grave (PAG) que recibieron apoyo nutricio durante un período comprendido entre enero de 1991 a enero de 1995. Los criterios de inclusión fueron los siguientes: cuadro clínico y datos de laboratorio de la enfermedad en estudio, evidencia de necrosis pancreática en la tomografía axial computarizada (TAC), con o sin masa abdominal palpable, con 3 o más criterios de Ranson y que hubieran sido seguidos en su evolución y resultado final por los investigadores. Se analizaron las siguientes variables edad, sexo, etiología de la pancreatitis aguda, días de evoluación y ayuno al momento de la interconsulta, albúmina inicial y final, peso inicial y final, tipo de apoyo nutricio y requerimientos aportados, número de días con apoyo nutricio, días de estancia en cuidados intensivos y en el hospital, apoyo nutricio en el hogar durante la convalecencia; tipo de tratamiento médico o quirúrgico, número de intervencione spractidadas, estratificación por criterios de Ranson, métodos de acceso para el apoyo nutricio y morbilidad hospitalaria. Resultados: Doce pacientes fueron hombres y 5 mujees su promedio de edad fue de 36 años, mínima de 13 y máxima de 60 años. La etiología de la pancreatitis aguda fue por el alcoholismo en 6 pacientes, biliar en 5, postraumática en 3, secundaria a medicamentos en 2 y por hiperlipidemia en uno. Promedio de días de evolución y ayuno al momento de la interconsulta para apoyo nutricio 9; todos presentaron entre 3 y 7 criterios de Ranson, promedio 4. Albúmina inicial promedio de 2.7 g/dl, final de 3.4 g/dl. Quince pacientes requirieron 2 cirugías en promedio y 2 fueron tratados conservadoramente. Doce recibieron nutrición parenteral a través de un catéter venoso central de múltiples vías y 5 recibieron nutrición mixta. El promedio de proteínas administradas fue de 2g/kg/día. Diez pacientes permanecieron, en promedio, 10 días en terapia intensiva y el apoyo nutricio se dio por espacio de 25 días en promedio, con extremos de 10 días mínimo y 45 máximo. Todos los pacientes perdieron, en promedio, 15 por ciento de su peso. La morbilidad fue del 70.5 por ciento, la estancia hospitalaria promedio fue de 25 días con mínimo de 10 a 45 días. Dos pacientes fallecieron por falla orgánica múltiple (FOM) (12 por ciento): Conclusión: La aplicación temprana de nutrición artificial disminuye la morbimortalidad

Role of feeding in the treatment of dogs with pancreatic degenerative atrophy.

Fourteen dogs with pancreatic degenerative atrophy (PDA) were fed their original diets or a special diet for 2 periods of 4 weeks to compare the severity of clinical signs in relation to different types of diet. During the first period, the dogs were given ordinary food, and in the second period, the dogs were given only the special diet that consisted of a commercial moderate-fat, low-fiber, highly-digestible food. In addition, equal amounts of pancreatic enzymes were added into the food during highly-digestible food. In addition, equal amounts of pancreatic enzymes were added into the food during both periods. The owners were given a questionnaire covering 9 typical signs of PDA. They were asked to assess the severity of signs daily for the 2 periods using a scale provided with the questionnaire. The general well-being of the dogs was significantly (p less than 0.05) better during the period when the dogs were fed a special diet. Of the individual clinical signs associated with PDA the severity of flatulence, borborygmi, volume of faeces and frequency of defecation were significantly (p less than 0.05) decreased on the special diet. There were no significant differences in appetite, drinking, colour and consistency of the faeces or in coprophagy between the 2 feeding periods. The costs of the special diet were almost double compared to the ordinary diets.

Medical and nutritional aspects of intractable diarrhea.

Diarrhea can be due to at least five pathogenetic mechanisms. Major examples of each are presented to better illustrate each type of diarrhea and to provide a springboard for discussion of the nutritional management of each class of diarrhea. Certainly, specific diseases require specific therapies, such as avoidance of gluten in adult coeliac disease, but the major dietary/nutritional alterations and subsequent treatment are similar for each class of disease. Nowhere in medicine and nutrition is an admonition to the health care team more important and more proper than in the treatment of chronic diarrheas: The feeding of healthy man, as well as the diet of the sick cannot be left to chance, guided by the appetite, or ruled by tradition, but can be safely directed only according to the laws of digestion and metabolism.