Adequate hydration also linked to less severe bouts of acute disease

by Ed Susman
Contributing Writer, MedPage Today
May 09, 2017

CHICAGO — A diet lacking in fruits, vegetables, and adequate fluid intake, was tied to severe disease in patients with acute pancreatitis, researchers said here.

In a prospective study in over 300 patients, about 81% of patients who had severe acute pancreatitis consumed less than three portions of fresh fruit and vegetables per day compared with 58.6% of patients who had mild bouts of acute pancreatitis (P=0.003), reported Amir Gougol, MD, of the University of Pittsburgh Medical Center, and colleagues.

In addition, patients who developed severe acute pancreatitis had a lower mean daily fluid intake (47.1 oz vs 55.8 oz, P=0.05), and a lower ratio of fluid intake to BMI (1.5 vs 1.9, P=0.03) prior to the onset of acute pancreatitis, they said in a presentation at Digestive Disease Week 2017.

“A diet poor in fruits and vegetables and decreased fluid intake are independently associated with severe disease in patients with acute pancreatitis,” the group wrote. “Patients who have developed acute pancreatitis should be counseled for dietary modification.”

Gougol noted that severe acute pancreatitis is often characterized by organ failure, especially renal failure. “Mild pancreatitis — while it is painful — is not a huge thing as far as prognosis is concerned,” he told MedPage Today. “Patients are discharged [from the hospital] in 2 or 3 days. Severe pancreatitis is a disaster. We have as many as 20% to 30% of these patients die, and length of stay in the hospital for these patients is about 30 days.”

While dietary intake has long been associated with various forms of pancreatitis, the study by Gougol’s group looked at the relationship of food and fluid intake as it affected the severity of acute pancreatitis.

They accessed a prospectively maintained cohort of patients who had been admitted to a tertiary hospital from 2008 to 2015 with a diagnosis of acute pancreatitis. A questionnaire with details on dietary habits was completed by interviewing enrolled patients during their hospitalization.

Nearly half of the patients were male, and the mean age was 51.

The authors reported that 240 (77.7%) patients developed mild/moderate acute pancreatitis and 69 (22.3%) developed severe disease.

Gougol’s group found no statistically significant differences in the type of diet and severity of pancreatitis. There were five patients who said they were vegetarians, and none of them developed severe disease. There was no clear dose relationship among those who maintained a mainly vegetarian diet that also included occasional meat. A diet that included daily meat or poultry similarly had no statistically significant differences (P=0.19).

Similarly, the authors did not find a correlation between disease severity and whether patients were eating low fat, average fat, or high fat diets (P=0.33). There was no correlation when the researchers evaluated the patients’ consumption of dairy products, stratified by less than one serving a day or one or more servings a day (P=0.33).

Multivariate analysis controlling for sex, age, etiology of acute pancreatitis, smoking habits, and alcohol intake showed an independent association between fruit/vegetable consumption — a 65% reduction in the risk of severe pancreatitis if the patient ate more — and a 50% reduction in risk if the patient had greater fluid intake, Gougol reported.

“We have evidence now that, if you were to change your diet to eat more fruit and vegetables and to drink more water, if you have pancreatitis, it will likely be of a milder form,” he said.

Harkirat Singh, MD, also of the University of Pittsburgh Medical Center, told MedPage Today that “Eating a lot of fruits and vegetables and drinking a lot of water are parts of a healthy diet. So what these people are saying it that if you eat healthy, your chance of getting this disease in a severe form is low.”

“Actually, if you eat healthy, your chance of getting any disease is low,” added Singh who was not involved in the study. “The findings go along with what we tell our patients — ‘If you are at risk of pancreatitis, but change your eating habit to include drinking more water, and [consuming] fruits and vegetable, you have less of a chance of having a severe case, and less of a chance of having major complications.”

• Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner