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Nutritional management of chronic pancreatitis: A systematic review and meta‐analysis of randomized controlled trials
Author(s) -
Wiese Mats,
Gärtner Simone,
Doller Julia,
Tran Quang Trung,
Frost Fabian,
Bannert Karen,
Jaster Robert,
Berlin Peggy,
Valentini Luzia,
Meyer Fatuma,
Metges Cornelia C,
Lamprecht Georg,
Lerch Markus M,
Aghdassi Ali A
Publication year - 2021
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15230
Subject(s) - medicine , jadad scale , randomized controlled trial , meta analysis , psychological intervention , pancreatitis , physical therapy , cochrane library , confidence interval , intensive care medicine , psychiatry
Background and Aim Malnutrition is a frequent complication of chronic pancreatitis. Adequate nutritional support is imperative, but there is still uncertainty about the optimal nutritional treatment. This work systematically compiles evidence from randomized controlled trials investigating dietary interventions in chronic pancreatitis and, in a further step, contrasts those findings with existing dietary recommendations. Methods The literature search (PubMed and Cochrane Central Register of Controlled Trials) included English and German full‐text articles, which had been published in peer‐reviewed journals. Two independent reviewers identified and selected studies. For meta‐analysis, forest plots with 95% confidence intervals were generated using a random‐effects model. Results Eleven randomized controlled trials fulfilled all selection criteria. In these trials, the following dietary interventions were tested: antioxidant treatment ( n = 6), vitamin D supplementation ( n = 3), supplementation with oral nutritional supplements ( n = 1), and symbiotics supplementation ( n = 1). Studies were of good methodological quality (mean Jadad score of 3.6) but heterogeneous in terms of interventions and study populations. Only for vitamin D, there was convincing evidence for efficacy of supplementation. We found no effect for antioxidant treatment on pain relief (standardized mean difference = −0.12; 95% confidence interval −0.73 to 0.48) and limited generalizability for interventions with oral nutritional supplements and symbiotics. Conclusions Nutritional management in chronic pancreatitis remains challenging. As well‐designed randomized controlled trials are scarce, in large part, recommendations can only be based on low‐level evidence studies or expert opinion. For now, consumption of a balanced diet remains the cornerstone recommendation for prevention, whereas more goal‐directed interventions are indicated for specific nutrient deficiencies.