Original article—liver, pancreas, and biliary tract
Dietary Counseling Versus Dietary Supplements for Malnutrition in Chronic Pancreatitis: A Randomized Controlled Trial

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Background & Aims: Up to 50% of patients with chronic pancreatitis (CP) are malnourished. There are limited data on the role of dietary intervention in improving the nutritional status of such patients. The aim was to compare the efficacy of medium chain triglyceride (MCT)–enriched commercial dietary supplements with dietary counseling for homemade food in the management of malnutrition in patients with CP. Methods: In a randomized controlled trial, consecutive undernourished patients with CP (body mass index [BMI] <18.5 kg/m2) at a tertiary care hospital were randomized to receive either dietary counseling for regular homemade food or commercial MCT-enriched dietary supplements for a period of 3 months to compensate for the dietary calorie deficit. All patients received standard management for CP including pancreatic enzyme supplements. Primary outcome measure was improvement in BMI. Results: Sixty malnourished patients with CP were randomized to counseling group (n = 29; mean age, 32 ± 10 years; male, 83%) and supplementation group (n = 31; mean age, 28 ± 10 years; male, 84%). BMI increased in both the counseling group and supplementation group (17.2 ± 1.7 vs 18.1 ± 1.8 kg/m2, P = .001; 16.7 ± 1.6 vs 18.2 ± 1.6 kg/m2, P = .001). There were similar improvements in triceps skinfold thickness, dietary intake, fecal fat, and pain score during a period of 3 months in both groups. There was, however, no significant difference between the counseling and supplementation groups with regard to any of the outcome measures. Conclusions: Dietary counseling for a balanced homemade diet is as good as commercial food supplements in improving malnutrition in patients with CP.

Section snippets

Methods

We conducted an RCT in our tertiary care academic center. Consecutive patients with CP attending the pancreas clinic at our center were included in the study during the period starting August 2000–July 2003. The diagnosis of CP was suspected on the basis of suggestive clinical features, ie, recurrent or chronic abdominal pain and/or presence of diabetes and/or steatorrhea. The diagnosis was confirmed if there was evidence of pancreatic calcification and/or ductal changes in the form of

Baseline Clinical Profile

The clinical characteristics of patients randomized to dietary counseling and to dietary supplementation have been described in Table 1. The mean age of the patients was 30 years (±10); 83% were men. The etiology of CP was alcoholic in 40% and idiopathic in 59%. The baseline hematology and biochemical parameters of patients in both the groups are given in Table 2.

Of the 60 patients studied, 29 were randomized to receive dietary counseling alone, whereas 31 received dietary supplements. There

Discussion

Patients with CP might experience maldigestion and malnutrition.4 Chronic inflammation and fibrosis in the gland can destroy exocrine tissue, leading to inadequate delivery of digestive enzymes to the duodenum in the prandial and postprandial periods and subsequent maldigestion. Maldigestion is augmented by inadequate bicarbonate delivery to the duodenum, with secondary inactivation of enzymes and bile acids by gastric acid.23 Abdominal pain, sitophobia, nausea, vomiting, postprandial satiety,

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    The study was supported by a research grant from the Indian Council of Medical Research, New Delhi.

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