Association between enteral nutrition formula types and initial time with prognosis in moderately severe and severe...

Moderately severe or severe acute pancreatitis (MSAP/SAP) is a crucial abdominal disorder. Enteral nutrition (EN) is a central issue after patients pass through the resuscitation stage. The preference for EN formulas and initial timing opportunities are controversial topics. We investigated the linkage between two types of EN formulas, short peptides and intact proteins, and initial time and SAP prognosis.

335 enrolled SAP patients were divided into three groups according to the EN formula accepted during two weeks of feeding. The groups were set as SPG (group fed by short peptide, SP), IPG (group fed by intact protein, IP) and CG (group converted from SP to IP at second week). Pearson's chi-square test and the Kruskal-Wallis test were used to compare the descriptive variables. Binary logistic regression was used to analyze the relationship between initial time and mortality. K-M survival curves and log-rank tests were used to evaluate long-term prognosis.

Although the patients were either fed by SP, IP or a mixture of products (from the SP to the IP), the groups showed no difference in the serum albumin/prealbumin recovery, invasive mechanical ventilation or 90-day survival rate. Timely EN formula conversion from the SP to the IP may reduce the insulin dosage for glucose-impaired patients. The results also proved that EN started 3-5 days after the onset of SAP was associated with lower mortality.

Therefore, an optimal EN strategy can be summarized. First, the selection of the EN formula should be based on the patients' basic conditions, especially glucose level, rather than on the pancreatic rest theory. Second, the conversion from SP to IP made it easier for patients to tolerate the EN and decreased insulin use. Finally, the proper opportunity to commence EN was considered to be 3-5 days after SAP onset.