title: A prospective, randomized trial of clear liquids versus low-fat solid diet as the initial meal in mild acute pancreatitis.
abstract: OBJECTIVE
  Patients recovering from mild acute pancreatitis typically receive a clear liquid diet (CLD) when ready to initiate oral nutrition. Patient discharge then depends on their successful advancement to solid food. We hypothesized that initiating oral nutrition with a low-fat solid diet (LFSD) after mild pancreatitis would be well tolerated and would result in a shorter length of hospitalization (LOH).
  
  
  METHODS
  Patients with mild pancreatitis were randomized to a CLD or LFSD when they were ready to resume oral nutrition. Decisions about diet advancement and hospital discharge were at the discretion of the medical team, without input from study team members. Patients were monitored daily for recurrence of pain, need to stop feeding, post-refeeding LOH (primary end point), and for 28 days post-refeeding to capture re-admission rates.
  
  
  RESULTS
  We randomized 121 patients: 66 to CLD and 55 to LFSD. The number of patients requiring cessation of feeding because of pain or nausea was similar in both groups (6% for CLD, 11% for LFSD; P = .51). The median LOH after refeeding was identical in both groups (1-day interquartile range, 1-2; P = .77). Patients in the LFSD arm consumed significantly more calories and grams of fat than those in the CLD arm during their first meal and on study day 1. There was no difference in the 28-day re-admission rates between the 2 arms.
  
  
  CONCLUSIONS
  Initiating oral nutrition after mild acute pancreatitis with an LFSD appeared safe and provided more calories than a CLD, but did not result in a shorter LOH.
authors.affiliation: Section of Gastroenterology, Boston University Medical Center, 85 East Concord Street, Room 7721, Boston, Massachusetts 02118, USA. brian.jacobson@bmc.org
authors.forename: Brian C
authors.initials: BC
authors.lastname: Jacobson
authors.forename: Martha B
authors.initials: MB
authors.lastname: Vander Vliet
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hughes
authors.forename: Rie
authors.initials: R
authors.lastname: Maurer
authors.forename: Katherine
authors.initials: K
authors.lastname: McManus
authors.forename: Peter A
authors.initials: PA
authors.lastname: Banks
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D018752:Diet, Fat-Restricted / Q000379:methods*; D004041:Dietary Fats / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000178:diet therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D004041:Dietary Fats