title: Parenteral immunonutrition in patients with acute pancreatitis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Acute pancreatitis is a systemic immunoinflammatory response to auto-digestion of the pancrease and peri-pancreatic organs. Patients with acute pancreatitis can rapidly develop nutritional deficiency; hence nutritional support is important and critical. Sometimes parenteral nutrition (PN) is inevitable in acute pancreatitis. Due to immunosuppressive and inflammatory nature of the disease, it seems that immunonutrients like glutamine and omega-3 fatty acids (ω-3 FAs) added to parenteral formulas may improve the conditions. We conducted a meta-analysis to evaluate the effects of parenteral immunonutrition on clinical outcomes (infectious complications, length of hospital stay (LOS) and mortality) in patients with acute pancreatitis.
  
  
  METHODS
  A computerized literature search on four databases (PubMed, Cochrane, ISI Web of Science, and Iran Medex) was performed to find all the randomized controlled trials (RCTs) assessed the effects of parenteral immunonutrition in acute pancreatitis. Necessary data were extracted and quality assessment of RCTs was performed with consensus in the study team. Fixed effects model was used to conduct the meta-analysis.
  
  
  RESULTS
  One hundred and ninety four references were found via our search in which 7 articles matched our criteria for enrolling the meta-analysis. Parenteral immunonutrition significantly reduced the risk of infectious complications (RR = 0.59; 95% CI, 0.39-0.88; p ≤ 0.05) and mortality (RR = 0.26; 95% CI, 0.11-0.59; p ≤ 0.001). LOS was also shorter in patients who received immunonutrition (MD = -2.93 days; 95% CI, -4.70 to -1.15; p ≤ 0.001).
  
  
  CONCLUSIONS
  Immunonutrients like glutamine and ω-3 FAs added to parenteral formulas can improve prognoses in patients with acute pancreatitis.
authors.affiliation: Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address: tinajafari15@yahoo.com.
authors.forename: Tina
authors.initials: T
authors.lastname: Jafari
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran; Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan 81745-319, Iran.
authors.forename: Awat
authors.initials: A
authors.lastname: Feizi
authors.affiliation: Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Askari
authors.affiliation: Department of Food Hygiene and Quality Control, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord 34141, Iran.
authors.forename: Aziz A
authors.initials: AA
authors.lastname: Fallah
mesh_terms: D000208:Acute Disease; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D007239:Infections / Q000150:complications; D007902:Length of Stay; D018529:Nutritional Support; D010195:Pancreatitis / Q000150:complications / Q000276:immunology* / Q000628:therapy*; D010288:Parenteral Nutrition; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic
chemical_list: D015525:Fatty Acids, Omega-3; D005973:Glutamine
keywords: Acute pancreatitis; Glutamine; Meta-analysis; Omega-3 fatty acids; Parenteral immunonutrition; Randomized controlled trials