title: Meta-Analysis of Early Nutrition: The Benefits of Enteral Feeding Compared to a Nil Per Os Diet Not Only in Severe, but Also in Mild and Moderate Acute Pancreatitis.
abstract: The recently published guidelines for acute pancreatitis (AP) suggest that enteral nutrition (EN) should be the primary therapy in patients suffering from severe acute pancreatitis (SAP); however, none of the guidelines have recommendations on mild and moderate AP (MAP). A meta-analysis was performed using the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). The following PICO (problem, intervention, comparison, outcome) was applied: P: nutrition in AP; I: enteral nutrition (EN); C: nil per os diet (NPO); and O: outcome. There were 717 articles found in Embase, 831 in PubMed, and 10 in the Cochrane database. Altogether, seven SAP and six MAP articles were suitable for analyses. In SAP, forest plots were used to illustrate three primary endpoints (mortality, multiorgan failure, and intervention). In MAP, 14 additional secondary endpoints were analyzed (such as CRP (C-reactive protein), WCC (white cell count), complications, etc.). After pooling the data, the Mann-WhitneyUtest was used to detect significant differences. Funnel plots were created for testing heterogeneity. All of the primary endpoints investigated showed that EN is beneficial vs. NPO in SAP. In MAP, all of the six articles found merit in EN. Analyses of the primary endpoints did not show significant differences between the groups; however, analyzing the 17 endpoints together showed a significant difference in favor of EN vs. NPO. EN is beneficial compared to a nil per os diet not only in severe, but also in mild and moderate AP.
authors: Institute for Translational Medicine, University of Pécs, Pécs H-7624, Hungary. katalin.martak@gmail.com.
authors: Katalin
authors: K
authors: Márta
authors: Institute for Translational Medicine, University of Pécs, Pécs H-7624, Hungary. nelli.farkas@aok.pte.hu.|Institute of Bioanalysis, University of Pécs, Pécs H-7624, Hungary. nelli.farkas@aok.pte.hu.
authors: Nelli
authors: N
authors: Farkas
authors: Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs H-7624, Hungary. szaboimi@yahoo.com.
authors: Imre
authors: I
authors: Szabó
authors: Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs H-7624, Hungary. anitai@freemail.hu.
authors: Anita
authors: A
authors: Illés
authors: Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs H-7624, Hungary. vincze.aron@pte.hu.
authors: Áron
authors: Á
authors: Vincze
authors: Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs H-7624, Hungary. pargabriella@gmail.com.
authors: Gabriella
authors: G
authors: Pár
authors: Institute for Translational Medicine, University of Pécs, Pécs H-7624, Hungary. sarlos.patricia@pte.hu.|Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs H-7624, Hungary. sarlos.patricia@pte.hu.
authors: Patrícia
authors: P
authors: Sarlós
authors: Institute for Translational Medicine, University of Pécs, Pécs H-7624, Hungary. bajor.judit8@gmail.com.|Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs H-7624, Hungary. bajor.judit8@gmail.com.
authors: Judit
authors: J
authors: Bajor
authors: Institute for Translational Medicine, University of Pécs, Pécs H-7624, Hungary. szucs.akos@gmail.com.|First Department of Surgery, Semmelweis University, Budapest H-1085, Hungary. szucs.akos@gmail.com.
authors: Ákos
authors: Á
authors: Szűcs
authors: Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs H-7624, Hungary. czimmer.jozsef@pte.hu.
authors: József
authors: J
authors: Czimmer
authors: Institute for Translational Medicine, University of Pécs, Pécs H-7624, Hungary. dora.mosztbacher@gmail.com.|First Department of Pediatrics, Semmelweis University, Budapest H-1083, Hungary. dora.mosztbacher@gmail.com.
authors: Dóra
authors: D
authors: Mosztbacher
authors: Institute for Translational Medicine, University of Pécs, Pécs H-7624, Hungary. andrea.parniczky@gmail.com.|Heim Pál Children's Hospital, Budapest H-1089, Hungary. andrea.parniczky@gmail.com.
authors: Andrea
authors: A
authors: Párniczky
authors: Institute for Translational Medicine, University of Pécs, Pécs H-7624, Hungary. szemesk@gmail.com.|Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs H-7624, Hungary. szemesk@gmail.com.
authors: Kata
authors: K
authors: Szemes
authors: Institute for Translational Medicine, University of Pécs, Pécs H-7624, Hungary. daniel.pecsi1991@gmail.com.
authors: Dániel
authors: D
authors: Pécsi
authors: Institute for Translational Medicine, University of Pécs, Pécs H-7624, Hungary. hegyi.peter@pte.hu.|Translational Gastroenterology Research Group, Hungarian Academy of Sciences, University of Szeged, Szeged H-6720, Hungary. hegyi.peter@pte.hu.|First Department of Medicine, University of Szeged, Szeged H-6720, Hungary. hegyi.peter@pte.hu.
authors: Péter
authors: P
authors: Hegyi
mesh_terms: D004032:Diet / Q000379:methods; D004035:Diet Therapy / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D009752:Nutritional Status / Q000502:physiology*; D010195:Pancreatitis / Q000178:diet therapy*; D010288:Parenteral Nutrition / Q000379:methods*
keywords: acute pancreatitis; early nutrition; energy; enteral feeding; meta-analysis