Nutritional and health benefits of semi-elemental diets: A comprehensive summary of the literature

Table 2 Selected studies of semi-elemental whey hydrolyzed protein diets and pancreatitis

Ref.	Study population	Design	Feeding mode (comparison)	No. patients (comparison)	Feeding duration	Relevant results1
Tiengou et al[27]	Consecutive patients with acute pancreatitis admitted to a gastroenterology and nutrition department	Randomized prospective pilot study	Peptamen (polymeric diet group, sondalis-Iso)	15 (15)	1 wk	Weight (kg): -1.3 ± 1.1 in the peptide group, -2.4 ± 0 in the polymeric group (P < 0.01) Total hospital stay (d): 23 ± 2 in the peptide group, 27 ± 1 in the polymeric group (P = 0.006) Infection: 1/15 in the peptide group, 3/15 in the polymeric group (NS)
Louie et al[9]	Consecutive patients with acute pancreatitis in an academic, multi-institutional, tertiary care system	RCT	Peptamen administered via nasojejunal feeding tubes (parenteral nutrition, intralipid administered via long-term vascular catheters)	10 (18)	Primary analyses within 1 wk of enrollment	C-reactive protein: Reduced 50% at a median of 5 d faster for the peptide group (6 d) vs the PN group (11 d) (P = 0.09) Serum cholecystokinin: 56 pmol/L to 55 pmol/L (P = 0.2) in the peptide group, 42 pmol/L to 32 pmol/L in the PN group (P = 0.5) Mortality: 0 deaths in the peptide group, 3 deaths in the PN group (attributable to complications of pancreatitis) Economic cost: Peptide group = $1375, PN group = $2608 (P = 0.08); when 1 NJ tube used: Peptide group = $1086, PN group = $2608 (P = 0.03)
McClave et al[28]	Patients with acute pancreatitis or an acute flare of chronic pancreatitis	RCT	Peptamen infused through a nasojejunal tube (total parenteral nutrition infused through a central or peripheral line)	16 (16) (30 patients over 32 admissions)	Primary analyses within 1 wk of enrollment	Length of ICU stay (d): 1.3 ± 0.9 in the peptide group, 2.8 ± 1.3 in the PN group (NS) Length of hospital stay (d): 9.7 ± 1.3 in the peptide group, 11.9 ± 2.6 in the PN group (NS) Economic cost: $761 ± 50.3 in the peptide group, $3294 ± 551.9 in the PN group (P < 0.005)
Kalfarentzos et al[32]	Patients with acute pancreatitis admitted to surgery unit	Randomized prospective trial	Reabilan HN administered via nasoenteric feeding tube (parenteral nutrition as all-in-one continuous subclavian polyurethane catheter infusion)	18 (20)	Mean: 34.8 d (mean: 32.8 d )	Septic complications: 27.8% in peptide group, 50% in PN group (P < 0.01) Any complications: 44.4% in peptide group, 75% in PN group (P < 0.05) Mean stay in ICU: 11 d in peptide group, 12 d in PN group (significance not provided)
Oláh et al[29]	Patients admitted to surgical ward with a diagnosis of acute pancreatitis	Two-phase controlled prospective trial	Survimed administered via NJ tube (parenteral nutrition as an all-in-one venous admixture)	41 (48)	5-9 d (5-16 d )	Necrosis: 29% in peptide group, 33% in PN group (NS) Septic complications: 12% in peptide group, 27% in PN group (P = 0.08) Surgery: 12% in peptide group, 23% in PN group (NS) Severe pancreatitis: 17% in peptide group, 21% in PN group (NS) Death: 4.9% in peptide group, 8.3% in PN group (NS)
Petrov et al[30]	Patients with severe acute pancreatitis	RCT	Peptamen administered through NJ tube (parenteral nutrition administered through central venous catheter)	35 (34)	Assessment on day of feed commence-ment, fourth and seventh days	Pancreatic infection: 20% in peptide group, 47% in PN group (P = 0.022) Noninfectious complications: 42.9% in peptide group, 17.6% in PN group (P = 0.036) Serum CRP concentration: 195 (164-216) mg/L on admission to 94 (56-117) mg/L on day 7 in peptide group, 210 (177-246) mg/L on admission to 93 (60-134) on day 7 in PN group (NS) Mortality: 6% in peptide group, 35% in PN group (P = 0.003)
Kumar et al[4]	Consecutive patients with severe acute pancreatitis	Randomized pilot study	Peptamen administered through enteral tubes in both groups; patients were randomly allocated to NG or NJ feeding	15 NG, 16 NJ	1 wk	Hospital stay (d): 29.93 ± 25.54 in NJ group, 24.06 ± 14.35 in NG group (P = 0.437) Mortality: 4/14 in NJ group, 5/16 in NG group Recurrence of pain: 1/14 in NJ group, 1/16 in NG group Serum albumin: No significant differences Anthropometric measurements: No significant differences in BMI, mid upper arm circumference, and triceps skin fold thickness)
Shea et al[6]	Patients with chronic pancreatitis; healthy control subjects	Follow-up study	Consumption of 3 cans of Peptamen (the same patients completed a daily pain assessment form for 2 wk prior to initiation of enteral formulation)	8, EN evaluated within this group; 6 healthy control subjects receiving EN also evaluated	2 wk baseline period, 10 wk formula period; healthy controls evaluated on a daily basis	Healthy controls: Postprandial plasma CCK: Mean basal CCK levels = 0.46 ± 0.29 pmol/L High fat solid meal = 10.75 ± 0.45 pmol/L Liquid meal full-length triglycerides and intact proteins = 7.9 ± 1.25 pmol/L Liquid meal Peptamen = 1.43 ± 0.72 pmol/L (P < 0.05 compared with other meals)
Freedman[31]	Healthy volunteers	Prospective cross-over	Peptamen, one can over 2 min following an overnight fast (1/4lb hamburger; one can of Ensure)	6 (6, served as own controls)	Assessment immediately after consumption	Chronic pancreatitis patients: Median improvement in pain scores from baseline = 68.5% (P = 0.011) 5 of 8 patients had statistically significant decreases in pain scores Mean basal CCK levels = 0.46 ± 0.29 pmol/L Hamburger = 10.75 ± 0.45 pmol/L Ensure = 7.9 ± 1.25 pmol/L Peptamen = 1.43 ± 0.72 pmol/L (P < 0.0001 compared with other meals)

¹Numerous results are reported within individual studies, please refer to the studies for a full summary of results. RCT: Randomized controlled clinical trial; NS: Not significant; PN: Parenteral nutrition; EN: Enteral nutrition; NJ: Nasojejunal; NG: Nasogastric; CCK: Cholecystokinin.