Dietary intake in patients with chronic pancreatitis: A systematic review and meta-analysis

Table 1 Demographic description of studies included in systematic review

Ref.	Setting (subgroup)	Groups (n)		GenderM/F		Age (mean ± SD, yr)		BMI (mean ± SD, kg/m2)		Dietary assessment method (by whom)	NOS
		CP, n (type)	Control, n (type)	CP	Control	CP	Control	CP	Control
Durbec et al[40]	Clinic (Marseille)	193 (142 alcohol-related)	490 (no PC, diabetes, liver disease)	193/0	490/0	44.5 ± 10.5	46.6 ± 13.3	20.2	24.2	Standardised questionnaire[39](dietitian)	6
	Clinic (9 countries)	247	521 (healthy)	247/0	521/0	44.8 ± 13.4	46.7 ± 9.9	20.5	24.1	As above (dietitian)	6
Pitchumoni et al[30]	Clinic	36 (36 alcohol-related)	26 (cirrhosis)	NR	NR	NR	NR	NR	NR	NR (“detailed survey”, method not specified) (nutritionist)	4
Uscanga et al[35]	Hospital	23 (23 alcohol-related)	20 (healthy)	21/2	-	41.2 ± 12.2	-	-	-	NR (nutritionist)	6
Guarnier et al[27]	Clinic	14 (8 alcohol-related)	-	14/0	-	50 ± 11	-	21.8 (X)	-	Diet history and FFQ (dietitian)	5
Mezey et al[7]	Hospital	42 (42 alcohol related)	28 (healthy)	25/17	19/9	40.7 ± 1.6	39.5 ± 1.8	NR	NR	NR (dietitian)	6
Balakrishnan et al[36]	Clinic(India)	28	23 (free of diabetes and digestive disease)	-	-	32.4	24.7	16.2	18.4	Questionnaire[40] (dietitian)	7
Balakrishnan et al[36]	Clinic(France)	25	17 (free from diabetes and digestive disease)	-	-	45.7	39.9	21.6	21.7	FFQ (dietitian)	7
Dani et al[29]	Clinic(Belo Horizonte)	28 (28 alcohol-related)	28 (healthy)	-	-	-	-	-	-	NR (NR)	5
Dani et al[29]	Clinic(Sao Paulo)	40 (40 alcohol-related)	40 (healthy)	-	-	-	-	-	-	NR (NR)	5
Noel-Jorand et al[20]	Clinic	31 (31 alcohol-related)	34 (non-alcoholic, ‘normal’ controls)	25/6	28/6	39.6 ± 6.0	44.8 ± 9.0	22 ± 2.7	22.9 ± 2.8	Standardised questionnaire[41] (NR, ‘highly trained person’)	6
Laugier et al[26]	Clinic(African)	34 (34 alcohol-related)	40 (healthy)	33/1	39/1	39.1 ± 1.3	35.2 ± 1.7	NR	NR	Questionnaire[40] (NR) (dietitian)	5
Laugier et al[26]	Clinic (French)	87	430 (healthy)	-	41/6	40.6 ± 1.3	46.6 ± 0.8	NR	NR	As above (NR)	5
Nakamura et al[6]	Clinic	38 (29 alcohol-related; 8 idiopathic)	35 (healthy)	36/2	-	52.3 ± 11.3	51.6 ± 11.1	20.1 ± 2.1	23.6 ± 3.2	3-7-d food diary (dietitian)	5
Lévy et al[23]	Hospital or attending clinic	56 (56 alcohol-related)	50 (healthy)	n/a	-	44.8 ± 8.4	43.1 ± 8.9	NR	NR	NR “Detailed survey” (NR)	5
Nakamura et al[31]	Hospital	15 (15 pancreatic steatorrhoea)	7 (7 intestinal steatorrhoea)	15/0	5/2	54.3 ± 7.5	52.4 ± 22.2	18.4 ± 2.6	19.4 ± 1.0	3-7 d food diary (NR)	4
Vaona et al[21]	Clinic	40	75 (healthy)	40/0	75/0	50 ± 10.0	50 ± 10.0	21.9 ± 3.1	26.1 ± 3.1	7-d food diary and 24-h recall (dietitian)	6
Singh et al[33]1	Clinic	76 (60% tropical PC; 40% alcohol-related)	-	63/13	-	32 (NR)	-	NR	-	FFQFor n = 20 subgroup, 24-h dietary recall (dietitian)	5
Hamberg et al[38]	Clinic	6 (6 alcohol-related)	-	4/2	-	50.3 ± 8.6	-	NR	-	3-d food diary and diet history (dietitian)	5
Midha et al[22]	Clinic	120 (idiopathic CP)	120 (healthy subjects attending gastroenterology OPD)	74/46	NR (sex-matched)	29.6 ± 10.5	NR (age-matched)	19.4 ± 3.4	21.3 ± 3.7	24 dietary recall and FFQ (dietitian)	5
Singh et al[39]	Clinic (Group 1 in RCT)	29	-	24/5	-	32 ± 10.0	-	17.2 ± 1.2	-	FFQ and 24-h recall (dietitian)	5
Singh et al[39]	Clinic (Group 2 in RCT)	31	-	26/5	-	28 ± 10.0	-	16.7 ± 1.6	-
Tinju et al[37]1	Clinic	94 (23% alcohol-related, 44% tropical, 28% idiopathic)	-	61/31	n/a	40.2 ± 131	-	NR	NR	FFQ and 24-h recall (dietitian)	5
Sathiaraj et al[15]	Clinic	89 (89 tropical PC diagnosed within 1 yr)	101	60/29	-	32.1 ± 14	NR	NR	NR	FFQ (dietitian)	6
Quilliot et al[28]	Clinic	80 (80 alcohol-related)	20 (healthy)	75/5	NR	57.6 ± 9.1	44 ± 11	25.7 ± 4.5	25 ± 2	7-d dietary recall and FFQ (NR)	5
Sobral-Oliveira et al[25]	Clinic	20 (20 alcohol-related, current non-drinkers)	16 (healthy never drinkers)	20/0	16/0	54.1 ± 11.4	54.1 ± 18.1	23.7 ± 4.6	26 ± 3.7	7-d diet history (dietitian)	6
Turner et al[32]	Clinic	83	-	61/22	-	43.4 (NR)	-	23.8 (NR)	-	24-h dietary recall (NR)	6
Roberts et al[24]	Clinic	52 (40% alcohol-related, 23% idiopathic, 12 autoimmune)	48(healthy)	35/17	19/29	50 ± 15.0	54 ± 13.0	24 ± 6.0	31 ± 8.0	FFQ (Vioscreen software) (NR)	6

¹No demographic or additional clinical details were provided for the n = 20 subgroup of patient with additional dietary assessment.

CP: Chronic pancreatitis; NOS: Newcastle Ottawa scale; FFQ: Food frequency questionnaire; BMI: Body mass index; M: Male; F: Female; NR: Not reported; RCT: Randomised controlled trial; PC: Pancreatitis cancer.

Table 2 Dietary intake of patients with chronic pancreatitis and controls from studies included in systematic review

Ref.	Number of subjects		Energy intake kcal/d (SD)		Carbohydrate intake g/d (SD)		Protein intake g/d (SD)		Fats intake g/d (SD)		Alcohol intake g/d (SD)
	CP	Control	CP	Control	CP	Control	CP	Control	CP	Control	CP	Control
Durbec et al[40]	193 (Marseille)	490	NR	NR	452.5 (178.1)	300.4 (104.4)	123.8 (56.4)	94.8 (29.5)	122.6 (50.4)	96.97 (28.8)	144 (78.7)	43.6 (56.6)
	247 (International)	521	NR	NR	389 (174.3)	305 (111.8)	119.2 (61)	96.1 (33.9)	115.7 (54.1)	97.8 (32.9)	149.9 (89.1)	37.2 (55.1)
Pitchumoni et al[30]	36	26	10501 (523)	8101 (330)	NR	NR	67 (22)	56 (23)	59 (33)	40 (22)	> 200	> 200
Uscanga et al[35]	23	20	3367 (748.6)	2332 (548.9)	532.6 (157.7)	357.3 (109.3)	117.6 (26.2)	84.4 (19.9)	83.7 (29.4)	64.4 (17.7)	203.9 (100.2)	NR
Guarnier et al[27]	14	UC	1893 (296)	UC	258.5 (44.3)	UC	66.5 (10.3)	UC	66.5 (14.8)	UC	NR	UC
Mezey et al[7]2	42	28	2,514 (142)	2298 (115)	139.2 (10.0)	221 (13.7)	57.1 (4.8)	76.2 (4.8)	53.8 (4.2)	85.6 (3.7)	177.8 (14.5)	47.7 (11.6)
Balakrishnan et al[36]2	28 (India)	23	1966 (154.8)	2012 (173.6)	354 (22.4)	385.7 (37.2)	55.7 (5.8)	51.3 (4.9)	23.4 (2.8)	25.5 (3.4)	NR	NR
	105 (France)	476	3411 (NR)	2453 (NR)	452.5 (178)	300.3 (104.4)	123.8 (56.4)	94.8 (29.5)	122.6 (50.4)	96.9 (28.8)	NR	NR
Dani et al[29]	28 (Belo Horizonte)	28	NR	NR	282(21.9)	220(12.2)	64(3.9)	45(3.8)	40(4.3)	34(3.4)	396.6(286.0)	NR
	40 (Sao Paulo)	40	NR	NR	270 (21.6)	319 (19.3)	100 (5.9)	80 (4.8)	97 (4.8)	85 (4.7)	295.3 (171.3)	NR
Noel-Jorand et al[20]	31	34	NR	1919 (NR)	NR	133 (NR)	119 (NR)	86 (NR)	120 (NR)	70 (NR)	232 (NR)	< 20 (NR)
Laugier et al[26]2	34 (Africa)	40	2339 (56.8)	2366 (55.3)	301 (15.2)	395 (10.1)	145 (5.9)	117 (3.4)	66 (3.8)	35 (2.6)	130 (12.7)	34 (5.5)
	87 (France)	430	3409 (45.4)	2454 (55.3)	452 (21.8)	300 (6.5)	124 (7.1)	95 (1.8)	123 (6.3)	97 (1.7)	150 (11.4)	43 (3.8)
Nakamura et al[6]	38	35	1650 (366)	2564 (477)	237 (63.9)	382 (82.5)	73 (15)	96 (17.5)	38 (12.3)	56 (13.6)	58 (130.6)	78 (110.4)
Lévy et al[23]	56	50	4178 (1906-13345)	4178 (1433-6418)	295 (108.8-541)	290 (797-772)	117 (34.6-162.7)	109 (22.6-181.6)	171 (59.7-447.7)	145 (42.2-332.7)	17.53 (0.9-64.5)	17.83 (2.3-50.4)
Nakamura et al[31]	15	7	1674 (188.2)	1985 (226.8)	NR	NR	NR	NR	45(8)	54(7.9)	NR	NR
Vaona et al[21]	40	75	25844 (850.2)	21034 (528.5)	362 (168)	250 (120)	95 (33)	88 (33)	76 (25)	83 (38)	37 (44)	32 (26)
Singh et al[33]	20	UC	1760 (375)	UC	274 (55)	UC	48 (13)	UC	53 (23)	UC	NR	UC
Hamberg et al[38]2	7	UC	NR	UC	NR	UC	36.8 (8.46)	UC	NR	UC	NR	UC
Midha et al[22]	120	120	1650 (699)	1663 (499)	262 (125)	257 (108)	56 (24)	54 (16)	38 (20)	47 (17)	NR	NR
Singh et al[39]	29 (Group 1)5	UC	2188 (672)	UC	346 (140)	UC	73 (24)	UC	52 (24)	UC	NR	UC
	31 (Group 2)5	UC	2053 (689)	UC	324 (126)	UC	69 (22)	UC	48 (18)	UC	NR	UC
Tinju et al[37]6	100	UC	1398 (515.9)	UC	231 (98.8)	UC	47 (18.8)	UC	37 (18.7)	UC	NR	UC
Sathiaraj et al[15]	89	101	1093 (257)	NR	195 (56)	UC	31 (10)	NR	19 (7)	NR	NR	NR
Quilliot et al[28]	80	20	2512 (644)	NR	NR	NR	NR	NR	NR	NR	NR	NR
Sobral-Oliveira et al[25]	20	16	1637 (546)	1622 (542)	224 (87)	225 (79)	71 (24)	70 (21)	51 (17)	49 (23)	253 (229)	NR
Turner et al[32]	83	54	842 (NR)	1143 (NR)	89 (NR)	116 (NR)	46 (NR)	60 (NR)	25 (NR)	48 (NR)	80 (NR)	30 (NR)
Roberts et al[24]	52	48	1549 (NR)	1664 (NR)	208 (NR)	181 (NR)	66 (NR)	60 (NR)	52 (NR)	62 (NR)	NR	NR

¹Results presented non-alcoholic calories only.

²Results expressed as mean ± SE.

³Expressed as kg of pure alcohol/kg body weight.

⁴Results presented as kJ/d- converted to kcal/d.

⁵Results from two groups of an interventional presented, both groups represent baseline nutrient intake.

⁶Results compared to population survey, no controls recruited. CP: Chronic pancreatitis; SD: Standard deviation; UC: Uncontrolled; NR: Not reported.

Table 3 Energy (calorie), protein, carbohydrate, and fat intake of patients with alcohol-related chronic pancreatitis[7,18,21,23,24,28,33] compared to those with non-alcohol-related chronic pancreatitis[14,20]

	Alcohol-related chronic pancreatitis (n = 208)	Non- alcohol-related chronic pancreatitis (n = 209)	P value
Energy, kcal/d (SD)	2642 (1090)	1372 (394)	0.0461
Carbohydrate, g/d (SD)	243 (194)	229 (47)	0.85
Protein, g/d (SD)	102 (32)	46(15)	0.021
Fat, g/d (SD)	91 (43)	29 (13)	0.011

¹Statistically different.

SD: Standard deviation.

Table 4 Studies analysing micronutrient intake in patients with chronic pancreatitis and controls

Ref.		Vitamin A (SD), IU	Vitamin B1 (SD) mg	Vitamin B2 (SD) mg	Vitamin C (mg)	Vitamin D (mcg)	Vitamin E (IU/mg)	Vitamin K (mg)	Calcium (SD), mg	Iron (SD), mg
Nakamura et al[6]	CP	2337.9 (3018.9)	0.9 (0.3)	1.28 (0.4)	98.5 (38.5)	NM	NM	NM	501.5 (145.4)	9.9 (2.7)
	Control1	4016.3 (4902.7)	1.21 (0.3)	1.61 (0.5)	85.0 (48.2)	NM	NM	NM	624.3 (227.2)	12.1 (2.8)
Tinju et al[37]	CP	M: 3659.7 (6546.8); F: 3888.4 (3936.1)	NM	NM	M: 54.0 (70.5); F: 50.0 (68.7)	NM	NM	NM	M: 496.3 (307.9); F: 485.8 (272)	M: 11.4 (6.7); F: 7.1 (2.8)
	Control	UC	UC	UC	UC	UC	UC	UC	UC	UC
Turner et al[32]2	CP	278 (μg/d)	NM	NM	25.3	NM	NM	NM	NM	NM
	Control	UC	UC	UC	UC	UC	UC	UC	UC	UC
Roberts et al[24]3	CP	744.4 (RAE)	NM	NM	NM	5.88	11.77	64	NM	NM
	Control2	651.3 (RAE)	NM	NM	NM	4.03	11.54	99.5	NM	NM

¹Healthy controls.

²Study presented data for “CP present” vs “CP absent”, however both groups were pancreatitis patients, there were no controls. No standard deviation provided.

³Data are expressed as median, no inter-quartile range provided. NM: Not measured; UC: Uncontrolled; M: Male; F: Female; RAE: Retinol activity equivalent.