The effect of immunonutrition in patients with acute pancreatitis: a systematic review and meta-analysis

Background The effect of immunonutrition is controversial compared to standard supplementation with respect to the management of patients with acute pancreatitis. Methods An online literature search on four databases (PubMed, Cochrane, Embase and Web of Science) was performed to identify all of the randomised controlled trials assessing the effects of enteral or parenteral immunonutrition in acute pancreatitis. A fixed or random effects model was chosen usingrevman, version 5.3 (). The count data were analysed using the risk ratio (RR) and 95% confidence interval (CI). Results Five hundred and sixty-eight patients were included via our search in which 14 articles matched our criteria for enrolling the meta-analysis. Immunonutrition significantly reduced the risk of organ failure (RR = 0.42; 95% CI = 0.26-0.70,P = 0.0008), infectious complications (RR = 0.78; 95% CI = 0.62-0.99;P = 0.04) and mortality (RR = 0.37; 95% CI = 0.21-0.66;P = 0.006). Length of hospital stay was also shorter in patients who received immunonutrition (mean difference = -1.73 days; 95% CI = -2.36 to -1.10;P < 0.00001). Total interventions of patients were decreased (RR = 0.73; 95% CI = 0.55-0.97;P = 0.03). Body mass index in patients with immunonutrition was reduced more than standard nutrition (mean difference = -2.00; 95% CI = -3.96 to -0.04;P = 0.05). Conclusions Immunonutrition support such as glutamine and omega-3 fatty acids is potentially beneficial with respect to improving clinical outcomes in patients with acute pancreatitis.

Automated summary

Immunonutrition, including support such as glutamine and omega-3 fatty acids, has been found to significantly reduce the risk of organ failure, infectious complications, and mortality in patients with acute pancreatitis. Additionally, it can shorten hospital stay and reduce the total interventions required. Patients receiving immunonutrition also experienced a greater reduction in body mass index compared to those receiving standard nutrition.