A prospective, randomized trial of clear liquids versus low-fat solid diet as the initial meal in mild acute pancreatitis

Background & Aims: Patients recovering from mild acute pancreatitis typically receive a clear liquid diet (CLD) when ready to initiate oral nutrition. Patient discharge then depends on their successful advancement to solid food. We hypothesized that initiating oral nutrition with a low-fat solid diet (LFSD) after mild pancreatitis would be well tolerated and would result in a shorter length of hospitalization (LOH). Methods: Patients with mild pancreatitis were randomized to a CLD or LFSD when they were ready to resume oral nutrition. Decisions about diet advancement and hospital discharge were at the discretion of the medical team, without input from study team members. Patients were monitored daily for recurrence of pain, need to stop feeding, post-refeeding LOH (primary end point), and for 28 days post-refeeding to capture re-admission rates. Results: we randomized 121 patients: 66 to CLD and 55 to LFSD. The number of patients requiring cessation of feeding because of pain or nausea was similar in both groups (6% for CLD, 11% for LFSD; P = .51). The median LOH after refeeding was identical in both groups (1-day interquartile range, 1-2; P = .77). Patients in the LFSD arm consumed significantly more calories and grams of fat than those in the CLD arm during their first meal and on study day 1. There was no difference in the 28-day re-admission rates between the 2 arms. Conclusions: Initiating oral nutrition after mild acute pancreatitis with an LFSD appeared safe and provided morecalories than a CLD, but did not result in a shorter LOH.