Pancreatic diseases, as a rule, have a severe course and often become chronic, significantly reducing the patient's quality of life. A special place in the treatment of pancreatitis is occupied by therapeutic nutrition. Compliance with a diet designed taking into account the individual characteristics of the patient allows you to prolong the interrelapse period and prevent the development of severe complications.
In recent decades, the incidence of inflammatory, neoplastic and other diseases of the pancreas has increased significantly. In most cases, they are quite severe and tend to become chronic. Almost always, chronic diseases of the pancreas lead to a significant deterioration in the quality of life of the patient.
Therapeutic nutrition for diseases of the pancreas is an integral part of complex therapy. Proper nutrition is necessary in the acute stage of the disease, helps prevent the progression and chronicity of the disease, and compensates for violations of the digestive function. Therefore, therapeutic nutrition is of great preventive value.
The objectives of diet therapy for pancreatic diseases are: correction of the patient's nutritional status and exclusion of adverse nutritional factors, elimination of body weight deficiency and malabsorption symptoms.
Basic Principles of Clinical Nutrition
Therapeutic nutrition should contribute to a targeted effect on the metabolism, it should both treat and prevent the exacerbation of diseases.
- It is necessary to observe the correct diet: eat regularly, at the same hours.
- It is necessary to diversify the diet.
- It is necessary to individualize medical nutrition: treat not the disease, but the patient.
- Balanced diet. It is necessary to take into account the calorie content and chemical composition of the main products.
- Proper cooking required.
- When compiling an individual diet, it is imperative to take into account concomitant diseases.
- Therapeutic nutrition promotes recovery most effectively if it is used in combination with other therapeutic factors: lifestyle changes, physical activation, the use of mineral waters, etc.
Dietary recommendations for each individual patient should be made individually, taking into account the type, severity of the course of the disease, food intolerance, comorbidities and taste preferences.
In therapeutic nutrition for diseases of the pancreas, strict phasing in the expansion of the diet is important. The staged diet therapy implies a gradual transition from complete starvation in acute pancreatitis (or exacerbation of chronic pancreatitis) to physiologically complete diets.
Therapeutic nutrition for acute pancreatitis and exacerbation of chronic pancreatitis
In the treatment of acute pancreatitis and the presence of a pronounced exacerbation of chronic pancreatitis, when there is an intense pain syndrome, high fermentemia and amylasuria, an important goal of treatment is to immobilize the production of pancreatic juice. This goal can be achieved by avoiding food intake in both solid and liquid form and strict bed rest. Even the impact on the patient of the sight and smell of food is excluded.
There are different opinions regarding the nature of fasting. Some authors consider it necessary to exclude the intake of not only food, but also liquids. According to the recommendations of other scientists – patients are allowed to take up to 1.5-2 liters of liquid per day in the form of boiled water, weak tea without sugar, alkaline mineral waters without gas ("Borjomi", "Essentuki No. 17", "Slavyanovskaya", "Bobruisk", "Novopolotskaya" , "Smirnovskaya") at room temperature (20 & ndash; 22 ° C), decoction of rose hips (10 g per 200 ml).
In severe nutritional disorders from the 2nd day of fasting, as well as during prolonged fasting to compensate for the patient's body's need for nutrients, patients are prescribed parenteral nutrition.
Depending on the type and severity of the course of the disease, hunger is prescribed for a period of 1-3 to 10-20 days. When determining the timing, it should be remembered that hypercatabolism that develops during prolonged fasting causes exhaustion of the patient, slows down reparative processes in the pancreas and worsens the course of the disease. Therefore, the transition to natural nutrition should be carried out as soon as possible.
The basic principle of nutrition is a careful gradual expansion of the diet and a slow increase in the amount of food introduced.
Mechanically, thermally and chemically sparing rations are used. All food is steamed or boiled. The food should be liquid or semi-liquid consistency, warm (the temperature of the finished dishes is 20 & ndash; 52 ° C). Recommend frequent (6-8 times / day) meals in small portions (no more than 300 g). In the initial period of treatment, after complete starvation, mainly carbohydrate nutrition is prescribed (high molecular weight polysaccharides.
In the future, when the exacerbation subsides, food containing a large amount of easily digestible forms of protein is added to the diet. The diet is widely used products of animal and vegetable origin, containing "inhibitors of proteolytic enzymes": egg white, oatmeal, soybeans, potatoes. Given the existing connection between the development and maintenance of pain syndrome and a lack of pancreatic enzymes in the duodenum, when the patient begins to eat, he is recommended to take adequate doses of polyenzymatic preparations during meals.
In the future, an additional quota of fats is added to the patient's diet. In connection with severe steatorrhea, which is characteristic of pancreatic diseases, it is advisable to replenish the losses by enriching the diet with products containing fatty acids with medium chains (vegetable oils). For patients with steatorrhea and weight loss who are not helped by polyenzyme replacement therapy, fats containing short chain fatty acids (coconut oil) are recommended, as they are more rapidly hydrolyzed and absorbed, well tolerated.
However, in 25% of patients they cause nausea and exacerbate diarrhea. Refractory fats (especially of animal origin) are poorly tolerated by patients, they support the inflammatory process, increase abdominal pain and diarrhea.
Patients are categorically contraindicated in products that have a "juicy" effect: meat, fish, bone, mushroom broths and decoctions, dishes and products prepared by frying, etc.
Absolute rejection of alcoholic beverages is considered a fundamental measure, since alcohol is a direct stimulant of pancreatic secretion. Alcohol also has a negative effect on the organs and structures associated with the pancreas: stomach, duodenum, sphincter of Oddi, blood vessels.
Diet therapy is prescribed for a long period (at least 2-3 months) in order to stimulate metabolic and reparative processes in the pancreas and other organs and systems of the body, normalize the immune status.
Nutrition in the phase of remission of acute and chronic pancreatitis
After achieving remission in exacerbation of pancreatitis, it is important to prevent the development of relapses and progression of pancreatitis, as well as to correct the resulting nutritional disorders.
K. Morgenroth et al. (1991) proposed the following dietary regimen for chronic pancreatitis in remission:
- frequent meals with a total energy value of 2500 & ndash; 3000 kcal against the background of adequate enzyme therapy;
- fat reduction up to 60 g/day (540 kcal);
- carbohydrate intake – 300-400 g/day (1200-1600 kcal) if necessary with an adequate dose of insulin;
- protein intake – 60–120 g/day (320–480 kcal).
During the period of remission, the range of recommended foods and dishes expands. In the remission phase of chronic pancreatitis, active inclusion in the diet of various vegetables and fruits in raw, boiled, baked and stewed form is shown. Vegetables are used in salads, vinaigrettes, side dishes and as separate dishes. Dishes from various cereals are prescribed (cereals, pilaf with dried fruits, carrots and boiled meat, puddings, cereals), boiled pasta.
Vegetable and cereal soups are served unmashed, beetroot soups, borscht and cabbage soup are allowed; vegetarian, milk, fruit soups. To improve the taste of dishes, you can use various sauces and spices. As drinks, you can include in the diet not only tea and rosehip broth, but also coffee with milk, vitamin teas, non-acidic fruit and vegetable juices.
Black coffee, cocoa, cold and carbonated drinks remain contraindicated.
Abstinence from alcoholic beverages and smoking are of paramount importance in the prevention of exacerbations of chronic pancreatitis.
Patients in remission are prescribed low- and medium-mineralized mineral waters containing bicarbonates, sulfate ion, divalent sulfur. Mineral waters are taken in a warm form (37 & ndash; 40 ° C) in a course of up to 3 & ndash; 4 weeks. Dosing of mineral waters is strictly individual.
Nutrition for chronic pancreatitis with endocrine insufficiency
A progressive pathological process with damage to the entire pancreas (including Langerhans cells) causes the development of not only excretory, but also endocrine insufficiency. This condition leads to the development of insulin and glucagon deficiency and the development of secondary diabetes mellitus.
The basis of the diet of patients with developed endocrine pancreatic insufficiency – principles of nutrition for patients with diabetes mellitus with changes necessary for chronic pancreatitis.
When developing an individual diet, foods and dishes containing a large amount of easily digestible carbohydrates are excluded. Semolina, rice, oatmeal, potatoes, confectionery and flour products (white wheat bread), sugar and sweets are excluded. From cereals, buckwheat is recommended. Allow special diabetic or gray wheat bread from wholemeal flour in limited quantities (no more than 250 g / day). When preparing cutlets, instead of bread, it is recommended to introduce fresh cottage cheese (for 100 g of meat - 50 g of cottage cheese). Various sweeteners are widely used.
Compotes, jellies, mousses are prepared with the addition of saccharin or xylitol. Carbohydrate-rich foods are distributed evenly throughout the day or their consumption is timed to coincide with the prescription of antidiabetic drugs.
According to smed.ru
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