Acute pancreatitis is acute inflammatory disease of the pancreas. Nutrition has a number of anti-inflammatory effects that could affect outcomes of patients with pancreatitis. Further, it is the most promising nonspecific treatment modality in acute pancreatitis to date. This paper summarizes the best available evidence regarding the use of nutrition with a view of optimising clinical management of patients with acute pancreatitis. 1. Epidemiology and Economic Burden of Acute Pancreatitis Acute pancreatitis is a common digestive disease and the most frequent disorder of the pancreas. It is observed in every part of the world, but the incidence of acute pancreatitis varies considerably between countries. Relatively low figures are reported from the United Kingdom (9.8 cases per 100,000 population per year), Germany (13.1 cases per 100,000 population per year), and Japan (15.4 cases per 100,000 population per year) [1–3]. Medium figures are reported from New Zealand (29.3 cases per 100,000 population per year), Iceland (32.3 cases per 100,000 population per year), and Norway (34.4 cases per 100,000 population per year) [4–6]. The highest figures in the literature are reported from the United States (73.0 cases per 100,000 population per year) and Finland (73.4 cases per 100,000 population per year) [7, 8]. However, direct comparison of incidences between countries is hardly legitimate because of diagnostic, aetiological, ethnic, and other differences between the study populations. Several reports from the United States and Western Europe indicate that the frequency of this disease has increased dramatically [9–11]. In the United States, there were significant upward trends in both absolute numbers of hospitalisations for acute pancreatitis and annual incidence [7]. The absolute number of admissions was 101,000 in 1988 as compared with 201,000 in 2002. The annual incidence was also the lowest in 1988 at 41 cases per 100,000 population and peaked in 2002 at 73 cases per 100,000 population. In Denmark, the annual incidence increased from 17 cases per 100,000 population in 1981 to 32 cases per 100,000 population in 2000 [9]. Similarly, in Sweden, the annual incidence increased from 18 cases per 100,000 population in 1985 to 35 cases per 100,000 population in 1999 [10]. Most studies reporting on trends also indicate a steady decrease in the case-fatality rate over time. The case fatality for acute pancreatitis has decreased from 15%–21% in the earlier studies to 2%–7% in the recent studies [1, 12]. Although the case-fatality rate has decreased, several studies
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