Authors’ Response

Abstract

In general, a low-fat diet has not been shown to expedite time to discharge, resolution of pain, or return to normal lipase levels for stable pediatric patients with acute pancreatitis (AP).1Abu-El-Haija M. Wilhelm R. Heinzman C. et al.Early enteral nutrition in children with acute pancreatitis.J Pediatr Gastroenterol Nutr. 2016; 62: 453-456Crossref PubMed Scopus (28) Google Scholar In spite of this, we acknowledge the benefit of a low-fat diet for patients with AP when it is associated with secondary causes of hypertriglyceridemia and disorders of hypertriglyceridemia including familial chylomicronemia syndrome. Hypertriglyceridemic AP is a less common cause of AP in children than in adults according to available studies, but it should still be considered in the work-up for AP in this patient population.2Bai H.X. Lowe M.E. Husain S.Z. What have we learned about acute pancreatitis in children?.J Pediatr Gastroenterol Nutr. 2011; 52: 262-270Crossref PubMed Scopus (177) Google Scholar Evidence on hypertriglyceridemic AP management in children is very limited.3Abu-El-Haija M. Kumar S. Quiros J.A. Husain S. Morinville V. Plasma exchange in hypertriglyceridemic pancreatitis in children.J Pediatr Gastroenterol Nutr. 2018; 66: e163Crossref PubMed Scopus (1) Google Scholar The incidence of pediatric pancreatitis is rising, which may be attributed to increased provider awareness of the condition and the resultant surge in biochemical screening.4Morinville V.D. Husain S.Z. Harrison Bai B.B. et al.Definitions of pediatric pancreatitis and survey of current clinical practices: Report from INSPPIRE (International Study Group Of Pediatric Pancreatitis: In Search For A Cure).J Pediatr Gastroenterol Nutr. 2012; 55: 261Crossref PubMed Scopus (294) Google Scholar, 5Nydegger A. Heine R.G. Ranuh R. Gegati-Levy R. Crameri J. Oliver M.R. Changing incidence of acute pancreatitis: 10-year experience at the Royal Children's Hospital, Melbourne.J Gastroenterol Hepatol. 2007; 22: 1313-1316Crossref PubMed Scopus (155) Google Scholar, 6Heinzman C. Wilhelm R. Abu-El-Haija M. Fei L. Acute pancreatitis: What is it, why is it on the rise, and what are the current nutrition recommendations?.J Acad Nutr Diet. 2018; 118: 985-987Abstract Full Text PDF PubMed Scopus (5) Google Scholar To better understand how to effectively treat AP, we agree with Rhodes and colleagues that we must understand the underlying etiology. For this reason, it is common practice in our facility to perform screening laboratory tests to elucidate etiological factors including but not limited to hemoglobin, electrolyte, and calcium, liver enzyme, and triglyceride levels for all first-time episodes of AP. The goal of medical nutrition therapy for patients with hypertriglyceridemia and related disorders is to reduce plasma triglyceride levels to less than 500 to 1,000 mg/dL to reverse clinical manifestations of the disease.7Santamarina-Fojo S. The familial chylomicronemia syndrome.Endocrinol Metab Clin North Am. 1998; 27: 551-567Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar In the literature some support can be found for reduction of dietary fat to approximately 15% of total calories in familial chylomicronemia syndrome, but again, the actual degree of restriction needed to achieve the desired result is variable.7Santamarina-Fojo S. The familial chylomicronemia syndrome.Endocrinol Metab Clin North Am. 1998; 27: 551-567Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar That degree of variability in a prescribed “low-fat” diet reinforces the difficulty with an agreed-upon definition. Patients identified with hypertriglyceridemia and related diseases receive care and interventions relevant to their needs and are referred to our cardiology lipid specialty group for lifelong management. This approach is not applicable for patients with pancreatitis resulting from other etiologies. Effective Treatment for Acute Pancreatitis Depends on Underlying EtiologiesJournal of the Academy of Nutrition and DieteticsVol. 119Issue 4PreviewHeinzman and colleagues,1 in the Practice Applications section of the June 2018 issue of this Journal, discuss the increasing incidence of acute pancreatitis (AP) in the pediatric population, emphasizing the lack of data on medical nutrition therapy for this condition. They discuss the lack of clarity among dietitians about the term “low-fat diet” for treatment for this population. A sample of dietitians surveyed recommended definitions varying from <10% to <30% of calories from fat. Some dietitians did not recommend a low-fat diet for patients with AP. Full-Text PDF