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Clinical trial: oral feeding with a soft diet compared with clear liquid diet as initial meal in mild acute pancreatitis.

The purpose of this primary study was to determine which method of treatment, a clear liquid diet or a soft diet, is the superior treatment to acute pancreatitis. A large sample size of 101 patients were randomly assigned to the clear liquid diet or soft diet, both following a period of fasting. The results proved a statistically significant difference in length of hospitalization. The soft diet had a median of 2 days less in the length of hospitalization as determined by a medical team unaffiliated to the study coordinators. This study suggests that oral refeeding with a soft diet, rather than a clear liquid diet, to treat mild acute pancreatitis could result in a shorter length of hospitalization.

Non‐liquid as initial meal in mild acute pancreatitis: Renewed meta‐analysis.

This secondary source, a meta-analysis of four randomized-control trials, reviewed pain recurrence and length of hospitalization when patients with acute pancreatitis were treated with a soft diet or a clear liquid diet. This meta-analysis considered large sample sizes amounting to 492 patients. Results indicated that a soft diet does not increase pain recurrence after re-feeding, as there was no significant difference in the recurrence of pain when comparing the soft diets with clear liquid diets. The length of hospitalization was reduced with a soft diet. Notably, this differs from common clinical practices after acute pancreatitis. The study warns that soft diets should not be considered the preferred diet until types, dosages, and specific regimens are identified and studied.

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

In this primary study, 121 patients were randomized to a clear liquid diet or low-fat solid diet after hospitalization for mild acute pancreatitis. The observed variables included pain recurrence, need to stop feeding, and re-admission rates. There was no difference in pain or nausea between the two groups. There was also no significant difference in the length of hospitalization or re-admission rates after 28 days. The low-fat solid diet consumed significantly more calories and fat than members of the clear liquid diet group. The study concluded that oral nutrition after mild acute pancreatitis could safely be done with a low-fat solid diet.

Early use of low residue diet is superior to clear liquid diet after elective colorectal surgery. A randomized controlled trial.

The diet advancement of oral nutrition after colorectal surgery was studied as either a clear fluid diet or low residue diet, starting one day after surgery. A randomized controlled trial compared the two methods. The sample size was 111 patients. Low residue diets resulted in a significantly shorter length of hospital stay by an average of a 1.4 day decrease. There was a significant increase in mean nausea for the clear fluid diet. There was no significant difference in postoperative morbidity. The study concluded that a low residue diet, in comparison to a clear fluid diet, is associated with less nausea and a shorter hospital stay without increasing postoperative morbidity.

Cholecystokinin decreases food intake in rats

This study found that CCK on 120 male adult rats produced a suppression of intake of solid and liquid diets, suggesting that CCK plays an inhibitory role in the short-term control of feeding behavior. The article tested a large sample size of 120 rats which suggests that the results are trustworthy; additionally, the study tested secretin injections and studied feeding behavior to isolate CCK as the determining factor. However, the results may not be transposable to humans because the sample were rats. This article supports the opponents of a clear liquid diet because they like to consider the hormonal implications of such a diet.

Deterministic and probabilistic control of the behavior of rats ingesting liquid diets

This article studied the distributions of licking and pauses between them in rats on a liquid diet of sucrose solution. They were studied to determine if the duration of these acts were deterministic or probabilistic in the central nervous system. Results showed a probabilistic rule in  the types of pauses that were longer than 0.3 seconds. It is an interesting study because the behavior is modeled by two controversial methods of data. While this is an older data set, I think it is nonetheless important because it has influenced how we study populations on liquid diets in more recent research. The profile of patients who might need a clear liquid diet are not likely to be accurately profiled so most recent data has been more individual, longitudinal studies; This is the research that should be more heavily trusted. However, again, a limitation of this study is that it is older and studied rats so results may not be fully transposable to humans.  

Do Support Groups Play a Role in Weight Loss after Laparoscopic Adjustable Gastric Banding?

This article focused on post-operative patients of laparoscopic adjustable gastric banding (LAGB). Support groups is beneficial to achieving optimal weight loss, according to the results of this 38 person study. Limitations may include that the support group treatment group included much less (n=10) of a sample size than the patients who underwent surgery without support groups. However, a positive is that this was a 1 year longitudinal study. Results showed that patients who attended support groups achieved more weight loss and support groups appear to be an important adjunct for post-operative patients to maintain improved weight loss. Importantly, this study may suggest that sticking to a liquid diet would be more achievable with support groups.  

Water intake and adherence to clear fluid goals in children receiving treatment for encopresis

This article studied a six-session group intervention for the treatment of retentive encopresis. Results found that an enhanced intervention (EI) will improve a children’s fluid goal adherence by modifying daily fluid intake to include more water and less juice. Limitations of this study include that only 19 children were studied, which is a relatively low sample size. The importance of nutrition-based education and behavioral strategies is emphasized in this study because participation in the intervention predicted higher daily water intake, lower daily juice intake, and better adherence to clear fluid goals. For proponents of eliminating the clear fluid diet, this could serve as a middle ground.  

Final Wikipedia Assignment

The use of a clear liquid diet during a patient’s perioperative recovery has recently become a matter of controversy. The Mayo Clinic describes “a clear liquid diet helps maintain adequate hydration, provides some important electrolytes, such as sodium and potassium, and gives some energy at a time when a full diet isn’t possible or recommended” . The risks associated with a clear liquid diet result from a lack of adequate calories and nutrients so it should be used short-term and by a doctor’s recommendation only. Important considerations ensue especially with diabetics; the Mayo Clinic advises a clear liquid diet should consist of “200 rams of carbohydrate spread equally throughout the day to help manage blood glucose”.

Variables such as hospital stay and amount of nausea are being tested to compare the efficacy of a clear liquid diet versus a more substantial soft diets. Recent research suggests that a clear liquid diet is not especially harmful when compared to a soft diet. In one clinical trial studying acute pancreatitis treatment, a soft diet had a median of 2 days less in the length of hospitalization. Oral referring with a soft diet, rather than a clear liquid diet, to treat mild acute pancreatitis could result in a shorter length of hospitalization . However, a separate clinical study also studying acute pancreatitis found that there was no difference in pain or nausea between the two groups of a clear liquid diet or low-fat solid diet after hospitalization and found no significant difference in the length of hospitalization or re-admission rates after 28 days. Overall, the study concluded that oral nutrition after mild acute pancreatitis could safely be down with a low-fat solid diet.

Social factors such as support groups, sustained weight loss, and adherence to treatment are also being researched. Post-operative patients of laparoscopic adjustable gastric binding surgery were observed. Patients who attended support groups achieved more weight loss and were more likely to adhere to a clear liquid diet . Similar results were found for children receiving treatment for encopresis. Enhanced interventions were found to improve a child’s fluid goal adherence by modifying daily fluid intake to include more water and less juice. Nutrition based education and behavioral strategies increase the likelihood of perioperative patients in abiding by clear fluid goals .