Registered Dieticians are Underutilized Even at an Academic Center of Excellence for Chronic Pancreatitis

Introduction: Chronic pancreatitis (CP) is a fibroinflammatory disease that often results in irreversible pancreatic injury causing endocrine and exocrine insufficiency. Malnutrition is a downstream complication of CP and contributes to debility and diminished quality of life. Experts require that centers of excellence (COE) have access to registered dieticians (RDs) for screening and co-management of malnutrition in CP. The primary aim of this study was to see how often RDs were used in the assessment and management of CP. We also sought to examine the impact of RDs on outcomes in patients with CP. Methods: We performed a retrospective review of patients referred to a single academic COE for CP between 01/2020 and 12/2021. All patients who met radiographic and/or endoechosonographic diagnostic criteria for CP were included. We compared patients who were and were not referred to the RD and compared outcomes over the course of a 6-month period. Results: We reviewed 260 patients during the study period of whom 70 patients met criteria for CP. The majority of patients were female (39/70) and 50% of patients had alcohol induced CP. 20 patients were referred to the RD, the majority of whom were males and White (P >0.05). Patients referred to an RD had a lower baseline weight (69.05 vs 71.3kg, P=0.24) and a greater proportion were on pancreatic enzyme replacement therapy (PERT) (85% vs 56%, P=0.02). However, 62% of patients on PERT (28/45) did not see an RD, and the majority of these patients (20/28) reported weight loss in their review of symptoms. A similar proportion of patients were actively smoking and drinking in the 2 groups. In review of outcomes, there were no significant differences in change in weight, number of admissions, and number of admission days between those who were and were not referred to RD. Interestingly the group referred to RD had more visits to the emergency department (P= 0.03) (Table 1). Conclusion: At a single Academic Pancreatitis COE, we report that approximately one-quarter of patients are referred for evaluation by an RD despite weight loss and comorbid exocrine pancreatic insufficiency requiring PERT. We report no change in outcomes in short term follow up though the impact of an RD may be better assessed prospectively and over a longer period. Table 1. - Outcomes for Patients referred to Registered Dieticians compared to those Patients who were not Referred to Registered Dietician (N=20) Not Referred to a Dietician (N=50) P-Value Change in Weight Over 6 Months, % 0.03 -0.001 0.815 Number of Admissions in 6 months, n 1.05 0.52 0.238 Number of Admission Days in 6 months 9.6 3.2 0.369 Number of Emergency Room Visits 2.25 1.24