Timing of enteral nutrition and clinical outcomes in mild-to-moderate acute pancreatitis: a retrospective cohort study

Background The optimal timing of enteral nutrition (EN) in acute pancreatitis (AP) remains clinically important. Objective This study evaluated whether early EN improved outcomes compared with delayed EN. Methodology This retrospective cohort study included 650 adults admitted with AP from January 2022 through December 2025. Patients were classified into an early EN group (initiation within 48 h; n = 392) or a delayed EN group (initiation after 48 h; n = 258). Demographic and clinical information, nutritional data, biochemical data, and outcome data were collected from medical records. Multiple regression analysis was used, adjusting for relevant confounders. Results Higher nutritional risk, lower albumin, and higher inflammatory burden at admission were all associated with delayed EN. Early EN was associated with shorter hospital stay (5.5 vs. 7.4 days; p < 0.001), quicker pain resolution, earlier adequate enteral intake (2.4 vs. 3.5 days; p < 0.001), and lower feeding intolerance (8.7% vs. 18.6%; p < 0.001). The early EN group also had lower rates of local and systemic complications and ICU transfer. Early EN remained independently associated with lower odds of feeding intolerance after adjustment (OR 0.52, 95% CI: 0.32–0.83; p = 0.006), decreased hospital stay (1.21 days, 95% CI: −1.58 to −0.84; p < 0.001), recurrent/worsening pain, systemic complications, and ICU transfer after adjustment. Conclusion In mild to moderate AP, early EN (within 48 h) was independently associated with more rapid recovery and fewer complications, supporting its use when clinically tolerated.