Severe acute pancreatitis 3 or more Ranson's prognostic signs is characterized by a generalized hypermetabolic response and nutritional depletion leading to malnutrition and septic complications. Nutritional support has come to be a significant component of the treatment of acute pancreatitis. However the route of nutrient administration and composition of substrates administered remain controversial. Available data suggest that intravenous infusion of amino acids, glucose and fat emulsions alone or in combination does not stimulate exocrine pancreatic secretion. Similarly, enteral feeds should have low fat composition and be delivered distal to the ligament of Treitz. This review outlines the current body of specific literature and provides preliminary guidelines for the nutritional support of patients with acute pancreatitis.