Research Article: Metabolic and lifestyle risk factors for acute pancreatitis in Chinese adults: A prospective cohort study of 0.5 million people

Date Published: August 1, 2018

Publisher: Public Library of Science

Author(s): Yuanjie Pang, Christiana Kartsonaki, Iain Turnbull, Yu Guo, Ling Yang, Zheng Bian, Yiping Chen, Iona Y. Millwood, Fiona Bragg, Weiwei Gong, Qinai Xu, Quan Kang, Junshi Chen, Liming Li, Michael V. Holmes, Zhengming Chen, Ronald C. W. Ma

Abstract: BackgroundLittle prospective evidence exists about risk factors and prognosis of acute pancreatitis in China. We examined the associations of certain metabolic and lifestyle factors with risk of acute pancreatitis in Chinese adults.Methods and findingsThe prospective China Kadoorie Biobank (CKB) recruited 512,891 adults aged 30 to 79 years from 5 urban and 5 rural areas between 25 June 2004 and 15 July 2008. During 9.2 years of follow-up (to 1 January 2015), 1,079 cases of acute pancreatitis were recorded. Cox regression was used to estimate adjusted hazard ratios (HRs) for acute pancreatitis associated with various metabolic and lifestyle factors among all or male (for smoking and alcohol drinking) participants. Overall, the mean waist circumference (WC) was 82.1 cm (SD 9.8) cm in men and 79.0 cm (SD 9.5) cm in women, 6% had diabetes, and 6% had gallbladder disease at baseline. WC was positively associated with risk of acute pancreatitis, with an adjusted HR of 1.35 (95% CI 1.27–1.43; p < 0.001) per 1-SD-higher WC. Individuals with diabetes or gallbladder disease had HRs of 1.34 (1.07–1.69; p = 0.01) and 2.42 (2.03–2.88; p < 0.001), respectively. Physical activity was inversely associated with risk of acute pancreatitis, with each 4 metabolic equivalent of task (MET) hours per day (MET-h/day) higher physical activity associated with an adjusted HR of 0.95 (0.91–0.99; p = 0.03). Compared with those without any metabolic risk factors (i.e., obesity, diabetes, gallbladder disease, and physical inactivity), the HRs of acute pancreatitis for those with 1, 2, or ≥3 risk factors were 1.61 (1.47–1.76), 2.36 (2.01–2.78), and 3.41 (2.46–4.72), respectively (p < 0.001). Among men, heavy alcohol drinkers (≥420 g/week) had an HR of 1.52 (1.11–2.09; p = 0.04, compared with abstainers), and current regular smokers had an HR of 1.45 (1.28–1.64; p = 0.02, compared with never smokers). Following a diagnosis of acute pancreatitis, there were higher risks of pancreatic cancer (HR = 8.26 [3.42–19.98]; p < 0.001; 13 pancreatic cancer cases) and death (1.53 [1.17–2.01]; p = 0.002; 89 deaths). Other diseases of the pancreas had similar risk factor profiles and prognosis to acute pancreatitis. The main study limitations are ascertainment of pancreatitis using hospital records and residual confounding.ConclusionsIn this relatively lean Chinese population, several modifiable metabolic and lifestyle factors were associated with higher risks of acute pancreatitis, and individuals with acute pancreatitis had higher risks of pancreatic cancer and death.

Partial Text: Acute pancreatitis is one of the most common gastrointestinal causes of hospital admission, with a case fatality rate ranging from 2% to 10%.[1] Chronic pancreatitis, although lower in prevalence than acute pancreatitis, has profound effects on quality of life [1]. Patients with acute or chronic pancreatitis are at higher risk of death and of developing pancreatic cancer [2,3]. Globally, the reported incidence of acute pancreatitis ranges from 4 to 45 per 100,000 persons, and in most high-income countries, it is increasing by about 2% to 4% annually [1]. In China, there are no large population-based data about the burden of pancreatitis available, although a recent Global Burden of Disease report suggested that the age-standardised death rate from pancreatitis in China has remained unchanged since 1990 [4]. Several important risk factors for pancreatitis—including gallstone disease, smoking, and heavy alcohol drinking—are known [5,6], although approximately 20% of pancreatitis cases are idiopathic (i.e., the aetiology remains undetermined) [5,6]. Other possible risk factors include obesity, diabetes, hypertriglyceridemia, and use of certain medications (e.g., oestrogens, steroids) [1,5,6]. Some of these risk factors for acute pancreatitis are also risk factors for pancreatic cancer, including smoking, heavy alcohol drinking, adiposity, and diabetes [7]. Although various mechanisms have been hypothesised, the aetiology of acute pancreatitis is still poorly understood [1].

To our knowledge, this is the first large prospective study in China and one of the largest prospective cohort studies worldwide examining risk factors for acute pancreatitis captured mainly through linkage to hospital records. We found clear evidence that several major modifiable metabolic and lifestyle risk factors were associated with higher risk of acute pancreatitis. For smoking and heavy alcohol drinking, our findings in Chinese adults were generally consistent with those previously reported in Western populations for acute pancreatitis. For metabolic risk factors, our findings for adiposity and diabetes were in agreement with previous studies on acute pancreatitis. Moreover, we showed inverse associations of physical activity with acute pancreatitis risk. Individuals with a diagnosis of acute pancreatitis had higher risks of pancreatic cancer and all-cause mortality.



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