Association of Dietary Habits with Severity of Acute Pancreatitis
Mohannad Dugum, Amir Gougol, Pedram Paragomi, Xiaotian Gao, Bassem Matta, Cemal Yazici, Gong Tang, Phil Greer, Ioannis Pothoulakis, Stephen J D O'Keefe, David C Whitcomb, Dhiraj Yadav, Georgios I Papachristou, Mohannad Dugum, Amir Gougol, Pedram Paragomi, Xiaotian Gao, Bassem Matta, Cemal Yazici, Gong Tang, Phil Greer, Ioannis Pothoulakis, Stephen J D O'Keefe, David C Whitcomb, Dhiraj Yadav, Georgios I Papachristou
Abstract
Background: The effect of diet on risk of acute pancreatitis (AP) has been suggested by prior studies, but the association of dietary habits with severity of AP has not been previously evaluated.
Objective: The objective of the study was to assess differences in reported dietary habits in patients with severe AP compared with those with mild or moderate AP.
Methods: A prospectively maintained cohort of patients with AP was utilized. A brief questionnaire on dietary habits was implemented. Dietary habits were categorized based on the overall type of diet, fruit/vegetable servings, fat content, dairy consumption, dessert/sweets consumption, and fluid intake. Patients were grouped into mild/moderate and severe AP. Multivariate analysis was used to determine whether dietary habits have an independent association with AP severity.
Results: 407 patients with AP were studied. Mean patient age was 51 y, and 202 (50%) were men. 29% of patients were smokers and 46% actively consumed alcohol. 225 patients had mild AP, 103 moderate AP, and 79 developed severe AP. The 3 groups were comparable in race, body mass index, etiology of AP, and comorbidities. Dietary factors were overall comparable between the groups except for diet type: subjects with severe AP had a higher percentage of consuming a meat-rich diet (84%) than patients with mild AP (72%) and moderate AP (67%) (P = 0.04). Based on multivariable logistic regression, the OR of developing severe AP was 2.5 (95% CI: 1.24-5.32, P = 0.01) between patients who eat a meat-rich diet and those who consume a vegetable-based diet.
Conclusions: A meat-rich diet is independently associated with the development of persistent organ failure (severe disease) in patients with AP. These findings require further evaluation and could be useful for patient counseling, risk stratification, and disease prevention. This study is registered at clinicaltrials.gov as NCT03075605.
Keywords: Revised Atlanta Classification; acute pancreatitis; diet; dietary questionnaires; disease severity.
Figures
References
- Peery AF, Crockett SD, Barritt AS, Dellon ES, Eluri S, Gangarosa LM, Jensen ET, Lund JL, Pasricha S, Runge T et al. . Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology 2015;149:1731–41.e3.
- Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102–11.
- Mounzer R, Langmead CJ, Wu BU, Evans AC, Bishehsari F, Muddana V, Singh VK, Slivka A, Whitcomb DC, Yadav D et al. . Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology 2012;142:1476–82.
- Sankaran SJ, Xiao AY, Wu LM, Windsor JA, Forsmark CE, Petrov MS. Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis. Gastroenterology 2015;149:1490–500
- Yadav D, O'Connell M, Papachristou GI. Natural history following the first attack of acute pancreatitis. Am J Gastroenterol 2012;107:1096–103
- Bertilsson S, Swärd P, Kalaitzakis E. Factors that affect disease progression after first attack of acute pancreatitis. Clin Gastroenterol Hepatol 2015;13:1662–9
- Setiawan VW, Pandol SJ, Porcel J, Wei PC, Wilkens LR, Le Marchand L, Pike MC, Monroe KR. Dietary factors reduce risk of acute pancreatitis in a large multiethnic cohort. Clin Gastroenterol Hepatol 2017;15:257–65
- Prizment AE, Jensen EH, Hopper AM, Virnig BA, Anderson KE. Risk factors for pancreatitis in older women: the Iowa Women's Health Study. Ann Epidemiol 2015;25:544–8.
- Oskarsson V, Orsini N, Sadr-Azodi O, Wolk A. Fish consumption and risk of non-gallstone-related acute pancreatitis: a prospective cohort study. Am J Clin Nutr 2015;101:72–78.
- Oskarsson V, Sadr-Azodi O, Orsini N, Andrén-Sandberg Å, Wolk A. Vegetables, fruit and risk of non-gallstone-related acute pancreatitis: a population-based prospective cohort study. Gut 2013;62:1187–92
- Yang H, Wang L, Shi YH, Sui GT, Wu YF, Lu XQ, Li MY, Xia Q, Bian XX, Li HH et al. . Risk factors of acute pancreatitis in the elderly Chinese population: a population-based cross-sectional study. J Dig Dis 2014;15:501–7
- Peery AF, Crockett SD, Barritt AS, Dellon ES, Eluri S, Gangarosa LM, Jensen ET, Lund JL, Pasricha S, Runge T et al. . Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology 2015;149:1731–41e3.
- Castiñeira-Alvariño M, Lindkvist B, Luaces-Regueira M, Iglesias-García J, Lariño-Noia J, Nieto-García L, Domínguez-Muñoz JE. “The role of high fat diet in the development of complications of chronic pancreatitis”. Clin Nutr 2013;32(5):830–6.
- Leung PS, Chan YC. Role of oxidative stress in pancreatic inflammation. Antioxid Redox Signal 2009;11:135–65.
- Yan MX, Li YQ, Meng M, Ren HB, Kou Y. Long-term high-fat diet induces pancreatic injuries via pancreatic microcirculatory disturbances and oxidative stress in rats with hyperlipidemia. Biochem Biophys Res Commun 2006;347:192e9.
- Tsukamoto H, Towner SJ, Yu GS, French SW. Potentiation of ethanol-induced pancreatic injury by dietary fat. Induction of chronic pancreatitis by alcohol in rats. Am J Pathol 1988;131:246e57.
- Memba R, Duggan SN, Ni Chonchubhair HM, Griffin OM, Bashir Y, O'Connor DB, Murphy A, McMahon J, Volcov Y, Ryan BM et al. . The potential role of gut microbiota in pancreatic disease: a systematic review. Pancreatology 2017;17(6):867–74.
- Tan C, Ling Z, Huang Y, Cao Y, Liu Q, Cai T, Yuan H, Liu C, Li Y, Xu K. Dysbiosis of intestinal microbiota associated with inflammation involved in the progression of acute pancreatitis. Pancreas 2015;44(6):868e75.
Source: PubMed