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High intra-abdominal fat associated with increased pancreatic cancer mortality
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2010 Digestive Disease Week
NEW ORLEANS — Although BMI was not a significant predictor for survival in patients with pancreatic cancer, researchers have found that elevated levels of intra-abdominal fat increased the risk for death as much as fourfold in some patients.
Speaking at a press conference during Digestive Disease Week 2010, Courtney Balentine, MD, a surgical resident at Baylor College of Medicine, said researchers postulated that BMI was a poor predictor for prognosis because it does not show physicians where fat is distributed in obese patients. Instead, they hypothesized that fat in the waist would be a better predictor for outcome in patients undergoing abdominal surgery. They concluded that patients with the most visceral fat were at the greatest risk for complications and death.
“If we stratify patients by BMI, we did not see any difference in terms of outcomes for survival,” Balentine said. “When you look at it in terms of the amount of intra-abdominal fat, we found that the more fat there is, the worse patients do. Even after we corrected for other factors, like age that predict worse outcomes, the intra-abdominal fat seems to discriminate who does well and who does poorly.”
The risk for complications in those with the largest waist size — 45 inches or more — was 61% compared with 28% in those patients with the thinnest waists. Researchers also noted that the risk for having surgical site infections or wound infections increased from only 14% in the thinnest patients to almost 50% in those with the largest waist circumferences.
Researchers said the odds of infection doubled each time waist circumference increased by 10 cm or 4 inches, and the odds of having any complication increased by 60%, even after researchers adjusted for other contributing factors.
To determine the amount of visceral fat, researchers performed CT scans to measure the distance between the back of the kidney and the abdominal wall on 61 patients who underwent a Whipple procedure for exocrine pancreatic adenocarcinoma from 2000 to 2009. Patients were then stratified into quartiles by amount of intra-abdominal fat.
Compared with patients in the lowest quartile, those in the second quartile had four times the risk for death (HR=4.02; 95% CI, 1.10-14.69). Patients in the third (HR=2.12; 95% CI, 0.28-16.22) and fourth quartiles (HR=1.35; 95% CI, 0.3-6.2) also showed an increased risk for death, but the risk did not reach statistical significance.
Balentine said if these results are confirmed, it is possible that physicians can adjust treatment, include weight-loss programs in care after surgery or prescribe medications targeting intra-abdominal fat, thereby helping patients live longer. – by Jason Harris
The pattern of where and how we deposit our fat — a pear-shaped person vs. an apple-shaped person — that, in itself, is a risk factor. This is preliminary work. These investigators will look at this in a variety of operations and a variety of diseases, and I predict one day we will have a variety of patterns of deposition.
– Craig P. Fischer, MD, MPH
Assistant
Professor of Surgery, The Methodist Hospital, Houston
For more information:
- Berger DH. #W1681. Presented at: 2010 Digestive Disease Week; May 1-6, 2010; New Orleans.
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