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Obesity, high triglycerides tied to acute pancreatitis risk
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Danish individuals with class II or III obesity are nearly three times more likely to develop acute pancreatitis during 8 years of follow-up compared with adults with normal weight, with the association mediated by hypertriglyceridemia, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
“Obese individuals have increased risk for acute pancreatitis, which is partly driven by the high plasma triglycerides found in the obese,” Børge G. Nordestgaard, MD, DMSc, chief physician at Herlev and Gentofte Hospital and Copenhagen University Hospital, told Endocrine Today. “Ideally, patients with obesity should lose weight; however, if that is not possible, reduction in plasma triglycerides may reduce the risk of acute pancreatitis. In addition, triglyceride reduction will also reduce the risk of atherosclerotic cardiovascular disease.”
Nordestgaard and colleagues analyzed data from 117,531 individuals without a history of acute pancreatitis at baseline, participating in the Copenhagen City Heart Study (1991-1994 or 2001-2003 examinations) and the Copenhagen General Population Study (2003-2015), with BMI measured at baseline. Researchers stratified participants as underweight (BMI < 18.5 kg/m²), normal weight (BMI between 18.5-24.9 kg/m²), overweight (BMI between 25-29.9 kg/m²), class I obesity (BMI between 30-34.9 kg/m²) and class II and III obesity (BMI 35 kg/m²). Participants provided nonfasting blood samples to assess triglycerides, total cholesterol, HDL and LDL cholesterol. Diagnosis of acute pancreatitis was defined as hospitalization or death due to acute pancreatitis, assessed from national Danish registries.
During a mean follow-up of 8 years, 458 participants developed a first attack of acute pancreatitis.
Researchers found that higher BMI was associated with higher risk for acute pancreatitis among individuals with a BMI of at least 22 kg/m². Compared with participants of normal weight, HRs for acute pancreatitis were 1.4 (95% CI, 1.1-1.8) for those with overweight, 2.1 (95% CI, 1.6-2.9) for those with class I obesity and 2.8 (95% CI, 1.8-4.3) for those with class II or III obesity. Triglycerides mediated 29% of the association between BMI and risk for acute pancreatitis in the age- and sex-adjusted model (95% CI, 12-46) and 22% in the multivariable-adjusted model (95% CI, 6-39).
“We speculate that hypertriglyceridemia in individuals with obesity could be a causal link between BMI and risk of acute pancreatitis, and our finding of BMI in the range of 23-28 kg/m² having the largest increase in both triglycerides and risk of acute pancreatitis supports this,” the researchers wrote. “Hypertriglyceridemia is a known independent risk factor for acute pancreatitis, even though the pathogenic mechanism is not fully understood.”
Nordestgaard said more triglyceride-reducing trials are needed to further document the reduced risk for acute pancreatitis and reduced risk for atherosclerotic CVD. – by Regina Schaffer
For more information:
Børge G. Nordestgaard, MD, DMSc , can be reached at the University of Copenhagen, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark; email: boerge.nordestgaard@regionh.dk.
Disclosures: The authors report no relevant financial disclosures.
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