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The Impact of Obesity on the Course and Outcome of Acute Pancreatitis

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Abstract

Obesity has reached epidemic proportions in many countries and is an established risk factor in many chronic illnesses, but its role in acute illness is less clear. Pancreatologists have long recognized obesity as a risk factor for a poor outcome in severe acute pancreatitis. There are now several studies that have identified obesity as a primary risk factor for developing local complications (abscess, pseudocyst, necrosis), organ failure, and death. Indeed, meta-analysis of these studies gives a relative risk of 4.3 for local complications, 2.0 for systemic complications, and 2.1 for death. This has led to proposed modifications of acute pancreatitis scoring systems to include obesity as an independent primary predictive factor of severe disease. Obesity is associated with a low-grade inflammatory state, which may predispose obese patients to such complications. Furthermore, visceral obesity and visceral adipose tissue may be particularly important in underlying the pathophysiology of these observations.

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References

  1. Martinez J, Johnson CD, Sanchez-Paya J, de Madaria E, Robles-Diaz G, Perez-Mateo M. Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis. Pancreatology 2006;6(3):206–9.

    Article  PubMed  CAS  Google Scholar 

  2. Johnson CD, Toh SK, Campbell MJ. Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis. Pancreatology 2004;4(1):1–6.

    Article  PubMed  CAS  Google Scholar 

  3. Lee YH, Pratley RE. The evolving role of inflammation in obesity and the metabolic syndrome. Curr Diab Rep 2005;5(1):70–5.

    Article  PubMed  CAS  Google Scholar 

  4. Fain JN, Madan AK, Hiler ML, Cheema P, Bahouth SW. Comparison of the release of adipokines by adipose tissue, adipose tissue matrix, and adipocytes from visceral and subcutaneous abdominal adipose tissues of obese humans. Endocrinology 2004;145(5):2273–82.

    Article  PubMed  CAS  Google Scholar 

  5. Papachristou GI, Papachristou DJ, Avula H, Slivka A, Whitcomb DC. Obesity increases the severity of acute pancreatitis: performance of APACHE-O score and correlation with the inflammatory response. Pancreatology 2006;6(4):279–85.

    Article  PubMed  Google Scholar 

  6. Vazquez LA, Pazos F, Berrazueta JR, Fernandez-Escalante C, Garcia-Unzueta MT, Freijanes J, et al. Effects of changes in body weight and insulin resistance on inflammation and endothelial function in morbid obesity after bariatric surgery. J Clin Endocrinol Metab 2005;90(1):316–22.

    Article  PubMed  CAS  Google Scholar 

  7. Working Party of the British Society of Gastroenterology, Association of Surgeons of Great Britain and Ireland, Pancreatic Society of Great Britain and Ireland, Association of Upper GI Surgeons of Great Britain and Ireland. UK Guidelines for the management of acute pancreatitis. Gut 2005;54 Supplement 3:iii1–9.

    Article  Google Scholar 

  8. Bradley EL. A clinically based classification system for acute pancreatitis: Summary of the International Symposium on Acute Pancreatitis, Atlanta. Arch Surg 1993;128:586–90.

    PubMed  Google Scholar 

  9. Lankisch PG, Schirren CA. Increased body weight as a prognostic parameter for complications in the course of acute pancreatitis. Pancreas 1990;5(5):626–9.

    Article  PubMed  CAS  Google Scholar 

  10. Porter KA, Banks PA. Obesity as a predictor of severity in acute pancreatitis. Int J Pancreatol. 1991;10(3–4):247–52.

    PubMed  CAS  Google Scholar 

  11. Karimgani I, Porter KA, Langevin RE, Banks PA. Prognostic factors in sterile pancreatic necrosis. Gastroenterology 1992; 103(5):1636–40.

    PubMed  CAS  Google Scholar 

  12. Martinez J, Sanchez-Paya J, Palazon JM, Aparicio JR, Pico A, Perez-Mateo M. Obesity: a prognostic factor of severity in acute pancreatitis. Pancreas 1999;19(1):15–20.

    Article  PubMed  CAS  Google Scholar 

  13. Funnell IC, Bornman PC, Weakley SP, Terblanche J, Marks IN. Obesity: an important prognostic factor in acute pancreatitis. Br J Surg 1993;80(4):484–6.

    Article  PubMed  CAS  Google Scholar 

  14. Suazo-Barahona J, Carmona-Sanchez R, Robles-Diaz G, Milke-Garcia P, Vargas-Vorackova F, Uscanga-Dominguez L, et al. Obesity: a risk factor for severe acute biliary and alcoholic pancreatitis. Am J Gastroenterol 1998;93(8):1324–8.

    PubMed  CAS  Google Scholar 

  15. Tsai CJ. Is obesity a significant prognostic factor in acute pancreatitis? Dig Dis Sci 1998;43(10):2251–4.

    Article  PubMed  CAS  Google Scholar 

  16. De Waele B, Vanmierlo B, Van Nieuwenhove Y, Delvaux G. Impact of body overweight and class I, II and III obesity on the outcome of acute biliary pancreatitis. Pancreas 2006;32(4):343–5.

    Article  PubMed  Google Scholar 

  17. Halonen KI, Leppaniemi AK, Puolakkainen PA, Lundin JE, Kemppainen EA, Hietaranta AJ, et al. Severe acute pancreatitis: prognostic factors in 270 consecutive patients. Pancreas 2000; 21(3):266–71.

    Article  PubMed  CAS  Google Scholar 

  18. Gloor B, Muller CA, Worni M, Martignoni ME, Uhl W, Buchler MW. Late mortality in patients with severe acute pancreatitis. Br J Surg 2001;88(7):975–9.

    Article  PubMed  CAS  Google Scholar 

  19. Talamini G, Bassi C, Falconi M, Sartori N, Frulloni L, Di Francesco V, et al. Risk of death from acute pancreatitis. Role of early, simple “routine” data. Int J Pancreatol 1996;19(1):15–24.

    PubMed  CAS  Google Scholar 

  20. Martinez J, Sanchez-Paya J, Palazon JM, Suazo-Barahona J, Robles-Diaz G, Perez-Mateo M. Is obesity a risk factor in acute pancreatitis? A meta-analysis. Pancreatology 2004;4(1):42–8.

    Article  PubMed  CAS  Google Scholar 

  21. Mery CM, Rubio V, Duarte-Rojo A, Suazo-Barahona J, Pelaez-Luna M, Milke P, et al. Android fat distribution as predictor of severity in acute pancreatitis. Pancreatology 2002;2(6):543–9.

    Article  PubMed  CAS  Google Scholar 

  22. Segersvard R, Sylvan M, Herrington M, Larsson J, Permert J. Obesity increases the severity of acute experimental pancreatitis in the rat. Scand J Gastroenterol 2001;36(6):658–63.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Mohammed Abu Hilal.

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Abu Hilal, M., Armstrong, T. The Impact of Obesity on the Course and Outcome of Acute Pancreatitis. OBES SURG 18, 326–328 (2008). https://doi.org/10.1007/s11695-007-9298-5

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