Dietary Factors Reduce Risk of Acute Pancreatitis in a Large Multiethnic Cohort

Abstract

Background & Aims Pancreatitis is a source of substantial morbidity and health cost in the United States. Little is known about how diet might contribute its pathogenesis. To characterize dietary factors that are associated with risk of pancreatitis, by disease subtype, we conducted a prospective analysis of 145,886 African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites in the Multiethnic Cohort. Methods In the Multiethnic Cohort (45–75 years old at baseline), we identified cases of pancreatitis using hospitalization claim files from 1993 through 2012. Patients were categorized as having gallstone-related acute pancreatitis (AP) (n=1210), AP not related to gallstones (n=1222), or recurrent acute pancreatitis or suspected chronic pancreatitis (n=378). Diet information was obtained from a questionnaire administered when the study began. Associations were estimated by hazard ratios and 95% CIs using Cox proportional hazard models adjusted for confounders. Results Dietary intakes of saturated fat (P trend=.0011) and cholesterol (P trend=.0008) and their food sources, including red meat (P trend<.0001) and eggs (P trend=.0052), were positively associated with gallstone-related AP. Fiber intake, however, was inversely associated with gallstone-related AP (P trend=.0005) and AP not related to gallstones (P trend=.0035). Vitamin D, mainly from milk, was inversely associated with gallstone-related AP (P trend=.0015) whereas coffee consumption protected against AP not related to gallstones (P trend<.0001). With the exception of red meat, no other dietary factors were associated with recurrent acute or suspected chronic pancreatitis. Conclusions Associations between dietary factors and pancreatitis were mainly observed for gallstone-related AP. Interestingly, dietary fiber protected against AP, related and unrelated to gallstones. Coffee drinking protected against AP not associated with gallstones. Further studies are warranted to confirm our findings.

Reply

“…Archibugi and Capurso in our paper reporting several dietary factors associated with pancreatitis risk in the Multiethnic Cohort 1 . Regarding the first point, the reason we excluded subjects from the analysis who underwent cholecystectomy at baseline or prior to the index date [the sentinel date for the acute pancreatitis (AP) case] was because these subjects were either no longer or at least at a much lower risk of developing biliary AP.…”

Recent advances in understanding and managing acute pancreatitis

“…The risk of gallstone-related AP may be influenced by diet: increased by consumption of saturated fats, cholesterol, red meat, and eggs 28 but decreased by fiber intake 28 and, as noted above, alcohol consumption 29 .…”

Food-Induced Acute Pancreatitis

“…The summary of each of these case reports of food-related acute pancreatitis has been provided in Table 1. Furthermore, several large multiethnic cohort studies have indicated that high dietary glycemic load, saturated fat, cholesterol, red meat, and eggs raise the risk of non-gallstone-related acute pancreatitis [27, 28]; In contrast, recent reports have indicated that the consumption of vegetables and fish (fatty and lean fish combined) may be associated with decreased risk of non-gallstone acute pancreatitis [29, 30]. The summary of prospective cohort studies related with food-induced acute pancreatitis in human was presented in Table 2.…”

“…These patients showed no recurrence of pancreatitis following the avoidance of responsible food [26]. Additionally, increased dietary glycemic load [27], intakes of saturated fat, cholesterol, red meat, and eggs [28] promote the risk of non-gallstone-related acute pancreatitis. In a large population-based prospective cohort of 80,019 Swedish people (aged 46–84 years), Oskarsson and coworker showed that vegetable consumption might play a role in the prevention of non-gall stone-related acute pancreatitis [26].…”

“…Several studies indicate that a high dietary glycemic load [27], fat, meat, egg etc. [28] were associated with the risk of non-gallstone-related acute pancreatitis. While other studies report that vegetables and fish (including fatty and lean fish) may be associated with decreased risk of non-gallstone acute pancreatitis [29, 30].…”