Diet and risk of acute pancreatitis

Abstract: Acute pancreatitis is a sudden inflammation of the pancreas. It has a broad spectrum of clinical outcomes, ranging from mild and self-limiting to severe and potentially fatal, and is often followed by recurrent attacks and/or progression to a chronic disease state (so-called chronic pancreatitis); especially if it is classified as non-gallstone-related acute pancreatitis. Alcohol abuse is considered to be the most important risk factor for non-gallstone-related acute pancreatitis. Even though dietary factors also might be risk factors, the literature on the role of diet in the development, recurrence, and progression of non- gallstone-related acute pancreatitis is sparse. A total of 5 studies were included in this thesis, for which the specific aims were to study: (Paper I) the association of fruit and vegetable consumption with incidence (first occurrence) of non-gallstone-related acute pancreatitis; (Paper II) the association between glycemic load (a measure that combines quantity and quality of carbohydrates) and incidence of non-gallstone-related acute pancreatitis; (Paper III) the association between fish consumption and incidence of non-gallstone-related acute pancreatitis; (Paper IV) the association between coffee drinking and incidence of non-gallstone-related acute pancreatitis; and (Paper V) the association between overall diet quality and risk of recurrent and progressive pancreatic disease after an incident episode of non-gallstone-related acute pancreatitis. In the incidence studies (Paper I–IV)—which used data from a large group of Swedish men and women who had completed a food-frequency questionnaire in 1997 (study samples ranging from 71,458 to 81,100 persons), and who were followed up for a maximum of 12 to 15 years via linkage to national health registers—I observed that incidence of non-gallstone-related acute pancreatitis (study samples ranging from 320 to 383 cases) had an inverse association (lower risk) with consumption of vegetables (Paper I) and fish (Paper III), a positive association (higher risk) with consumption of high-glycemic load foods (Paper II), and a null association with consumption of fruit (Paper I) and coffee (Paper IV). In the recurrence and progression study (Paper V)—which used data on the 386 persons who had been diagnosed with incident non-gallstone-related acute pancreatitis between 1998 and 2013, and who were subsequently followed up until the end of 2014 (mean follow-up of 4.8 years)—I observed no clear association between overall diet quality (calculated using a recommended food score, which was based on 25 healthy food items) and risk of recurrent and progressive pancreatic disease (defined as recurrent episodes of acute pancreatitis and/or incident episodes of chronic pancreatitis or pancreatic cancer; study sample of 90 cases). Taken together, these findings suggest that diet, a previously overlooked factor, might be important in the primary prevention of non-gallstone-related acute pancreatitis—and as such, they uniquely contribute to the existing literature on the role of diet in health promotion and disease prevention. On the other hand, the findings are less supportive of an important role of diet in the secondary prevention of non-gallstone- related acute pancreatitis (ie, as a potential way to reduce recurrence and progression), at least for the overall diet quality; even though a role of individual food items and nutrients cannot be excluded.