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Kim and Han: Obesity and Pancreatic Diseases
Special Review
Obesity and Digestive Disorders
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 59(1): 35-39.

Published online: 25 January 2012

DOI: https://doi.org/10.4166/kjg.2012.59.1.35

Obesity and Pancreatic Diseases

Ho Gak Kim, Jimin Han

Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.

Correspondence to: Ho Gak Kim, Division of Gastroenterology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 3056-6 Daemyeong 4-dong, Nam-gu, Daegu 705-718, Korea. Tel: +82-53-650-4041, Fax: +82-53-624-3281, hgkim@cu.ac.kr

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Obesity is defined as BMI (calculated as weight in kg divided by height in m2) more than 30, and overweight is defined as BMI of 25-29.9. Obesity has been considered as a risk factor for pancreatic diseases, including pancreatitis and pancreatic cancer. Severe acute pancreatitis is significantly more frequent in obese patients. Furthermore, obese patients develop systemic and local complications of acute pancreatitis more frequently. The underlying mechanisms are increased inflammation and necrosis from increased amount of intra- and peri-pancreatic fat. In addition, obesity is a poor prognostic factor in acute pancreatitis, and overweight before disease onset appears to be a risk factor for chronic pancreatitis. Overweight and/or obesity are associated with greater risk of pancreatic cancer and younger age of onset. Physical activity appears to decrease the risk of pancreatic cancer, especially among those who are overweight. Long-standing diabetes increases the risk of pancreatic cancer. The pathogenic mechanism is that obesity and physical inactivity increase insulin resistance. In a state of hypersinulinemia, increased circulating level of insulin-like growth factor-1 induces cellular proliferation of pancreatic cancer. Obesity is associated with negative prognostic factor and increased mortality in pancreatic cancer. However, there are controversies regarding the effects of obesity on long-term post-operative results in the patient with pancreatic cancer.

Keywords: Obesity, Overweight, Pancreatic diseases, Pancreatic neoplasms, Pancreatitis

Figures and Tables

Fig. 1
Hypothetical concept of the role of adipose tissue in acute pancreatitis (modified from Fig. 2 of reference 16). Peripancreatic and pancreatic necrosis in acute pancreatitis cause a release of highly active cytokines and adipokines from adipose tissue. Released cytokines and adipokines are responsible to multiorgan failure, insulin resistance, and metabolic alteration, which determine the morbidity and mortality of acute pancreatitis. IL-1, interleukin-1; IL-6, interleukin-6; TNF, tumor necrosis factor.
kjg-59-35-g001
Fig. 2
The influence of obesity and inactive activity to pancreatic cancer (modified from Fig. 1 of reference 22). Obesity, inactive physical activity and abdominal adiposity increase the secretion of insulin through insulin resistance. Hyperinsulinemia and decreased insulin- like growth factor binding protein-1 (IGFBP-1) induces the secretion of insulin-like growth factor-1 (IGF-1), which stimulates proliferation of pancreatic cancer cells.
kjg-59-35-g002

Notes

Financial support: None.

Conflict of interest: None.

References

1. Iodice S, Gandini S, Maisonneuve P, Lowenfels AB. Tobacco and the risk of pancreatic cancer: a review and meta-analysis. Langenbecks Arch Surg. 2008. 393:535–545.
2. Everhart J, Wright D. Diabetes mellitus as a risk factor for pancreatic cancer. A meta-analysis. JAMA. 1995. 273:1605–1609.
3. Berrington de Gonzalez A, Sweetland S, Spencer E. A meta-analysis of obesity and the risk of pancreatic cancer. Br J Cancer. 2003. 89:519–523.
4. Larsson SC, Orsini N, Wolk A. Body mass index and pancreatic cancer risk: a meta-analysis of prospective studies. Int J Cancer. 2007. 120:1993–1998.
5. Porter KA, Banks PA. Obesity as a predictor of severity in acute pancreatitis. Int J Pancreatol. 1991. 10:247–252.
6. Lankisch PG, Schirren CA. Increased body weight as a prognostic parameter for complications in the course of acute pancreatitis. Pancreas. 1990. 5:626–629.
7. Wang SQ, Li SJ, Feng QX, Feng XY, Xu L, Zhao QC. Overweight is an additional prognostic factor in acute pancreatitis: a meta-analysis. Pancreatology. 2011. 11:92–98.
8. Ammann RW, Raimondi S, Maisonneuve P, Mullhaupt B. Zurich Pancreatitis Study Group. Is obesity an additional risk factor for alcoholic chronic pancreatitis? Pancreatology. 2010. 10:47–53.
9. Frossard JL, Lescuyer P, Pastor CM. Experimental evidence of obesity as a risk factor for severe acute pancreatitis. World J Gastroenterol. 2009. 15:5260–5265.
10. Martínez J, Johnson CD, Sánchez-Payá J, de Madaria E, Robles-Díaz G, Pérez-Mateo M. Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis. Pancreatology. 2006. 6:206–209.
11. Suazo-Baráhona J, Carmona-Sánchez R, Robles-Díaz G, et al. Obesity: a risk factor for severe acute biliary and alcoholic pancreatitis. Am J Gastroenterol. 1998. 93:1324–1328.
12. Funnell IC, Bornman PC, Weakley SP, Terblanche J, Marks IN. Obesity: an important prognostic factor in acute pancreatitis. Br J Surg. 1993. 80:484–486.
13. Shin KY, Lee WS, Chung DW, et al. Influence of obesity on the severity and clinical outcome of acute pancreatitis. Gut Liver. 2011. 5:335–339.
14. Sempere L, Martinez J, de Madaria E, et al. Obesity and fat distribution imply a greater systemic inflammatory response and a worse prognosis in acute pancreatitis. Pancreatology. 2008. 8:257–264.
15. Clement K, Langin D. Regulation of inflammation-related genes in human adipose tissue. J Intern Med. 2007. 262:422–430.
16. Schäffler A, Schölmerich J. The role of adiponectin in inflammatory gastrointestinal diseases. Gut. 2009. 58:317–322.
17. Michaud DS, Giovannucci E, Willett WC, Colditz GA, Stampfer MJ, Fuchs CS. Physical activity, obesity, height, and the risk of pancreatic cancer. JAMA. 2001. 286:921–929.
18. Stolzenberg-Solomon RZ, Graubard BI, Chari S, et al. Insulin, glucose, insulin resistance, and pancreatic cancer in male smokers. JAMA. 2005. 294:2872–2878.
19. Li D, Morris JS, Liu J, et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA. 2009. 301:2553–2562.
20. Jee SH, Ohrr H, Sull JW, Yun JE, Ji M, Samet JM. Fasting serum glucose level and cancer risk in Korean men and women. JAMA. 2005. 293:194–202.
21. Suh S, Kim KW. Diabetes and cancer: is diabetes causally related to cancer? Diabetes Metab J. 2011. 35:193–198.
22. Giovannucci E, Michaud D. The role of obesity and related metabolic disturbances in cancers of the colon, prostate, and pancreas. Gastroenterology. 2007. 132:2208–2225.
23. O'Rorke MA, Cantwell MM, Cardwell CR, Mulholland HG, Murray LJ. Can physical activity modulate pancreatic cancer risk? A systematic review and meta-analysis. Int J Cancer. 2010. 126:2957–2968.
24. Wolpin BM, Michaud DS, Giovannucci EL, et al. Circulating insulin-like growth factor binding protein-1 and the risk of pancreatic cancer. Cancer Res. 2007. 67:7923–7928.
25. Hines OJ, Reber HA. Pancreatic surgery. Curr Opin Gastroenterol. 2009. 25:460–465.
26. Khan S, Sclabas G, Reid-Lombardo K, et al. Does body mass index/morbid obesity influence outcome in patients who undergo pancreatoduodenectomy for pancreatic adenocarcinoma? J Gastrointest Surg. 2010. 14:1820–1825.
27. Dandona M, Linehan D, Hawkins W, Strasberg S, Gao F, Wang-Gillam A. Influence of obesity and other risk factors on survival outcomes in patients undergoing pancreaticoduodenectomy for pancreatic cancer. Pancreas. 2011. 40:931–937.
28. Tsai S, Choti MA, Assumpcao L, et al. Impact of obesity on perioperative outcomes and survival following pancreaticoduodenectomy for pancreatic cancer: a large single-institution study. J Gastrointest Surg. 2010. 14:1143–1150.
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