美国大样本多种族队列研究发现降低急性胰腺炎风险的饮食因素

　　胰腺炎是发病率和医疗成本相当高的疾病之一。既往关于饮食因素对胰腺炎发病机制的影响所知甚少。

　　2017年2月，美国胃肠病学会研究所官方期刊《临床胃肠肝脏病学》正式发表南加利福尼亚大学凯克医学院和诺里斯综合癌症中心、洛杉矶西奈雪松医学中心、夏威夷大学癌症中心、纽约纪念斯隆凯特林癌症中心的大样本多种族队列研究报告，发现包括饱和脂肪、胆固醇、红肉、蛋类、膳食纤维、维生素D、咖啡在内的饮食因素可能与胰腺炎有相关性。

　　多种族队列是一个总样本量超过21.5万、1993～1995年入组时年龄为45～75岁的男女人群，该研究对其中14.5886万非裔美国人、夏威夷原住民、日本裔美国人、拉丁美洲人、白人，按疾病亚型，前瞻分析了与胰腺炎风险相关的饮食因素特征。

　　该研究通过1993～2012年住院医疗保险索赔文件从多种族队列找出胰腺炎病例，将患者按诊断分为胆结石相关急性胰腺炎（1210例）、胆结石无关急性胰腺炎（1222例）、复发急性胰腺炎或疑似慢性胰腺炎（378例）。研究开始时发放问卷获得饮食信息，使用针对混杂因素校正的Cox比例风险模型、通过风险比和95%置信区间估计相关性。

　　结果发现：

  • 饱和脂肪、胆固醇、红肉、蛋类的饮食摄入量，与胆结石相关急性胰腺炎的风险成正比（趋势P值：0.0011、0.0008、＜0.0001、0.0052）。

  • 膳食纤维摄入量，与胆结石相关急性胰腺炎、胆结石无关急性胰腺炎的风险成反比（趋势P值：0.0005、0.0035）。

  • 维生素D（主要来自牛奶）摄入量，与胆结石相关急性胰腺炎的风险成正比（趋势P值：0.0015）。

  • 咖啡摄入量，与胆结石无关急性胰腺炎的风险成反比（趋势P值：＜0.0001）。

  • 红肉摄入量，与复发急性或疑似慢性胰腺炎的风险有相关性（趋势P值：0.02），但是四分位风险比未达统计学意义。

　　因此，饮食因素主要影响胆结石相关急性胰腺炎。有趣的是，膳食纤维有助防止急性胰腺炎（无论是否与胆结石相关），咖啡有助防止与胆结石无关的急性胰腺炎。需要进一步研究确认这些发现。

Clin Gastroenterol Hepatol. 2017 Feb;15(2):257-65.

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

Setiawan VW, Pandol SJ, Porcel J, Wei PC, Wilkens LR, Le Marchand L, Pike MC, Monroe KR.

Keck School of Medicine, University of Southern California, Los Angeles, California; Norris Comprehensive Cancer Center, Los Angeles, California; Cedars-Sinai Medical Center, Los Angeles, California; University of Hawaii Cancer Center, Honolulu, Hawaii; Memorial Sloan Kettering Cancer Center, New York, New York.

BACKGROUND & AIMS: Pancreatitis is a source of substantial morbidity and health cost in the United States. Little is known about how diet might contribute to 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 (age at baseline, 45-75 y), 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 AP 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% confidence intervals 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 associated positively with gallstone-related AP. Fiber intake, however, was associated inversely with gallstone-related AP (P trend = .0005) and AP not related to gallstones (P trend = .0035). Vitamin D, mainly from milk, was associated inversely 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 observed mainly 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.

KEYWORDS: Epidemiology; Pancreas; Population

PMID: 27609706

PMCID: PMC5241169

DOI: 10.1016/j.cgh.2016.08.038

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