Consumption of red meat, saturated fat, and cholesterol increase risk for gallstone-related acute pancreatitis, researchers report in the February issue of Clinical Gastroenterology and Hepatology. Dietary fiber protects against acute pancreatitis—related and unrelated to gallstones—whereas coffee protects against acute pancreatitis not associated with gallstones, the study of thousands of patients shows.
Pancreatitis is a source of substantial morbidity and health cost in the United States. Gallstones are the most common cause of acute pancreatitis, and cholecystectomy prevents recurrence. Recurrent acute pancreatitis, which is mostly non–gallstone-related, can progress to chronic pancreatitis.
There is no treatment for pancreatitis, so it is important to identify factors that can be modified to prevent this disease. Diet is involved in the etiology of most digestive diseases, including pancreatitis, but no convincing dietary factors for pancreatitis have been reported.
Veronica Wendy Setiawan et al collected data from 1210 patients with gallstone-related acute pancreatitis, 1222 with pancreatitis not related to gallstones, and 378 patients with recurrent or chronic pancreatitis. The patients were African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites participating in the Multiethnic Cohort Study— a prospective cohort of more than 215,000 men and women, 45–75 years old.
The authors identified cases of pancreatitis using hospitalization claim files from 1993 through 2012. Subjects completed a questionnaire that included questions about their diet when the study began.
Setiawan et al associated dietary intake of saturated fat and cholesterol, and their sources, including red meat and eggs, with gallstone-related acute pancreatitis.
Fiber intake, however, was associated inversely with acute pancreatitis related and unrelated to gallstones. Setiawan et al propose that fiber might alter the intestinal microbiota to reduce epithelial permeability and prevent transit of endotoxin into the circulation. Endotoxin has been reported to promote development of pancreatitis in rats. Insoluble fiber might also protect against development of gallstones.
Vitamin D, mainly from milk, was associated inversely with gallstone-related acute pancreatitis. A study in mice showed that the vitamin D receptor ligand calcipotriol reduces markers of inflammation and fibrosis in pancreatic tissues.
Coffee consumption (caffeinated only) protected against pancreatitis not related to gallstones, in a dose-dependent manner. This makes sense because coffee intake has been associated with a reduced incidence of diabetes—a risk factor for pancreatitis. Caffeine inhibits pathologic calcium signaling in pancreatic acinar cells.
With the exception of red meat, no other dietary factors were associated with recurrent acute or suspected chronic pancreatitis. Setiawan et al did not find an association with omega-3 fatty acids or with fish intake in all ethnic groups. However, in an ethnic-specific analysis, the authors found an inverse association between fish intake and gallstone-related acute pancreatitis in Caucasians.
Studies of animals and humans have previously identified diets high in fat or cholesterol to be risk factors for gallstone formation.
Strengths the study included its prospective and population-based design, ethnic diversity, long follow-up evaluation, large size, and detailed information on known/potential risk factors.
Setiawan et al conclude that intake of red meat, saturated fat, cholesterol, coffee, fiber, vitamin D, fruits, and vegetables all affect risk of pancreatitis. Given the lack of an effective treatment of pancreatitis, studies are needed to determine the effectiveness of dietary factor interventions.