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Ortega E, Vlacho B, Treserres RP, Mata-Cases M, Altes A, Mauricio D, Franch-Nadal J. Severe hypertriglyceridemia prevalence at a primary care setting in Catalonia, Spain. J Clin Lipidol 2023; 17:777-787. [PMID: 37741728 DOI: 10.1016/j.jacl.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/31/2023] [Accepted: 09/01/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Hypertriglyceridemia (HTG) increases the risk of cardiovascular disease and pancreatitis, and its prevalence varies across populations. OBJECTIVE To determine the prevalence of moderate-to-severe hypertriglyceridemia (msHTG, 500-879 mg/dl) and severe hypertriglyceridemia (sHTG, ≥ 880 mg/dl) in a primary care population in Catalonia, Spain, and to categorize them according to presence/absence of factors potentially causing HTG. METHODS Retrospective analysis of clinical and laboratory data in SIDIAP (Information System for the Development of Primary Care Research) from 2010, 2013, 2016, and 2019. We considered medications with hypolipidemic effects and those potentially increasing TG levels. We developed logistic regression models adjusted by age and sex to calculate the probability of having ms/sHTG according to covariates of interest. RESULTS In the study years, 36.2‒42.0% of the >3.5 million active primary care users had ≥1 TG determination. Prevalence for msHTG was 0.7% and for sHTG 0.2% among those with recorded TG. In 2019, 54.7% were female; median (IQR) age was 62.5 (49.4‒73.7) years. Prevalence was higher in 36‒50-year-old persons (1.3% msHTG, 0.4% sHTG) and men (1.1% msHTG, 0.3% sHTG). Most cases were associated with secondary and <20% with non-secondary causes, the latter being most prevalent in young patients. The secondary causes more strongly associated with msHTG/sHTG were obesity, uncontrolled diabetes mellitus (DM) and gamma-glutamyl transferase >100 U/L. CONCLUSION The prevalence of msHTG was 0.7% and that of sHTG was 0.2% between 2010 and 2019 among individuals with recorded TG. msHTG/sHTG most often affected men around their fifties and people with obesity and uncontrolled DM. Most msHTG and sHTG cases were associated with the presence of secondary causes.
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Affiliation(s)
- Emilio Ortega
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Lipid and Vascular Risk Unit, Endocrinology and Nutrition Department, Hospital Clinic Barcelona, Spain; CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.
| | - Bogdan Vlacho
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ray Puig Treserres
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Primary Health Care Center, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Andreu Altes
- Primary Health Care Center, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain; Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain; Departament of Medicine, University of Vic - Central University of Catalonia, Vic, Barcelona, Spain
| | - Josep Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Primary Health Care Center, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain
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Phillips AE, Wilson AS, Greer PJ, Hinton A, Culp S, Paragomi P, Pothoulakis I, Singh V, Lee PJ, Lahooti I, Whitcomb DC, Papachristou GI. Relationship of circulating levels of long-chain fatty acids to persistent organ failure in acute pancreatitis. Am J Physiol Gastrointest Liver Physiol 2023; 325:G279-G285. [PMID: 37461868 PMCID: PMC10511174 DOI: 10.1152/ajpgi.00074.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/22/2023]
Abstract
During acute pancreatitis (AP), free fatty acids (FFAs) are liberated from circulating triglycerides (TG) and injured adipocytes by pancreatic lipase. Circulating FFAs have been suspected as a source of systemic lipotoxicity in AP. However, assessment of FFAs is difficult and time-consuming, and little is known about relative levels of FFAs between patients with different severities of AP and controls. This study's aims were to assess early circulating levels of FFAs, (both saturated and unsaturated) in patients with AP vs. controls, and associations between FFA levels and AP severity. Serum samples from patients with AP were collected at enrollment (day 1 of hospital stay); serum samples were also collected from controls. FFAs including palmitic, palmitoleic, stearic, oleic, and linoleic acid were extracted and quantitated using gas chromatography separation. Severity of AP was determined by Revised Atlanta Classification. Differences in FFA levels and percentages of total FFAs were assessed between patients with AP and controls and patients with AP of different severity grades. A total of 93 patients with AP (48 female, 52%) and 29 controls (20 female, 69%) were enrolled. Of the patients with AP, 74 had mild/moderate and 19 had severe AP. Serum levels of all FFAs except stearic acid were significantly higher in patients with AP compared with controls. A strong and independent association between elevated palmitoleic acid levels and severe AP was found. Serum unsaturated FFA levels, specifically palmitoleic acid, appear to correlate with severe AP. These findings have potential clinical implications for targeted AP therapies.NEW & NOTEWORTHY Drivers of the inflammatory response in acute pancreatitis remain incompletely understood. Unsaturated fatty acids, specifically palmitoleic, appear to have an association with more severe acute pancreatitis. This finding presents a new clinical understanding of fatty acid toxicity and highlights a potential future target for treatment in severe acute pancreatitis.
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Affiliation(s)
- Anna Evans Phillips
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Annette S Wilson
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Phil J Greer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Stacey Culp
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Pedram Paragomi
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Ioannis Pothoulakis
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Vijay Singh
- Division of Gastroenterology, Department of Medicine, Mayo Clinic, Scottsdale, Arizona, United States
| | - Peter J Lee
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Ila Lahooti
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - David C Whitcomb
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University, Columbus, Ohio, United States
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Chen L, Zhou X, Tu X, Cheng H, Duan Z, Lu G, Yuan Y. People's perceptions and experience of managing life after recurrent pancreatitis: a qualitative study in eastern China. Sci Rep 2022; 12:18749. [PMID: 36335196 PMCID: PMC9637212 DOI: 10.1038/s41598-022-22287-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 10/12/2022] [Indexed: 11/08/2022] Open
Abstract
There is a high rate of recurrent hypertriglyceridemic acute pancreatitis (HTG-RAP) and risk of developing into chronic pancreatitis among recurrent hypertriglyceridemic acute pancreatitis. The key to avoiding recurrence is home-based self-management. However, self-management has proven to be difficult. Exploring experiences and perceptions of home-based self-management among patients with HTG-RAP could inform intervention development and policy making in primary care. To explore experiences and perceptions of home-based self-management among patients with HTG-RAP. This is primarily a qualitative study involving patients from eastern China. The study was designed using semi-structured interviews combined with open interviews among individuals and focus groups. Interviews with patients (n = 25) and relatives (n = 2) were conducted from October to December, 2021. Data were analyzed using the thematic analysis approach. Five themes were identified: (1) pity, (2) sense of uncertainty, (3) contradiction, (4) the way to cope, and (5) benefits. The themes constituted a continuous process where a final coping strategy was confirmed. Patients expressed sorrow, struggle, pity, adaptation, and benefits. The disease still bothered them without attack, both mentally and physically. These key points deserve considerable attention to improve the quality of life of patients and lifestyle modification. Patients with pancreatitis were more likely to manage the disease but under a tough process, and during the struggle, they experienced a continuous and contradictory period. Ultimately, the final condition was reached.
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Affiliation(s)
- Lin Chen
- grid.268415.cCollege of Nursing, Yangzhou University, Jiangsu, China
| | - Xingxing Zhou
- grid.268415.cCollege of Nursing, Yangzhou University, Jiangsu, China
| | - Xiamin Tu
- grid.268415.cCollege of Medicine, Yangzhou University, Jiangsu, China
| | - Hongmei Cheng
- grid.452743.30000 0004 1788 4869Department of Nursing, the affiliated hospital of Yangzhou University, Jiangsu, China
| | - Zhaotao Duan
- grid.452743.30000 0004 1788 4869Department of Nursing, the affiliated hospital of Yangzhou University, Jiangsu, China
| | - Guotao Lu
- grid.452743.30000 0004 1788 4869Department of Nursing, the affiliated hospital of Yangzhou University, Jiangsu, China
| | - Yuan Yuan
- grid.452743.30000 0004 1788 4869Department of Nursing, the affiliated hospital of Yangzhou University, Jiangsu, China
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Zhou L, Gao YW, Xu SX, Lu GT, Xiao WM. Meta-analysis of risk factors for recurrent acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2021; 29:517-525. [DOI: 10.11569/wcjd.v29.i10.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With the continuous improvement of living standards, the incidence of recurrent acute pancreatitis is also increasing year by year, and this disease has become a hot research topic in recent years. Understanding the etiology of recurrent acute pancreatitis has become an urgent problem to be solved in clinical practice.
AIM To explore the risk factors for recurrent acute pancreatitis (RAP) by means of systematic evaluation, and provide evidence for better prevention of RAP.
METHODS We searched CNKI, CBM, VIP, Wanfang, The Cochrane Library, PubMed, Embase, and Web of Science databases to collect case-control and cohort studies on the risk factors associated with RAP from January 1, 2000 to February 29, 2020. "Pancreatitis", "recurrence", "risk factors", and their free words were selected as keywords. The retrieved articles were evaluated and filtrated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed based on the articles scored above 6 by using Revman5.3 software.
RESULTS A total of 15 articles were included, with the cumulative number of cases and controls reaching 2258 and 8482, respectively. The results of meta-analysis showed that alcohol consumption [odds ratio [OR] = 1.83, 95%CI (1.30, 2.59), P = 0.0006], smoking [OR = 2.09, 95%CI (1.61, 2.73), P < 0.00001], biliary AP [OR = 1.82, 95%CI (1.28, 2.57), P = 0.0008], hypertriacylglyceremic AP [OR = 2.24, 95%CI (1.76, 2.85), P < 0.00001], alcoholic AP [OR = 2.68, 95%CI (2.03, 3.55), P < 0.00001], diabetes [OR = 1.57, 95%CI (1.48, 1.66), P < 0.00001], fatty liver [OR = 2.05, 95%CI (1.22, 3.47), P = 0.007], and CT score [OR = 3.52, 95%CI (2.28, 5.43), P < 0.00001] were statistically significant risk factors for RAP.
CONCLUSION Current evidence shows that the risk factors for RAP include disease factors (biliary, alcoholic, and hypertriacylglyceremic AP, fatty liver, and diabetes), behavioral factors (alcohol consumption and smoking), and related indicators (CT score). Due to the limited quantity and quality of included studies, more prospective high-quality clinical studies are needed to verify the above conclusion.
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Affiliation(s)
- Lu Zhou
- Yangzhou University Medical Academy, Yangzhou 225000, Jiangsu Province, China
| | - Yi-Wen Gao
- School of Nursing, Yangzhou University, Yangzhou 225000, Jiangsu Province, China
| | - Song-Xin Xu
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou 225000, Jiangsu Province, China
| | - Guo-Tao Lu
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou 225000, Jiangsu Province, China
| | - Wei-Ming Xiao
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou 225000, Jiangsu Province, China
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