Acute pancreatitis in obese patients

Abstract

Introduction: Obesity increases severity of acute pancreatitis by unclear mechanisms. Recent clinical studies demonstrate that all major complications are more common and more severe in patients who are obese. Patients with higher body mass index have increased risk of local and systemic complications of acute pancreatitis and patients with android fat distribution and higher waist circumference are at greater risk for developing the severe acute pancreatitis (SAP). Aims:We investigated the relationship between visceral adipose tissue and acute pancreatitis. Patients &methods:We examined 13 patients with acute pancreatitis. In 6 patients BMI was more 30. Computed tomography was performed in all patients. Results: Pancreatitis induces the activation of peritoneal macrophages and a strong inflammatory response in mesenteric sites of adipose tissue. In obese humans, we found that an increase in the volume of intrapancreatic adipocytes was associated with more extensive pancreatic necrosis during acute pancreatitis and that acute pancreatitis was associated with multisystem organ failure in obese individuals. Patients with SAP had higher BMIs and more intrapancreatic fat than those with mild AP. Conclusion: The results confirm the involvement of adipose tissue on the progression of systemic inflammatory response during acute pancreatitis. However, there is a considerable diversity in different adipose tissue sites. These differences need to be taken into account in order to understand the progression from local pancreatic damage to systemic inflammation during acute pancreatitis. Therapeutic approaches that target unsaturated fatty acid-mediated lipotoxicity may reduce adverse outcomes in obese patients with critical illnesses such as severe acute pancreatitis.