Abstract
The association between intake of dietary fibre and glucose metabolism has been extensively investigated in numerous metabolic disorders. However, little is known about this association in individuals after an attack of acute pancreatitis (AP). The aim was to investigate the associations between intake of dietary fibre and markers of glucose metabolism in individuals with new-onset prediabetes or diabetes after acute pancreatitis (NODAP), pre-exiting type 2 prediabetes or diabetes, and normoglycaemia after acute pancreatitis. This cross-sectional study was nested within the parent prospective longitudinal cohort study. The studied markers of glucose metabolism were fasting plasma glucose and glycated haemoglobin. Habitual intake of dietary fibre was determined using the EPIC-Norfolk food frequency questionnaire. Multivariable linear regression analyses were conducted. The study included a total of 108 individuals after AP. In the NODAP group, increased intakes of total fibre (β = −0.154, p = 0.006), insoluble fibre (β = −0.133, p = 0.01), and soluble fibre (β = −0.13, p = 0.02) were significantly associated with a reduction in fasting plasma glucose. Increased intakes of vegetables (β = −0.069, p = 0.004) and nuts (β = −0.039, p = 0.038) were significantly associated with a reduction in fasting plasma glucose. Increased intake of nuts (β = −0.054, p = 0.001) was also significantly associated with a reduction in glycated haemoglobin. None of the above associations were significant in the other study groups. Habitual intake of dietary fibre was inversely associated with fasting plasma glucose in individuals with NODAP. Individuals after an attack of AP may benefit from increasing their intake of dietary fibre (specifically, vegetables and nuts) with a view to preventing NODAP.
Highlights
Post-pancreatitis diabetes mellitus, which is a subtype of diabetes of the exocrine pancreas, is the most frequent sequela of acute pancreatitis (AP) [1,2]
Evidence from a population-based study showed that individuals with post-pancreatitis diabetes mellitus are more likely to receive insulin therapy by 16.8% at five years after diabetes diagnosis when compared with individuals with Type 2 diabetes [6]
While in the past it was thought that only extensive pancreatic necrosis or chronic inflammation of the pancreas can lead to the development of new-onset diabetes, several recent studies have consistently shown that glucose derangements can develop after an attack of mild acute pancreatitis [2,25,26,27]
Summary
Post-pancreatitis diabetes mellitus, which is a subtype of diabetes of the exocrine pancreas, is the most frequent sequela of acute pancreatitis (AP) [1,2]. An earlier metaanalysis of randomised controlled trials in individuals with Type 2 diabetes showed that an increase in dietary fibre intake (through food high in fibre or soluble fibre supplements for at least eight weeks) resulted in a significant decrease in fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) [11]. A later systematic review of both randomised controlled trials and observational studies in adults with prediabetes, Type 1 diabetes, or Type 2 diabetes showed that increased intake of soluble dietary fibre and wholegrain led to decreased levels of FPG, HbA1c, and insulin in randomised controlled trials (with an average duration of 6 to 12 weeks) as well as with reduced all-cause mortality in prospective observational studies (with a mean follow-up of 8.8 years) [10]. To date, dietary fibre intake has never been investigated in the context of NODAP
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