The increasing prevalence and adverse impact of morbid obesity in paediatric acute pancreatitis

Abstract

SummaryObjectiveMorbid obesity is proinflammatory has been associated with adverse clinical outcomes in acute pancreatitis (AP) among adults. Obesity is increasingly prevalent in children and hence, we sought to evaluate the impact of morbid obesity on the clinical outcomes of AP using a large paediatric population‐based cohort.MethodsWe analysed the US Kids' Inpatient Database between years 2003 and 2016 to include all patients (age ≤ 21 years) with a primary diagnosis of AP using specific ICD‐9‐CM and ICD‐10‐CM codes. We compared clinical outcomes between children without obesity (controls) and those with morbid obesity (cases). The primary outcome was severe AP (2012 revised Atlanta classification) and secondary outcomes included healthcare resource utilization (length of stay and hospital costs).ResultsAmong 36 698 paediatric AP hospitalizations, 1275 (3.5%) were found to have morbid obesity. From 2003 to 2016, the proportion of children with morbid obesity among AP patients increased from 1.3% to 5.5% (P < .001). More than half (54%) of the children with morbid obesity were presented with cholelithiasis as contributive aetiology. The prevalence of severe AP was significantly higher in morbid obesity (7.3% vs 3.8%, P < .001). Multivariate analysis revealed that morbid obesity was increasingly associated with severe AP (OR 1.79, 95% CI 1.4, 2.26), prolonged hospitalization (by 0.41 days, P = .03), and higher hospital costs (by $1596, P < .001).ConclusionUnlike adult population, there is a lack of other confounding comorbidities in children and this national‐level analysis shows that morbid obesity independently prognosticates adverse clinical outcomes in paediatric AP.

Assessment of Computed Tomography-Defined Muscle and Adipose Tissue Features in Relation to Length of Hospital Stay and Recurrence of Hypertriglyceridemic Pancreatitis

“…Blaszczak et al reported that class III obesity seems to have an adverse mortality effect in patients with AP [11]. A recent study by Thavamani et al suggested that morbid obesity is an independent risk factor for clinical outcomes in pediatric AP [12]. The mechanism by which obesity aggravates pancreatitis has been investigated.…”

“…Clinical and experimental data have shown that obesity is a risk factor for AP [4,[8][9][10][11][12][13]. However, most studies did not distinguish between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT).…”

Undernutrition and Obesity Are Associated with Adverse Clinical Outcomes in Hospitalized Children and Adolescents with Acute Pancreatitis

“…Recent studies indicate that the incidence of acute pancreatitis (AP) is steadily increasing in children [1][2][3][4][5][6]. The incidence rate of AP-related hospitalization is even higher, and it increased from 10.5 per 10,000 in 2003 to 14.6 per 10,000 hospitalizations in 2016 [6].…”

“…Recent studies indicate that the incidence of acute pancreatitis (AP) is steadily increasing in children [1][2][3][4][5][6]. The incidence rate of AP-related hospitalization is even higher, and it increased from 10.5 per 10,000 in 2003 to 14.6 per 10,000 hospitalizations in 2016 [6]. The majority of cases of acute pancreatitis in children resolve spontaneously requiring supportive care, and, unlike in adults, the mortality rate of acute pancreatitis is low [6].…”

“…The majority of cases of acute pancreatitis in children resolve spontaneously requiring supportive care, and, unlike in adults, the mortality rate of acute pancreatitis is low [6]. However, 4-34% of children and adolescents with acute pancreatitis may develop severe disease with complications requiring intensive care unit (ICU) admission and prolonged hospital stay, resulting in increased health care expenditure [6][7][8][9].…”