Association of Obesity with Complications of Acute Pancreatitis

Acute pancreatitis (AP) is defined as the infection and degeneration of pancreatic acinar cells of pancreas. In the United States. It is one of the top causes of hospitalizations linked to gastrointestinal illnesses.¹The prevalence of AP ranges from 4 to more than 100 per 100,000 people annually in Europe. The major risk factors of AP are diabetes mellitus, smoking, alcohol abuse and gallstones.² Severe AP occurs in around 20% of patients and is associated with consequences such as walled-off pancreatic necrosis, acute kidney damage (AKI), including acute respiratory distress syndrome (ARDS). It has a 30% mortality rate, and early detection of severity is essential for improved clinical results and survival.^3-4 A body mass index (BMI) of 30 kg/m2 or more of an individual is termed as obesity. Its prevalence increased from 30.5% in 2000 to 41.9% in 2020, making it a global pandemic.⁵ The metabolic and cardiovascular consequences of obesity are well-established in the peer-reviewed literature, and it contributes  0.7% - 2.8% of overall healthcare costs.⁶ Obesity is becoming more common, and so is the prevalence of AP. Obesity has been linked to gallstone development, diabetes, and hyperlipidemia, all of which are risk factors for AP.⁷ Obesity has been linked in certain studies to both local and systemic problems as well as AP mortality. The postulated mechanism being breakdown of adipocytes by pancreatic enzymes during acute inflammation resulting in out flux of unsaturated fatty acids contributing to local and systemic problems.^7-8 While some studies identified obesity as a substantial changeable risk variable for AP & related complications, the peer-reviewed literature has inconsistent findings. Certain studies even show a counterintuitive impact of obesity in acute pancreatitis. ^8-9 The present study was conducted to find out the Association of Obesity with complications of acute pancreatitis.

The present prospective study was carried out at the Department of General surgery Bolan medical college Quetta from June 2025 to November 2025 after taking approval from the ethical committee of the hospital. Individuals of both genders and different age groups (ranged 22-70 years) diagnosed with acute pancreatitis based on biochemical (high plasma amylase or lipase, upper or lower abdominal pain) and clinical characteristic (CRP of above 10mg/dl serum concentration) were included in this study. While individual with chronic pancreatitis or not welling to participate were excluded from the study. Written consent was taken from each participant. Serum samples were obtained within twenty-four hours of hospital admission.  Sample size was determined using WHO calculator. The sample size determined was 204 .According to the who guidelines BMI was defined.10The study divided the individuals with acute pancreatitis into two groups: those with a normal BMI (102 participants) and those with a BMI >30kg/m2. (102 participants). Non-probability sequential sampling method was used for data collection. There were 102 participants, both exposed (obesity) and unexposed (not obese). Clinical, physiological, and biochemical data were documented. Patients were categorized into three categories (mild, moderate, and severe acute pancreatitis) according to the Atlanta classification.11Patients were monitored for ten days to assess the results of acute pancreatitis. Data was entered and analyzed using SPSS version 26.  To evaluate the normality of the data the Shapiro-Wilk test was used.  BMI, weight Age, length of ICU admission and height were expressed as means and standard deviations. Frequency and percentages were used for representation of Gender, chronic illnesses such as hypertension, diabetes, a family history of acute pancreatitis, in-hospital mortality, organ failure and necrosis. Acute pancreatitis outcomes have been compared among exposed and unexposed groups using Chi-square or Fisher exact tests, with statistical significance defined as p<0.05 and RR > 1 indicating a significant connection. Stratification was performed to control confounders such age, sex, family history of acute pancreatitis, and comorbidities to examine the influence of these on outcomes of the exposure and non-exposed group.

A total of 202 individuals diagnosed with acute pancreatitis were enrolled. The mean age of the study population was 54.27 ± 12.21 years and that for obese was 54.32 ± 11.21 and non-obese was 54.23 ± 13.19 years. Obese individuals weighed 91.31 ± 7.26 kg, whereas non-obese participant’s weight was 71.63 ± 10.89 kg. Obese individuals had mean height was 163.92 ± 6.60 cm, while non-obese height was171.40 ± 8.25 cm. There were substantial differences in weight and height across the groups. Gender wise distribution showed that male were more common in non-obese group 62 (60.8%) as compared to female 40 (39.2%).Over all male were 114 (55.9%) and female were 114 (55.9%).Among the study participants 64 patients (31.6%) had mild 104 (51.48%) with moderate  and 34 (16.8%) with severe pancreatitis. The frequency of hypertension and family history of acute pancreatitis were comparable between the groups. While diabetes mellitus was more common 65 (63.7%) in non-obese individuals as compared to obese group 54 (52.9%). The mean hospital stay and the length of ICU stay were similar across obese and non-obese groups as explained in table 1. Death rate in the hospital was higher in the individuals with obesity 16(15.6%) as compared to non-obese individuals 4(4%). This deference was statistically significant between the two groups.  Similarly Obese group had high rate of organ failure 48(47.05%) compared to individuals with no obesity 26(25.4%) (p -value <0.05). Necrosis was high in obese group but was not statistically significant (p-value > 0.05) as shown in table 2.

Acute pancreatitis is defined by the production and activation of an enzyme trypsinogen to trypsin, which leads in tissue destruction. It manifests with stomach pain extending to the back, nausea, vomiting, and fever. The prognosis is variable, but the death rate is high. Most individuals recover without complications. However, a variety of complications, including acute respiratory distress syndrome, systemic inflammatory response syndrome, sepsis, and multi-organ failure with pancreatic necrosis, may occur. Various scoring systems based on clinical and biochemical data, have been used to predict the severity of acute pancreatitis.¹³ Furthermore, the Revised Atlanta classification was utilized to classify acute pancreatitis into mild, moderately severe, and severe categories.¹⁴ Obesity & outcomes in individuals with acute pancreatitis were shown to be significantly correlated in many Asian and Pakistani studies.^15-16

A total of 202 individuals diagnosed with acute pancreatitis were enrolled. The mean age of the study population was 54.27 ± 12.21 years and that for obese was 54.32 ± 11.21 and non-obese was 54.23 ± 13.19 years. Over all male were 114 (55.9%) and female were 114 (55.9%).Among the study participants 64 patients (31.6%) had mild 104 (51.48%) with moderate and 34 (16.8%) with severe pancreatitis. Similar demographic features were reported from the study carried out by Zahoor in which male were dominated over female and most of the participants had moderate pancreatitis which support our study.¹⁷ In our study death rate in the hospital was higher in the individuals with obesity 16(15.6%) as compared to non-obese individuals 4(4%). This deference was   statistically significant between the two groups.  Similarly Obese group had high rate of organ failure 48(47.05%) compared to individuals with no obesity 26(25.4%) (p -value <0.05). Necrosis was high in obese group but was not statistically significant. Our findings are comparable to those of Papachristou et al. Obese persons with BMI >30kg/m2 had significantly greater incidence of organ failure (31 percent), necrosis (17 percent), & mortality (14%), compared to normal/non-obese adults with BMI <30 kg/m2 (14 percent, 8%, & 1.4%, respectively).¹⁸ our findings are also comparable to another study in which it was reported that obesity is strongly associated with AP.¹⁷ Obesity is a known risk factor for acute pancreatitis in all age groups, as it is for many other conditions. Thavamani et al. from the United States investigated the effect of morbid obesity on the clinical outcomes of acute pancreatitis in a juvenile population. Obesity was found to be a co-morbid independent predictor of adverse outcomes in the juvenile group with acute pancreatitis.¹⁹ Another study  investigated the influence of demographic variables, obesity, and related health conditions on the onset of acute pancreatitis and discovered that coexisting health conditions, pancreatic necrosis, and those who underwent open surgical necrosectomy within thirty days, were significantly associated with mortality within thirty days as well as chronic organ failure.²⁰ These results are fairly comparable to what we found. Further studies are required to investigate the link between obesity and AP effects.

 Limitations of the study

The study failed to investigate the possible mechanisms underlying the connection between obesity and negative outcomes. Furthermore, the study failed to consider other confounding variables such as inherited traits, lifestyle choices, or specialized medical histories that might have affected the outcome.

Obesity was shown to be significantly associated with worse outcomes in acute pancreatitis. Obese individuals had higher rate of hospital associated death rate and organ failure than their non-obese individuals.

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