Association between Baseline Fasting Plasma Glucose Levels and Risk of Acute Pancreatitis in Non-obese Population: a Prospective Cohort Study

Abstract

Background Previous studies have shown that the risk of acute pancreatitis (AP) is increased in obesity population, while obese patients are often combined with abnormal fasting plasma glucose (FPG). It still remians controversial whether FPG independently increases the risk of AP and the relationship between FPG and the risk of AP in non-obese patients has been rarely reported in China and abroad. Objective To explore the association between baseline FPG level and the risk of AP in non-obese population. Methods Using a prospective cohort study method, a total of 102 512 non-obese cases from the Kailuan study cohort who completed physical examination for the first time in KaiLuan General Hospital and its 10 affiliated hospitals from 2006 to 2009 were enrolled as study subjects. Epidemiological data, anthropometric data, laboratory test indicators and other information of the subjects were collected. The study subjects were divided into 4 groups according to the FPG quartile: the first quartile group (group Q1, FPG≤4.66 mmol/L, n=25 929) ; the second quartile group (group Q2, 4.66 mmol/L≤FPG<5.10 mmol/L, n=25 797) ; the third quartile group (group Q3, 5.10 mmol/L≤FPG<5.67 mmol/L, n=25 162) ; the fourth quartile group (group Q4, FPG≥5.67 mmol/L, n=25 624). The Kaplan-Meier method was used to plot the survival curves of new-onset AP in non-obese population. The cumulative incidence of AP in non-obese population in different FPG level groups were calculated and Log-rank method was used for inter-group test. The Cox proportional hazard regression model was used to analyze the influencing factors for the new-onset AP in non-obese population and the correlation between different FPG level groupings and new-onset AP in non-obese population. Results The median follow-up time in this study was (12.8±2.4) years with the cumulative incidence of 320 cases and incidence density of 2.44 cases per 10 000 person-years in AP. There were statistically significant differences in the cumulative incidence of AP among the 4 FPG level groups (χ2=13.96, P<0.001). The results of Cox proportional hazard regression analysis showed that advanced age〔HR=1.02, 95%CI (1.01, 1.03), P=0.001〕, high triacylglycerol (TG) level〔HR=1.22, 95%CI (1.13, 1.30), P<0.001〕, history of cholithiasis〔HR=2.79, 95%CI (1.88, 4.13), P<0.001〕were risk factors for new-onset AP in non-obese population. Years of education ≥9 years〔HR=0.65, 95%CI (0.47, 0.90), P<0.001〕was the protective factor for new-onset AP in non-obese population. The HR for new-onset AP in group Q4 was 1.40 〔95%CI (1.02, 1.92), P=0.038〕. After excluding the population applying hypoglycemic drugs, the conclusions were unchanged, the HR for new-onset AP in group Q4 was 1.40 〔95%CI (1.02, 1.92), P=0.036〕. Conclusion Advanced age, high TG levels, and history of cholithiasis are risk factors for new-onset AP, years of education ≥9 years is the protective factor for new-onset AP. And the risk of AP increases when FPG ≥5.67 mmol/L in non-obose population.

Keywords

• pancreatitis|acute pancreatitis|fasting plasma glucose|incidence|morbidity risk|non-obese people|root cause analysis|cohort studies