Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis

Abstract

Background: Recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) are associated with alcohol consumption and cigarette smoking. The etiology of RAP and CP is complex, and effects of alcohol and smoking may be limited to specific patient subsets. We examined the current prevalence of alcohol use and smoking and their association with RAP and CP in patients evaluated at US referral centers.

Methods: The North American Pancreatitis Study 2, a multicenter consortium of 20 US centers, prospectively enrolled 540 patients with CP, 460 patients with RAP, and 695 controls from 2000 to 2006. Using self-reported monthly alcohol consumption during the maximum lifetime drinking period, we classified subjects by drinking status: abstainer, light drinker (< or =0.5 drink per day), moderate drinker (women, >0.5 to 1 drink per day; men, >0.5 to 2 drinks per day), heavy drinker (women, >1 to <5 drinks per day; men, >2 to <5 drinks per day), or very heavy drinker (> or =5 drinks per day for both sexes). Smoking was classified as never, past, or current and was quantified (packs per day and pack-years).

Results: Overall, participants' mean (SD) age was 49.7 (15.4) years; 87.5% were white, and 56.5% were women. Approximately one-fourth of both controls and patients were lifetime abstainers. The prevalence of very heavy drinking among men and women was 38.4% and 11.0% for CP, 16.9% and 5.5% for RAP, and 10.0% and 3.6% for controls. Compared with abstaining and light drinking, very heavy drinking was significantly associated with CP (odds ratio, 3.10; 95% confidence interval, 1.87-5.14) after controlling for age, sex, smoking status, and body mass index. Cigarette smoking was an independent, dose-dependent risk factor for CP and RAP.

Conclusions: Very heavy alcohol consumption and smoking are independent risks for CP. A minority of patients with pancreatitis currently seen at US referral centers report very heavy drinking.

Figure 1.

Distribution of drinking categories based on self-reported alcohol consumption during the maximum lifetime drinking period among controls, recurrent acute (RAP) or chronic pancreatitis (CP) patients in the NAPS2 study- a) all study participants; b) males; c) females. Refer to methods section for definitions of drinking categories.

Figure 1.

Distribution of drinking categories based on self-reported alcohol consumption during the maximum lifetime drinking period among controls, recurrent acute (RAP) or chronic pancreatitis (CP) patients in the NAPS2 study- a) all study participants; b) males; c) females. Refer to methods section for definitions of drinking categories.

Figure 1.

Distribution of drinking categories based on self-reported alcohol consumption during the maximum lifetime drinking period among controls, recurrent acute (RAP) or chronic pancreatitis (CP) patients in the NAPS2 study- a) all study participants; b) males; c) females. Refer to methods section for definitions of drinking categories.

Figure 2

a) Distribution of self-reported alcohol consumption (average drinks per day) among controls, recurrent acute (RAP) and chronic pancreatitis (CP) patients in the NAPS2 study stratified by drinking categories. Data is presented as median and IQR. The whiskers represent data within 1.5x IQR above and below the 25^th and 75^th percentiles and open circles represent outliers. Refer to methods section for definitions of drinking categories. 2b) Distribution of “At-Risk” drinking behavior among controls, recurrent acute (RAP) and chronic pancreatitis (CP) patients in the NAPS2 study. Controls and pancreatitis patients with a TWEAK score <3 and subjects who were assigned a drinking category are not shown in the figure.

Figure 2

a) Distribution of self-reported alcohol consumption (average drinks per day) among controls, recurrent acute (RAP) and chronic pancreatitis (CP) patients in the NAPS2 study stratified by drinking categories. Data is presented as median and IQR. The whiskers represent data within 1.5x IQR above and below the 25^th and 75^th percentiles and open circles represent outliers. Refer to methods section for definitions of drinking categories. 2b) Distribution of “At-Risk” drinking behavior among controls, recurrent acute (RAP) and chronic pancreatitis (CP) patients in the NAPS2 study. Controls and pancreatitis patients with a TWEAK score <3 and subjects who were assigned a drinking category are not shown in the figure.

Figure 3.

Distribution of self reported smoking among controls, recurrent acute (RAP) or chronic pancreatitis (CP) patients in the NAPS2 study stratified by drinking categories - a) smoking status presented as past or current; b) amount of smoking is presented as pack years of smoking. The proportions are based on effective numbers. Never smokers account for the proportions not reflected in the graphs.

Figure 3.

Distribution of self reported smoking among controls, recurrent acute (RAP) or chronic pancreatitis (CP) patients in the NAPS2 study stratified by drinking categories - a) smoking status presented as past or current; b) amount of smoking is presented as pack years of smoking. The proportions are based on effective numbers. Never smokers account for the proportions not reflected in the graphs.