Impact of Elevated Serum Triglycerides on Children with Acute Recurrent or Chronic Pancreatitis from INSPPIRE-2

Zachary M Sellers¹, Matthew J Giefer², Fuchenchu Wang³, Gretchen A Cress⁴, Maisam A Abu-El-Haija⁵, Ankur Chugh⁶, Reuven Z Cohen⁷, Elissa M Downs⁸, Douglas S Fishman⁹, A Jay Freeman¹⁰, Cheryl E Gariepy¹⁰, Tanja Y Gonska¹¹, Amit S Grover¹², Doug Lindblad¹³, Quin Y Liu¹⁴, Asim Maqbool¹⁵, Jacob A Mark¹⁶, Brian A McFerron¹⁷, Megha S Mehta¹⁸, Veronique D Morinville¹⁹, Kenneth Ng²⁰, Robert A Noel²¹, Chee Y Ooi²², Emily R Perito²³, Madhura Y Phadke¹³, Wenly Ruan⁹, Sarah Jane Schwarzenberg⁸, David M Troendle¹⁸, Michael Wilschanski²⁴, Yuhua Zheng²⁵, Ying Yuan³, Mark E Lowe²⁶, Aliye Uc⁴; Consortium for the Study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer

Affiliations

¹ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA. Electronic address: zsellers@stanford.edu.
² The University of Queensland, Brisbane, Queensland, Australia; AU and Ochsner Hospital for Children, New Orleans, LA.
³ The University of Texas, MD Anderson Cancer Center, Houston, TX.
⁴ University of Iowa, Stead Family Children's Hospital, IA.
⁵ Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH.
⁶ Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI.
⁷ Emory University, Children's Healthcare of Atlanta, Atlanta, GA.
⁸ University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
⁹ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
¹⁰ Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
¹¹ Department of Pediatrics, University of Toronto, and Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
¹² Boston Children's Hospital and Harvard Medical School, Boston, MA.
¹³ Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
¹⁴ Cedars-Sinai Medical Center, Los Angeles, CA.
¹⁵ Children's Hospital of Philadelphia, Philadelphia, PA.
¹⁶ University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, CO.
¹⁷ Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.
¹⁸ University of Texas Southwestern Medical Center and Children's Health, Dallas, TX.
¹⁹ Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
²⁰ Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD.
²¹ Baylor College of Medicine, San Antonio, TX.
²² Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales and Department of Gastroenterology, Sydney Children' Hospital Randwick, Sydney, Nova Scotia, Australia.
²³ University of California, San Francisco, San Francisco, CA.
²⁴ Hadassah Hebrew University Hospital, Jerusalem, Israel.
²⁵ Children's Hospital Los Angeles, Los Angeles, CA.
²⁶ Washington University School of Medicine, St. Louis, MO.

PMID: 39277078
PMCID: PMC11645242 (available on 2026-01-01)
DOI: 10.1016/j.jpeds.2024.114298

Multicenter Study

Impact of Elevated Serum Triglycerides on Children with Acute Recurrent or Chronic Pancreatitis from INSPPIRE-2

Zachary M Sellers et al. J Pediatr. 2025 Jan.

. 2025 Jan:276:114298.

doi: 10.1016/j.jpeds.2024.114298. Epub 2024 Sep 12.

Authors

Affiliations

¹ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA. Electronic address: zsellers@stanford.edu.
² The University of Queensland, Brisbane, Queensland, Australia; AU and Ochsner Hospital for Children, New Orleans, LA.
³ The University of Texas, MD Anderson Cancer Center, Houston, TX.
⁴ University of Iowa, Stead Family Children's Hospital, IA.
⁵ Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH.
⁶ Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI.
⁷ Emory University, Children's Healthcare of Atlanta, Atlanta, GA.
⁸ University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
⁹ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
¹⁰ Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
¹¹ Department of Pediatrics, University of Toronto, and Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
¹² Boston Children's Hospital and Harvard Medical School, Boston, MA.
¹³ Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
¹⁴ Cedars-Sinai Medical Center, Los Angeles, CA.
¹⁵ Children's Hospital of Philadelphia, Philadelphia, PA.
¹⁶ University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, CO.
¹⁷ Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.
¹⁸ University of Texas Southwestern Medical Center and Children's Health, Dallas, TX.
¹⁹ Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
²⁰ Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD.
²¹ Baylor College of Medicine, San Antonio, TX.
²² Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales and Department of Gastroenterology, Sydney Children' Hospital Randwick, Sydney, Nova Scotia, Australia.
²³ University of California, San Francisco, San Francisco, CA.
²⁴ Hadassah Hebrew University Hospital, Jerusalem, Israel.
²⁵ Children's Hospital Los Angeles, Los Angeles, CA.
²⁶ Washington University School of Medicine, St. Louis, MO.

PMID: 39277078
PMCID: PMC11645242 (available on 2026-01-01)
DOI: 10.1016/j.jpeds.2024.114298

Abstract

Objective: To determine if mild-moderate hypertriglyceridemia (HTG) is associated with increased development of chronic pancreatitis (CP) or pancreatitis-associated complications in children with acute recurrent or CP.

Study design: Longitudinal data from the INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2 (INSPPIRE-2) cohort of children with acute recurrent or CP (n = 559) were analyzed. Subjects were divided into normal triglycerides (<150 mg/dL; 1.7 mmol/L), any HTG (≥150 mg/dL; ≥1.7 mmol/L), mild-moderate HTG (150-499 mg/dL; 1.7-5.6 mmol/L), moderate HTG (500-999 mg/dL; 5.6-11.3 mmol/L), and severe HTG groups (≥1000 mg/dL; ≥11.3 mmol/L), based on highest serum triglyceride value. Laboratory, imaging, pancreatitis and hospital events, complications, and quality of life data were analyzed.

Results: In children with acute recurrent or CP and HTG, there was no increase in the number of pancreatitis attacks per person-years, nor an increase in CP prevalence. However, HTG severity was associated with increased pancreatic inflammation, pancreatic cysts, pain, hospital days, number of hospitalizations, intensive care, and missed school days.

Conclusions: Mild-moderate HTG in children with acute recurrent or CP was not associated with increased pancreatitis frequency, nor increased development of CP, but was associated with increased pancreatitis complications and disease burden. As a treatable condition, treatment of mild-moderate HTG may be considered to reduce pancreatitis-associated complications and medical burden in children with acute recurrent or CP.

Keywords: lipids; pancreas; pediatric; triglycerides.

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Conflict of interest statement

Declaration of Competing Interest Z.M.S. is currently an employee of 4D Molecular Therapeutics Inc and a consultant for BridgeBio Pharma and Renexxion. M.A.H. is the president of CAPER, a board member of CAPER, and a board member of the National Pancreas Foundation. T.G. received a research grant from Vertex Pharmaceuticals, and she is a consultant for Cystic Fibrosis Foundation (CFF). C.Y.O. is a consultant for and has received research grant from Vertex Pharmaceuticals. E.R.P. is a consultant for BridgeBio and Ultragenyx. S.J.S. is a consultant for UpToDate, Nestle, Abbvie, Renexxion, and the CFF. A.J.F. is a consultant for Takeda and AbbVie, CFF, and is a member of the CAPER board. V.D.M. is an Associate Editor for JPGN Reports. D.M.T. is an Associate Editor for JPGN. M.W. is a consultant for and has received research grants from Vertex Pharmaceuticals. M.E.L. receives royalties from Millipore Inc and UpToDate and consults for CFF. A.U. is a consultant for CFF and Abbvie Inc. The other authors declare no conflicts of interest.

References

1. Amann ST, Yadav D, Barmada MM, O'Connell M, Kennard ED, Anderson M, et al. Physical and mental quality of life in chronic pancreatitis: a case-control study from the North American Pancreatitis Study 2 cohort. Pancreas. 2013;42(2):293–300. - PMC - PubMed
1. Uc A, Cress GA, Wang F, Abu-El-Haija M, Ellery KM, Fishman DS, et al. Analysis of INSPPIRE-2 Cohort: Risk Factors and Disease Burden in Children With Acute Recurrent or Chronic Pancreatitis. J Pediatr Gastroenterol Nutr. 2022;75(5):643–9. - PMC - PubMed
1. Tham SW, Wang F, Gariepy CE, Cress GA, Abu-El-Haija MA, Bellin MD, et al. Health-Related Quality of Life in Pediatric Acute Recurrent or Chronic Pancreatitis: Association With Biopsychosocial Risk Factors. J Pediatr Gastroenterol Nutr. 2022;74(5):636–42. - PMC - PubMed
1. Liu QY, Abu-El-Haija M, Husain SZ, Barth B, Bellin M, Fishman DS, et al. Risk Factors for Rapid Progression From Acute Recurrent to Chronic Pancreatitis in Children: Report From INSPPIRE. J Pediatr Gastroenterol Nutr. 2019;69(2):206–11. - PMC - PubMed
1. Toskes PP. Hyperlipidemic pancreatitis. Gastroenterol Clin North Am. 1990;19(4):783–91. - PubMed

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Impact of Elevated Serum Triglycerides on Children with Acute Recurrent or Chronic Pancreatitis from INSPPIRE-2

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Impact of Elevated Serum Triglycerides on Children with Acute Recurrent or Chronic Pancreatitis from INSPPIRE-2

Authors

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Conflict of interest statement

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