Pancreatic Insufficiency Secondary to Tobacco Exposure A Controlled Cross-Sectional Evaluation

• Type of Material: Article
• Authors: Kara L. Raphael, Emory University; Saurabh Chawla, Emory University; Sungjin Kim, Cedars Sinai Medical Center; Christopher G. Keith, Emory University; David Propp, Emory University; Zhengjia Chen, Emory University; Kevin E. Woods, Cancer Treatment Centers of America; Steven Keilin, Emory University; Qiang Cai, Emory University; Field Willingham, Emory University
• Language: English
• Date: 2017-02-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/MPA.0000000000000721
• Title of Journal or Parent Work: Pancreas
• ISSN: 0885-3177
• Volume: 46
• Issue: 2
• Start Page: 237
• End Page: 243
• Grant/Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.; This manuscript was supported in part by a development grant from the Department of Medicine at Emory University School of Medicine.
• Keywords: fecal elastase-1; METAANALYSIS; Gastroenterology & Hepatology; ALCOHOL-CONSUMPTION; Science & Technology; FECAL ELASTASE-1; HISTORY; CIGARETTE-SMOKING; RECURRENT ACUTE; DISEASE; Life Sciences & Biomedicine; tobacco; smoking; RISK; HABITS; pancreatic insufficiency; UNITED-STATES
• Research Categories: Biology, Biostatistics; Health Sciences, Oncology

Abstract

Objectives: Tobacco exposure is an established risk factor for pancreatic cancer and chronic pancreatitis; however, its role in pancreatic insufficiency is not clear. Methods: This controlled, cross-sectional study examined smokers and nonsmokers with no history of pancreatic disease. Histories and validated inventories of alcohol and tobacco use were obtained, and pancreatic insufficiency was assessed using the fecal elastase-1 assay. Results: Of 7854 patients approached, 226 were interviewed and 200 enrolled. The rates of pancreatic insufficiency [18% (18/100)] and severe pancreatic insufficiency [10% (10/100)] were significantly higher in smokers than in controls [6% (6/100), P = 0.009 and 1% (1/100), P = 0.010, respectively]. On multivariate logistic regression, the risk of pancreatic insufficiency in smokers was significantly increased [odds ratio, 4.34 (1.37-13.75); P = 0.012], controlling for alcohol use and relevant covariates. Tobacco exposure was associated with the highest odds ratio for pancreatic insufficiency. Alcohol consumption was strongly associated with tobacco exposure (P < 0.001), but not with pancreatic insufficiency by multivariate analysis (P = 0.792). Conclusions: This study suggests that tobacco exposure is independently associated with pancreatic exocrine insufficiency in patients without a prior diagnosis of pancreatic disease. Tobacco exposure seems to have greater detrimental effects on pancreatic function than alcohol in this population.