Alcohol Consumption as a Risk Factor for Acute and Chronic Pancreatitis: A Systematic Review and a Series of Meta-analyses

Abstract

Background

Pancreatitis is a highly prevalent medical condition associated with a spectrum of endocrine and exocrine pancreatic insufficiencies. While high alcohol consumption is an established risk factor for pancreatitis, its relationship with specific types of pancreatitis and a potential threshold have not been systematically examined.

Methods

We conducted a systematic literature search for studies on the association between alcohol consumption and pancreatitis based on PRISMA guidelines. Non-linear and linear random-effect dose–response meta-analyses using restricted cubic spline meta-regressions and categorical meta-analyses in relation to abstainers were conducted.

Findings

Seven studies with 157,026 participants and 3618 cases of pancreatitis were included into analyses. The dose–response relationship between average volume of alcohol consumption and risk of pancreatitis was monotonic with no evidence of non-linearity for chronic pancreatitis (CP) for both sexes (p = 0.091) and acute pancreatitis (AP) in men (p = 0.396); it was non-linear for AP in women (p = 0.008). Compared to abstention, there was a significant decrease in risk (RR = 0.76, 95%CI: 0.60–0.97) of AP in women below the threshold of 40 g/day. No such association was found in men (RR = 1.1, 95%CI: 0.69–1.74). The RR for CP at 100 g/day was 6.29 (95%CI: 3.04–13.02).

Interpretation

The dose–response relationships between alcohol consumption and risk of pancreatitis were monotonic for CP and AP in men, and non-linear for AP in women. Alcohol consumption below 40 g/day was associated with reduced risk of AP in women. Alcohol consumption beyond this level was increasingly detrimental for any type of pancreatitis.

Funding

The work was financially supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (R21AA023521) to the last author.

Highlights

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  The dose–response relationships between alcohol use and different types of pancreatitis in men and women are different.

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  The relationship was linear for chronic and acute pancreatitis in men, but non-linear for acute pancreatitis in women.

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  There is a threshold effect for acute pancreatitis in women at the level of up to 40 g/day.

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  The risk of pancreatitis was higher than previously thought beyond the level of 40 g of pure alcohol/day.

The article updates existing knowledge on the relationship between average alcohol consumption and the risk of pancreatitis. Specifically, there are differences between acute and chronic pancreatitis and different sexes. For women there is a threshold of 40 g of ethanol per day — below this level alcohol use is not increasing the risk of acute pancreatitis and might even be beneficial. Above this threshold alcohol use is detrimental. Beyond this threshold the risk of pancreatitis, acute and chronic, in both sexes is greater than previously thought, and increases with increases of average consumption.