Chronic comorbidities and nutrition-related outcomes in acute pancreatitis

Abstract

The prevalence of chronic comorbidities is increasing worldwide and this has been paralleled by an increasing interest in how these comorbidities affect clinically meaningful outcomes in acutely or critically-ill patients. Research has indicated that obesity and diabetes mellitus may have a role to play in the risk and course of acute pancreatitis, an example of an acute disease. Nutritional status is of great importance during acute and critical illness therefore, this thesis aims to better understand the effect that chronic comorbidities such as obesity, diabetes mellitus, and metabolic syndrome have on nutrition-related outcomes in an acute pancreatitis setting. Patients with acute pancreatitis were prospectively enrolled into this cohort study between December 2009 and March 2015 at Auckland City Hospital. The nutrition-related outcomes: quantity of food consumed, meal satisfaction, abdominal pain, nausea, and bloating on days one, two, and three of hospitalisation were the primary end points presented in this thesis. Results obtained from this study showed that there were significant differences in patient-reported nausea on day three of hospitalisation between those with and without pre-existing diabetes mellitus, and those with and without metabolic syndrome. Those with pre-existing diabetes mellitus and metabolic syndrome reported worse nausea than those who did not have these comorbidities. Results obtained also showed that the risk of developing type two diabetes mellitus score was significantly associated with abdominal pain on day two of hospitalisation. The effect of confounding factors on nutrition-related outcomes were also investigated in this thesis and significant differences in terms of age and nausea between those with and without metabolic syndrome, and also between patients with different risks of developing type two diabetes mellitus were found, as well as a significant difference between ethnicity and abdominal pain on day two of hospitalisation. Ethnic differences were observed in terms of body mass index, differences in sex were observed between those with different body adiposity indexes, and differences in pain management received between those with different body adiposity indexes, and risks of type two diabetes mellitus scores. The findings of this study indicate the potential role that chronic comorbidities may play in nutritionrelated outcomes. Future research should be directed towards understanding the impact that chronic comorbidities have on nutrition-related outcomes in patients with acute and critical illness. Additionally there is also a great demand for more extensive research into the mechanisms that cause adverse outcomes in these patients.