title: Insights into the development of alcoholic chronic pancreatitis at Soweto, South Africa: a controlled cross-sectional study.
abstract: OBJECTIVE
  We asked why so few working-class Africans of Soweto have chronic pancreatitis (CP) when alcoholism is the norm.
  
  
  METHODS
  Twenty-one alcoholics with acute psychosis but normal pancreas were investigated for lifestyle, micronutrient status, electrophilic stress, and iron overload.
  
  
  RESULTS
  Alcoholics consumed more ethanol daily than did 14 previously studied patients with CP (P = 0.003); cigarette usage was similar; both groups had even poorer vitamin C status than 14 healthy controls, and no participant had iron overload. The CP group had higher scores for exposure to occupational xenobiotics than did alcoholics (P < 0.05), with lower plasma glutathione (P = 0.047) and urinary inorganic sulfate (P = 0.009). Further analysis identified hyperhomocysteinemia in the alcoholic set, with lower vitamin B12 (P < 0.001), higher folic acid (P = 0.003), and similar vitamin B6 levels compared with controls.
  
  
  CONCLUSIONS
  The transition from alcoholism to CP in Soweto is associated with occupational exposure to xenobiotics. Among detoxification systems that are strained thereby, glutathione and inorganic sulfate depend on methionine intake, which is ample in Sowetans, whereas vitamin C, which exerts a glutathione-sparing effect, is deficient. Hence, a daily tablet of vitamin C may enable community prophylaxis against the disease--but homocysteine status would need monitoring.
authors.affiliation: Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.
authors.forename: Isidor
authors.initials: I
authors.lastname: Segal
authors.forename: Reid
authors.initials: R
authors.lastname: Ally
authors.forename: Linda P
authors.initials: LP
authors.lastname: Hunt
authors.forename: Lance N
authors.initials: LN
authors.lastname: Sandle
authors.forename: Johan B
authors.initials: JB
authors.lastname: Ubbink
authors.forename: Joan M
authors.initials: JM
authors.lastname: Braganza
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001205:Ascorbic Acid / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005978:Glutathione / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000097:blood* / Q000209:etiology / Q000652:urine*; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D013019:South Africa; D013431:Sulfates / Q000652:urine*; D015262:Xenobiotics / Q000506:poisoning; D055815:Young Adult
chemical_list: D013431:Sulfates; D015262:Xenobiotics; D005978:Glutathione; D001205:Ascorbic Acid