title: Factors that affect risk for pancreatic disease in the general population: a systematic review and meta-analysis of prospective cohort studies.
abstract: OBJECTIVE
  Pancreatic diseases place significant burdens on health care systems worldwide. However, there is lack of agreement about which factors increase or reduce risk for pancreatic disease. We reviewed high-quality studies of factors that affect risk for pancreatic diseases in the general population.
  
  
  METHODS
  We searched 3 databases (Medline, Embase, and Scopus) for prospective cohort studies of modifiable risk and/or protective factors for acute pancreatitis, chronic pancreatitis, and pancreatic cancer in adult populations. Factors that were investigated in 2 or more studies were assessed by meta-analysis if the required data were available. Subgroup analyses were performed when appropriate. Outcome measures were relative risk (RR) and 95% confidence interval (CI).
  
  
  RESULTS
  Our analysis included 51 population-based studies with more than 3 million individuals and nearly 11,000 patients with pancreatic diseases. A total of 31 different factors were investigated. Current tobacco use was the single most important risk factor for pancreatic diseases (RR, 1.87; 95% CI, 1.54-2.27), followed by obesity (RR, 1.48; 95% CI, 1.15-1.92) and heavy use of alcohol (RR, 1.37; 95% CI, 1.19-1.58). Tobacco and heavy use of alcohol had bigger effects on risk of acute pancreatitis and chronic pancreatitis than pancreatic cancer. Vegetable consumption (RR, 0.71; 95% CI, 0.57-0.88) and fruit consumption (RR, 0.73; 95% CI, 0.60-0.90) provided the greatest degree of protection against pancreatic diseases on the basis of meta-analyses. Vegetable consumption had stronger association with protection against acute pancreatitis and fruit consumption with protection against pancreatic cancer.
  
  
  CONCLUSIONS
  On the basis of systematic review and meta-analysis, current tobacco use, obesity, and heavy use of alcohol are associated with significant increases in risk for pancreatic diseases. Vegetables and fruit consumption are associated with reduced risk for pancreatic diseases. Prevention strategies for acute pancreatitis, chronic pancreatitis, and pancreatic cancer should consider these factors.
authors: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors: Ammar
authors: A
authors: Alsamarrai
authors: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors: Stephanie L M
authors: SL
authors: Das
authors: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors: John A
authors: JA
authors: Windsor
authors: Department of Surgery, University of Auckland, Auckland, New Zealand. Electronic address: max.petrov@gmail.com.
authors: Maxim S
authors: MS
authors: Petrov
mesh_terms: D000437:Alcoholism / Q000150:complications; D015331:Cohort Studies; D006801:Humans; D009765:Obesity / Q000150:complications; D010190:Pancreatic Neoplasms / Q000453:epidemiology*; D010195:Pancreatitis / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
keywords: Acute Pancreatitis; Alcohol; Chronic Pancreatitis; Obesity; Pancreatic Cancer; Tobacco