title: The clinical relevance of obesity in acute pancreatitis: targeted systematic reviews.
abstract: BACKGROUND
  With the rising prevalence of obesity, its impact on the severity and outcome of acute pancreatitis remains an important consideration when managing obese patients with acute pancreatitis.
  
  
  OBJECTIVE
  To determine the clinical relevance of obesity in acute pancreatitis.
  
  
  METHODS
  A series of clinically relevant questions were framed which formed the basis of our literature search using PubMed and EMBASE databases. These related to acute pancreatitis severity, systemic inflammatory response, mortality, local and systemic complications. The search was restricted to human studies. Studies were classified according to the Oxford Centre for Evidence Based Medicine levels of evidence 1 for prognostic studies. Obesity was defined according to the guidelines of the World Health Organization. In keeping with studies included the binary classification (mild and severe) of acute pancreatitis was used.
  
  
  RESULTS
  Obesity is associated with an amplified systemic inflammatory response in acute pancreatitis and is a prognostic factor for mortality, local, systemic complications and severity in acute pancreatitis. Obesity was not found to be an independent prognostic factor for mortality and organ failure in patients with acute pancreatitis. It was evident that further studies are required to determine whether incorporating obesity into existing scoring systems improves severity prediction. Emerging evidence suggests that an obesity paradox is present in patients with acute pancreatitis.
  
  
  CONCLUSIONS
  This review demonstrates that obesity has a clinically relevant impact on the course and outcome of acute pancreatitis.
authors.affiliation: Surgical Center for Outcomes Research and Evaluation, Department of Surgery & Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand. Electronic address: r.premkumar@auckland.ac.nz.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Premkumar
authors.affiliation: Surgical Center for Outcomes Research and Evaluation, Department of Surgery & Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Anthony R J
authors.initials: AR
authors.lastname: Phillips
authors.affiliation: Surgical Center for Outcomes Research and Evaluation, Department of Surgery & Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Maxim S
authors.initials: MS
authors.lastname: Petrov
authors.affiliation: Surgical Center for Outcomes Research and Evaluation, Department of Surgery & Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand. Electronic address: j.windsor@auckland.ac.nz.
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
mesh_terms: D000208:Acute Disease; D006801:Humans; D009765:Obesity / Q000150:complications*; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology
keywords: Acute pancreatitis; Local and systemic complications; Mortality; Obesity; Severity; Systemic inflammatory response