title: Pancreatic Insufficiency Secondary to Tobacco Exposure: A Controlled Cross-Sectional Evaluation.
abstract: Tobacco exposure is an established risk factor for pancreatic cancer and chronic pancreatitis; however, its role in pancreatic insufficiency is not clear.
  
  
  
  This controlled, cross-sectional study examined smokers and nonsmokers with no history of pancreatic disease. Histories and validated inventories of alcohol and tobacco use were obtained, and pancreatic insufficiency was assessed using the fecal elastase-1 assay.
  
  
  
  Of 7854 patients approached, 226 were interviewed and 200 enrolled. The rates of pancreatic insufficiency [18% (18/100)] and severe pancreatic insufficiency [10% (10/100)] were significantly higher in smokers than in controls [6% (6/100), P = 0.009 and 1% (1/100), P = 0.010, respectively]. On multivariate logistic regression, the risk of pancreatic insufficiency in smokers was significantly increased [odds ratio, 4.34 (1.37-13.75); P = 0.012], controlling for alcohol use and relevant covariates. Tobacco exposure was associated with the highest odds ratio for pancreatic insufficiency. Alcohol consumption was strongly associated with tobacco exposure (P < 0.001), but not with pancreatic insufficiency by multivariate analysis (P = 0.792).
  
  
  
  This study suggests that tobacco exposure is independently associated with pancreatic exocrine insufficiency in patients without a prior diagnosis of pancreatic disease. Tobacco exposure seems to have greater detrimental effects on pancreatic function than alcohol in this population.
authors.affiliation: From the *Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA; †Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA; ‡Department of Medicine, Division of General Medicine, Emory University School of Medicine, Atlanta, GA; §Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA; ∥Cancer Treatment Centers of America, Atlanta, GA.
authors.forename: Kara L
authors.initials: KL
authors.lastname: Raphael
authors.forename: Saurabh
authors.initials: S
authors.lastname: Chawla
authors.forename: Sungjin
authors.initials: S
authors.lastname: Kim
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Keith
authors.forename: David R
authors.initials: DR
authors.lastname: Propp
authors.forename: Zhengjia N
authors.initials: ZN
authors.lastname: Chen
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Woods
authors.forename: Steven A
authors.initials: SA
authors.lastname: Keilin
authors.forename: Qiang
authors.initials: Q
authors.lastname: Cai
authors.forename: Field F
authors.initials: FF
authors.lastname: Willingham
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D003430:Cross-Sectional Studies; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis* / Q000209:etiology*; D005243:Feces / Q000201:enzymology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010196:Pancreatic Elastase / Q000378:metabolism; D012307:Risk Factors; D000074285:Smokers / Q000706:statistics & numerical data*; D012907:Smoking / Q000009:adverse effects*
chemical_list: D010196:Pancreatic Elastase