急性膵炎も糖質過剰摂取で起きる

急性膵炎を起こすとき、中性脂肪が異常に高いことが多いとされています。1500~2000mg/dl程度上昇すると言われます。ちなみに正常値(基準値)は検査機関によって多少異なりますが、50~149です。つまり10倍以上になるわけです。

しかし、JAMA Intern Medの今回の研究はもっと中性脂肪が低くても、急性膵炎のリスクがかなり高くなることを示しています。

中性脂肪が89 mg/dL以下の人と比べて急性膵炎のリスクが、89 mg/dL~176 mg/dLで1.6倍、177 mg/dL~265 mg/dLで2.3倍、366 mg/dL~353 mg/dL で2.9倍、354 mg/dL~442 mg/dL で3.9倍、443 mg/dL 以上になるとなんと8.7倍にもなるのです。

糖質制限をする前の私の中性脂肪は450を超えていたので危なかったです。

この研究の中性脂肪を測定した時間帯がはっきりしませんが、「nonfasting」なので空腹時ではなく、食事によって中性脂肪が上昇した時と考えられます。みなさんの健康診断は当然のように空腹時で血液の検査を行っていますが、血糖値と同様に食後1~2時間の検査というのが必要な時期です。体の一番状態の良いときに検査をするのではなく、一番悪い時の検査が意味を持っているのです。空腹時という一番良い状態で、検査結果が異常を示すときはもうすでに大きな体の異常を示しているということです。予防という観点からでは空腹時の血液検査は問題があると思います。

ところで、中性脂肪の値は糖質摂取量のバイオマーカー(人の身体の状態を客観的に測定し評価するための指標)とも言われています。つまり、糖質摂取が多い程、上昇するのです。そう考えると、急性膵炎の原因の一つは糖質過剰摂取ということになります。

糖質制限をすると通常、中性脂肪値がぐんと下がります。私は現在は50以下です。是非、糖質の摂りすぎに気を付けてください。

Nonfasting Mild-to-Moderate Hypertriglyceridemia and Risk of Acute Pancreatitis

JAMA Intern Med. Published online November 7, 2016.

Question  Is nonfasting mild-to-moderate hypertriglyceridemia associated with acute pancreatitis?

Findings  In 116 550 individuals from the general population, nonfasting mild-to-moderate hypertriglyceridemia of 177 mg/dL (2 mmol/L) or higher was associated with high risk of acute pancreatitis, with risk estimates higher than for myocardial infarction.

Meaning  Mild-to-moderate hypertriglyceridemia is associated with increased risk not only for myocardial infarction but also for acute pancreatitis.

Abstract

Importance  Severe hypertriglyceridemia is associated with increased risk of acute pancreatitis. However, the threshold above which triglycerides are associated with acute pancreatitis is unclear.

Objective  To test the hypothesis that nonfasting mild-to-moderate hypertriglyceridemia (177-885 mg/dL; 2-10 mmol/L) is also associated with acute pancreatitis.

Design, Setting, and Participants  This prospective cohort study examines individuals from the Copenhagen General Population Study in 2003 to 2015 and the Copenhagen City Heart Study initiated in 1976 to 1978 with follow-up examinations in 1981 to1983, 1991 to 1994, and in 2001 to 2003. Median follow-up was 6.7 years (interquartile range, 4.0-9.4 years); and includes 116 550 individuals with a triglyceride measurement from the Copenhagen General Population Study (n = 98 649) and the Copenhagen City Heart Study (n = 17 901). All individuals were followed until the occurrence of an event, death, emigration, or end of follow-up (November 2014), whichever came first.

Exposures  Plasma levels of nonfasting triglycerides.

Main Outcomes and Measures  Hazard ratios (HRs) for acute pancreatitis (n = 434) and myocardial infarction (n = 3942).

Results  Overall, 116 550 individuals were included in this study (median [interquartile range] age, 57 [47-66] years). Compared with individuals with plasma triglyceride levels less than 89 mg/dL (<1 mmol/L), the multivariable adjusted HRs for acute pancreatitis were 1.6 (95% CI, 1.0-2.6; 4.3 events/10 000 person-years) for individuals with triglyceride levels of 89 mg/dL to 176 mg/dL (1.00 mmol/L-1.99 mmol/L), 2.3 (95% CI, 1.3-4.0; 5.5 events/10 000 person-years) for 177 mg/dL to 265 mg/dL (2.00 mmol/L-2.99 mmol/L), 2.9 (95% CI, 1.4-5.9; 6.3 events/10 000 person-years) for 366 mg/dL to 353 mg/dL (3.00 mmol/L-3.99 mmol/L), 3.9 (95% CI, 1.5-10.0; 7.5 events/10 000 person-years) for 354 mg/dL-442 mg/dL (4.00 mmol/L-4.99 mmol/L), and 8.7 (95% CI, 3.7-20.0; 12 events/10 000 person-years) for individuals with triglyceride levels greater than or equal to 443 mg/dL (≥5.00 mmol/L) (trend, P = 6 × 10−8). Corresponding HRs for myocardial infarction were 1.6 (95% CI, 1.4-1.9; 41 events/10 000 person-years), 2.2 (95% CI, 1.9-2.7; 57 events/10 000 person-years), 3.2 (95% CI, 2.6-4.1; 72 events/10 000 person-years), 2.8 (95% CI, 2.0-3.9; 68 events/10 000 person-years), and 3.4 (95% CI, 2.4-4.7; 78 events/10 000 person-years) (trend, P = 6 × 10−31), respectively. The multivariable adjusted HR for acute pancreatitis was 1.17 (95% CI, 1.10-1.24) per 89 mg/dL (1 mmol/L) higher triglycerides. When stratified by sex, age, education, smoking, hypertension, statin use, study cohort, diabetes, body mass index (calculated as weight in kilograms divided by height in meters squared), alcohol intake, and gallstone disease, these results were similar with no statistical evidence of interaction.

Conclusions and Relevance  Nonfasting mild-to-moderate hypertriglyceridemia from 177 mg/dL (2 mmol/L) and above is associated with high risk of acute pancreatitis, with HR estimates higher than for myocardial infarction.

シェアする

  • このエントリーをはてなブックマークに追加

フォローする