J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 12, Number 9, September 2020, pages 568-578

Chronic Pancreatitis Is Characterized by Elevated Circulating Periostin Levels Related to Intra-Pancreatic Fat Deposition

Figure 1. Periostin levels in the study groups. Bars represent mean values whereas whiskers represent two standard deviations.

Figure 2. Relative contributions of the studied fat phenotypes to circulating periostin levels in individuals with chronic pancreatitis (a), individuals after acute pancreatitis (b), and healthy individuals (c). Data are presented as percentages of corresponding fat phenotypes that explain the variance of periostin.

**Table 1.** Characteristics of the Study Groups
	Healthy controls (n = 37)	Acute pancreatitis (n = 75)	Chronic pancreatitis (n = 9)	P^a
Data are presented as mean ± standard deviation or percentage. Triglycerides, total cholesterol, HDL cholesterol, LDL cholesterol, insulin, HOMA-IR, HOMA-ß, and pancreatic amylase data were log-transformed. ^aP values were from one-way ANOVA. *Statistically significant values (P less than 0.05). HDL: high-density lipoprotein; LDL: low-density lipoprotein; HbA1c: hemoglobin A1c; HOMA-ß: homeostatic model assessment of ß-cell function; HOMA-IR: homeostatic model assessment of insulin resistance; ANOVA: analysis of variance.
Age (years)	48.6 ± 17.4	53.7 ± 14.8	54.3 ± 9.9	0.229
Men, n (%)	18 (28.6)	51 (68.0)	7 (77.8)	0.086
Body mass index (kg/m²)	25.6 ± 5.4	29.5 ± 6.4	27.6 ± 5.5	0.006*
Triglycerides (mmol/L)	1.2 ± 0.8	2.3 ± 3.1	2.2 ± 1.5	0.001*
Total cholesterol (mmol/L)	4.6 ± 1.2	4.8 ± 1.3	5.1 ± 1.1	0.459
HDL cholesterol (mmol/L)	1.3 ± 0.5	1.3 ± 0.4	1.5 ± 0.6	0.353
LDL cholesterol (mmol/L)	2.8 ± 0.9	2.6 ± 1.0	2.5 ± 1.0	0.611
HbA1c (mmol/mol)	33.1 ± 3.2	40.5 ± 11.2	45.7 ± 12.9	< 0.001*
Insulin (mIU/L)	11.8 ± 8.0	16.8 ± 35.6	15.8 ± 14.1	0.707
HOMA-IR (mIU/L·mmol/L)	2.6 ± 2.0	4.4 ± 8.2	5.7 ± 4.9	0.132
HOMA-β (mIU/L·mmol/L)	50.1 ± 30.4	55.3 ± 143.6	37.4 ± 35.9	0.353
Pancreatic amylase (U/L)	29.0 ± 16.0	26.8 ± 17.3	23.4 ± 8.5	0.517
Ever-smokers, n (%)	18 (48.6)	66 (88.0)	7 (77.8)	0.109
Alcohol consumption (g/week)	54.8 ± 69.4	112.1 ± 195.7	312.1 ± 298.6	0.002*

Table 1. Characteristics of the Study Groups

Healthy controls (n = 37)

Acute pancreatitis (n = 75)

Chronic pancreatitis (n = 9)

P^a

Data are presented as mean ± standard deviation or percentage. Triglycerides, total cholesterol, HDL cholesterol, LDL cholesterol, insulin, HOMA-IR, HOMA-ß, and pancreatic amylase data were log-transformed. ^aP values were from one-way ANOVA. *Statistically significant values (P less than 0.05). HDL: high-density lipoprotein; LDL: low-density lipoprotein; HbA1c: hemoglobin A1c; HOMA-ß: homeostatic model assessment of ß-cell function; HOMA-IR: homeostatic model assessment of insulin resistance; ANOVA: analysis of variance.

Age (years)

48.6 ± 17.4

53.7 ± 14.8

54.3 ± 9.9

0.229

Men, n (%)

18 (28.6)

51 (68.0)

7 (77.8)

0.086

Body mass index (kg/m²)

25.6 ± 5.4

29.5 ± 6.4

27.6 ± 5.5

0.006*

Triglycerides (mmol/L)

1.2 ± 0.8

2.3 ± 3.1

2.2 ± 1.5

0.001*

Total cholesterol (mmol/L)

4.6 ± 1.2

4.8 ± 1.3

5.1 ± 1.1

0.459

HDL cholesterol (mmol/L)

1.3 ± 0.5

1.3 ± 0.4

1.5 ± 0.6

0.353

LDL cholesterol (mmol/L)

2.8 ± 0.9

2.6 ± 1.0

2.5 ± 1.0

0.611

HbA1c (mmol/mol)

33.1 ± 3.2

40.5 ± 11.2

45.7 ± 12.9

< 0.001*

Insulin (mIU/L)

11.8 ± 8.0

16.8 ± 35.6

15.8 ± 14.1

0.707

HOMA-IR (mIU/L·mmol/L)

2.6 ± 2.0

4.4 ± 8.2

5.7 ± 4.9

0.132

HOMA-β (mIU/L·mmol/L)

50.1 ± 30.4

55.3 ± 143.6

37.4 ± 35.9

0.353

Pancreatic amylase (U/L)

29.0 ± 16.0

26.8 ± 17.3

23.4 ± 8.5

0.517

Ever-smokers, n (%)

18 (48.6)

66 (88.0)

7 (77.8)

0.109

Alcohol consumption (g/week)

54.8 ± 69.4

112.1 ± 195.7

312.1 ± 298.6

0.002*

**Table 2.** Significance of the Differences in Abdominal Fat Phenotypes Between the Study Groups
Fat phenotype	Overall^a	Chronic pancreatitis vs. acute pancreatitis^b	Chronic pancreatitis vs. healthy controls^b	Acute pancreatitis vs. healthy controls^b
Data are presented as P values. Model 2: adjusted for age and sex; Model 3: adjusted for age, sex, body mass index, and triglycerides; Model 4: adjusted for age, sex, body mass index, triglycerides, and HbA1c; Model 5: adjusted for age, sex, body mass index, triglycerides, HbA1c, alcohol consumption, and smoking status. ^aOverall P values were from one-way ANOVA in model 1 (unadjusted) and one-way ANCOVA in models 2 - 5 (adjusted as described above). ^bFisher’s least significant difference method was used. *Statistically significant values (P less than 0.05). HbA1c: hemoglobin A1c; ANOVA: analysis of variance; ANCOVA: analysis of covariance.
Intra-pancreatic fat (%)
Model 1	< 0.001*	0.050	< 0.001*	0.001*
Model 2	0.001*	0.053	0.001*	0.004*
Model 3	0.008*	0.021*	0.002*	0.104
Model 4	0.010*	0.021*	0.002*	0.102
Model 5	0.037*	0.034*	0.011*	0.248
Liver fat (%)
Model 1	0.687	0.858	0.795	0.388
Model 2	0.756	0.822	0.872	0.462
Model 3	0.759	0.133	0.036	0.166
Model 4	0.708	0.759	0.883	0.421
Model 5	0.553	0.931	0.504	0.287
Skeletal muscle fat (%)
Model 1	0.314	0.572	0.228	0.190
Model 2	0.381	0.396	0.196	0.327
Model 3	0.081	0.169	0.034	0.117
Model 4	0.058	0.182	0.028	0.069
Model 5	0.107	0.262	0.052	0.097
Visceral fat (cm³)
Model 1	< 0.001*	0.101	< 0.001*	< 0.001*
Model 2	< 0.001*	0.163	0.001*	< 0.001*
Model 3	0.011*	0.027	0.003*	0.083
Model 4	0.009*	0.001*	< 0.001*	0.035*
Model 5	0.020*	0.033*	0.005*	0.107
Subcutaneous fat (cm³)
Model 1	0.090	0.524	0.598	0.030*
Model 2	0.011*	0.695	0.220	0.003*
Model 3	0.447	0.680	0.213	0.759
Model 4	0.272	0.909	0.108	0.432
Model 5	0.118	0.105	0.041*	0.072

Table 2. Significance of the Differences in Abdominal Fat Phenotypes Between the Study Groups

Fat phenotype

Overall^a

Chronic pancreatitis vs. acute pancreatitis^b

Chronic pancreatitis vs. healthy controls^b

Acute pancreatitis vs. healthy controls^b

Data are presented as P values. Model 2: adjusted for age and sex; Model 3: adjusted for age, sex, body mass index, and triglycerides; Model 4: adjusted for age, sex, body mass index, triglycerides, and HbA1c; Model 5: adjusted for age, sex, body mass index, triglycerides, HbA1c, alcohol consumption, and smoking status. ^aOverall P values were from one-way ANOVA in model 1 (unadjusted) and one-way ANCOVA in models 2 - 5 (adjusted as described above). ^bFisher’s least significant difference method was used. *Statistically significant values (P less than 0.05). HbA1c: hemoglobin A1c; ANOVA: analysis of variance; ANCOVA: analysis of covariance.

Intra-pancreatic fat (%)

Model 1

< 0.001*

0.050

< 0.001*

0.001*

Model 2

0.001*

0.053

0.001*

0.004*

Model 3

0.008*

0.021*

0.002*

0.104

Model 4

0.010*

0.021*

0.002*

0.102

Model 5

0.037*

0.034*

0.011*

0.248

Liver fat (%)

Model 1

0.687

0.858

0.795

0.388

Model 2

0.756

0.822

0.872

0.462

Model 3

0.759

0.133

0.036

0.166

Model 4

0.708

0.759

0.883

0.421

Model 5

0.553

0.931

0.504

0.287

Skeletal muscle fat (%)

Model 1

0.314

0.572

0.228

0.190

Model 2

0.381

0.396

0.196

0.327

Model 3

0.081

0.169

0.034

0.117

Model 4

0.058

0.182

0.028

0.069

Model 5

0.107

0.262

0.052

0.097

Visceral fat (cm³)

Model 1

< 0.001*

0.101

< 0.001*

Model 2

< 0.001*

0.163

0.001*

< 0.001*

Model 3

0.011*

0.027

0.003*

0.083

Model 4

0.009*

0.001*

< 0.001*

0.035*

Model 5

0.020*

0.033*

0.005*

0.107

Subcutaneous fat (cm³)

Model 1

0.090

0.524

0.598

0.030*

Model 2

0.011*

0.695

0.220

0.003*

Model 3

0.447

0.680

0.213

0.759

Model 4

0.272

0.909

0.108

0.432

Model 5

0.118

0.105

0.041*

0.072

**Table 3.** Associations Between Abdominal Fat Phenotypes and Periostin Levels
Fat phenotype	Healthy controls	Acute pancreatitis	Chronic pancreatitis
Data are presented as β coefficients, standard errors, and P values (from linear regression). *Statistically significant values (P less than 0.05). SE: standard errors.
Intra-pancreatic fat (%)	-14.491	12.205	0.244	-0.012	9.549	0.999	49.627	18.875	0.034*
Liver fat (%)	-0.195	3.523	0.956	-0.417	1.698	0.807	-6.517	7.564	0.422
Skeletal muscle fat (%)	5.924	3.582	0.107	-0.046	2.816	0.987	12.328	8.619	1.430
Visceral fat (cm³)	-0.020	0.018	0.522	0.001	0.012	0.342	0.050	0.029	0.308
Subcutaneous fat (cm³)	-0.004	0.030	0.840	0.015	0.016	0.923	0.044	0.030	0.123

Table 3. Associations Between Abdominal Fat Phenotypes and Periostin Levels

Fat phenotype

Healthy controls

Acute pancreatitis

Chronic pancreatitis

Data are presented as β coefficients, standard errors, and P values (from linear regression). *Statistically significant values (P less than 0.05). SE: standard errors.

Intra-pancreatic fat (%)

-14.491

12.205

0.244

-0.012

9.549

0.999

49.627

18.875

0.034*

Liver fat (%)

-0.195

3.523

0.956

-0.417

1.698

0.807

-6.517

7.564

0.422

Skeletal muscle fat (%)

5.924

3.582

0.107

-0.046

2.816

0.987

12.328

8.619

1.430

Visceral fat (cm³)

-0.020

0.018

0.522

0.001

0.012

0.342

0.050

0.029

0.308

Subcutaneous fat (cm³)

-0.004

0.030

0.840

0.015

0.016

0.923

0.044

0.030

0.123