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Maxim S Petrov
School of Medicine, University of Auckland, Auckland, New Zealand

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Journal article
Published: 19 June 2021 in Clinical Nutrition
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Summary Background Insulin resistance is a well-known derangement after an attack of pancreatitis but the role of dietary fat intake and intra-pancreatic fat deposition (IPFD) in it is unknown. We aimed to investigate the relationship of dietary fat intake with markers of insulin resistance in individuals after acute pancreatitis, taking into account IPFD. Methods This was a cross-sectional study. The EPIC-Norfolk food frequency questionnaire was used to determine the habitual intake of saturated, monounsaturated, polyunsaturated fatty acids. The studied markers of insulin resistance were fasting insulin, HOMA-IR, and METS-IR. 3 T magnetic resonance imaging was used to quantify IPFD. Linear regression analysis, with adjustment for possible confounders, was performed. Results A total of 111 individuals after acute pancreatitis (33 low IPFD, 40 moderate IPFD, and 38 high IPFD) were included. In the high IPFD group, intake of monounsaturated fatty acids was inversely associated with both fasting insulin, and HOMA-IR, and METS-IR in the unadjusted (β = −65.405, p < 0.001; β = −15.762, p < 0.001; β = −0.760, p = 0.041, respectively) and fully adjusted models (β = −155.620, p < 0.001; β = −34.656, p < 0.001, β = −2.008, p = 0.018, respectively). Intake of polyunsaturated or saturated fatty acids did not have a consistently significant pattern of associations with the three markers of insulin resistance. None of the above associations was significant in the low IPFD and moderate IPFD groups. Conclusions Habitual dietary fat intake is associated with insulin resistance only in individuals after an attack of pancreatitis who have high IPFD. These indviduals may benefit from a calorically balanced diet that is rich in monounsaturated fatty acids.

ACS Style

Juyeon Ko; Loren Skudder-Hill; Conor Tarrant; Wandia Kimita; Sakina H. Bharmal; Maxim S. Petrov. Intra-pancreatic fat deposition as a modifier of the relationship between habitual dietary fat intake and insulin resistance. Clinical Nutrition 2021, 40, 4730 -4737.

AMA Style

Juyeon Ko, Loren Skudder-Hill, Conor Tarrant, Wandia Kimita, Sakina H. Bharmal, Maxim S. Petrov. Intra-pancreatic fat deposition as a modifier of the relationship between habitual dietary fat intake and insulin resistance. Clinical Nutrition. 2021; 40 (7):4730-4737.

Chicago/Turabian Style

Juyeon Ko; Loren Skudder-Hill; Conor Tarrant; Wandia Kimita; Sakina H. Bharmal; Maxim S. Petrov. 2021. "Intra-pancreatic fat deposition as a modifier of the relationship between habitual dietary fat intake and insulin resistance." Clinical Nutrition 40, no. 7: 4730-4737.

Review
Published: 30 May 2021 in Expert Opinion on Investigational Drugs
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Introduction: Post-pancreatitis diabetes mellitus is one of the most common types of secondary diabetes. The pharmaceutical armamentarium in the field of diabetology can be broadened if the design of novel drugs is informed by pathogenetic insights from studies on post-pancreatitis diabetes mellitus. Areas covered: The article provides an overview of preclinical and clinical studies of compounds selectively antagonizing the gastric inhibitory peptide receptor, simultaneously stimulating both the glucagon-like peptide-1 and glucagon receptors, and activating ketogenesis. Expert opinion: The current pharmacotherapy for post-pancreatitis diabetes mellitus is relatively ineffective. This type of diabetes represents a unique platform for rigorous, efficient, and practical search for glucose-lowering therapeutic candidates. Various methods of gastric inhibitory peptide receptor (expressed in the pancreas) antagonism have undergone extensive preclinical testing in diabetes, with promising compounds being trialed in man. Molecular mimicry with oxyntomodulin ─ an extra-pancreatic hormone homologous with pancreatic hormone glucagon and involved in the regulation of exocrine pancreatic function ─ could be harnessed. The emerging findings of a salutary effect of ketosis mimetics in people with prediabetes set the stage for a novel approach to preventing diabetes.

ACS Style

Maxim S. Petrov. Post-pancreatitis diabetes mellitus: investigational drugs in preclinical and clinical development and therapeutic implications. Expert Opinion on Investigational Drugs 2021, 30, 737 -747.

AMA Style

Maxim S. Petrov. Post-pancreatitis diabetes mellitus: investigational drugs in preclinical and clinical development and therapeutic implications. Expert Opinion on Investigational Drugs. 2021; 30 (7):737-747.

Chicago/Turabian Style

Maxim S. Petrov. 2021. "Post-pancreatitis diabetes mellitus: investigational drugs in preclinical and clinical development and therapeutic implications." Expert Opinion on Investigational Drugs 30, no. 7: 737-747.

Journal article
Published: 29 March 2021 in Nutrients
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The association between intake of dietary fibre and glucose metabolism has been extensively investigated in numerous metabolic disorders. However, little is known about this association in individuals after an attack of acute pancreatitis (AP). The aim was to investigate the associations between intake of dietary fibre and markers of glucose metabolism in individuals with new-onset prediabetes or diabetes after acute pancreatitis (NODAP), pre-exiting type 2 prediabetes or diabetes, and normoglycaemia after acute pancreatitis. This cross-sectional study was nested within the parent prospective longitudinal cohort study. The studied markers of glucose metabolism were fasting plasma glucose and glycated haemoglobin. Habitual intake of dietary fibre was determined using the EPIC-Norfolk food frequency questionnaire. Multivariable linear regression analyses were conducted. The study included a total of 108 individuals after AP. In the NODAP group, increased intakes of total fibre (β = −0.154, p = 0.006), insoluble fibre (β = −0.133, p = 0.01), and soluble fibre (β = −0.13, p = 0.02) were significantly associated with a reduction in fasting plasma glucose. Increased intakes of vegetables (β = −0.069, p = 0.004) and nuts (β = −0.039, p = 0.038) were significantly associated with a reduction in fasting plasma glucose. Increased intake of nuts (β = −0.054, p = 0.001) was also significantly associated with a reduction in glycated haemoglobin. None of the above associations were significant in the other study groups. Habitual intake of dietary fibre was inversely associated with fasting plasma glucose in individuals with NODAP. Individuals after an attack of AP may benefit from increasing their intake of dietary fibre (specifically, vegetables and nuts) with a view to preventing NODAP.

ACS Style

Xinye Li; Wandia Kimita; Jaelim Cho; Juyeon Ko; Sakina Bharmal; Maxim Petrov. Dietary Fibre Intake in Type 2 and New-Onset Prediabetes/Diabetes after Acute Pancreatitis: A Nested Cross-Sectional Study. Nutrients 2021, 13, 1112 .

AMA Style

Xinye Li, Wandia Kimita, Jaelim Cho, Juyeon Ko, Sakina Bharmal, Maxim Petrov. Dietary Fibre Intake in Type 2 and New-Onset Prediabetes/Diabetes after Acute Pancreatitis: A Nested Cross-Sectional Study. Nutrients. 2021; 13 (4):1112.

Chicago/Turabian Style

Xinye Li; Wandia Kimita; Jaelim Cho; Juyeon Ko; Sakina Bharmal; Maxim Petrov. 2021. "Dietary Fibre Intake in Type 2 and New-Onset Prediabetes/Diabetes after Acute Pancreatitis: A Nested Cross-Sectional Study." Nutrients 13, no. 4: 1112.

Randomized controlled trial
Published: 20 March 2021 in Clinical Nutrition ESPEN
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Summary Background and aims Exogenous ketone supplementation is emerging as a nutritional intervention that beneficially affects blood glucose control. We hypothesized that varying abdominal fat phenotypes play a role in the effect of exogenously induced ketosis. The aim was to investigate whether intra-abdominal fat distribution modulates the effect of exogenous ketones on glucoregulatory peptides in new-onset prediabetes. Methods Eighteen individuals with new-onset prediabetes after acute pancreatitis were randomized to receive a ketone monoester supplement or placebo in a crossover fashion. All participants underwent magnetic resonance imaging on a 3T scanner to determine their abdominal fat phenotypes. They were non-exclusively categorized as low adiposity or high adiposity phenotypes based on their abdominal and ectopic fat distribution (regardless of body mass index and waist circumference). Blood samples were analyzed for glucoregulatory peptides. Total area under the curve (AUC) over 150 min was calculated for each analyte. Results The total AUCs for insulin and C-peptide were significantly higher after ketone supplementation in individuals with high intra-pancreatic fat deposition, skeletal muscle fat deposition, and subcutaneous fat volume; and low visceral fat volume and intra-hepatic fat deposition. The total AUC for glucose-dependent insulinotropic peptide was significantly higher after ketone supplementation in individuals with high intra-pancreatic fat deposition, skeletal muscle fat deposition, subcutaneous fat volume, and visceral fat volume. The total AUC for glucagon-like peptide-1 was not associated with any adiposity phenotype. Conclusions Individuals with high depositions of intra-pancreatic fat, skeletal muscle fat, subcutaneous fat may not achieve favorable outcomes of blood glucose control following ketone supplementation. Abdominal fat distribution is an important factor in the pathogenesis of new-onset prediabetes and it may influence the effectiveness of nutritional strategies designed for these individuals. Registered under ClinicalTrials.gov identifier no NCT03889210.

ACS Style

Sakina H. Bharmal; Gisselle C. Alarcon Ramos; Juyeon Ko; Maxim S. Petrov. Abdominal fat distribution modulates the metabolic effects of exogenous ketones in individuals with new-onset prediabetes after acute pancreatitis: Results from a randomized placebo-controlled trial. Clinical Nutrition ESPEN 2021, 43, 117 -129.

AMA Style

Sakina H. Bharmal, Gisselle C. Alarcon Ramos, Juyeon Ko, Maxim S. Petrov. Abdominal fat distribution modulates the metabolic effects of exogenous ketones in individuals with new-onset prediabetes after acute pancreatitis: Results from a randomized placebo-controlled trial. Clinical Nutrition ESPEN. 2021; 43 ():117-129.

Chicago/Turabian Style

Sakina H. Bharmal; Gisselle C. Alarcon Ramos; Juyeon Ko; Maxim S. Petrov. 2021. "Abdominal fat distribution modulates the metabolic effects of exogenous ketones in individuals with new-onset prediabetes after acute pancreatitis: Results from a randomized placebo-controlled trial." Clinical Nutrition ESPEN 43, no. : 117-129.

Original article
Published: 15 February 2021 in Acta Diabetologica
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The aim was to investigate sex- and age-stratified risks of cause-specific death and life expectancy in individuals with post-pancreatitis diabetes mellitus (PPDM). Nationwide data on mortality in New Zealand were obtained. For two head-to-head comparisons (PPDM versus type 2 diabetes mellitus [T2DM]; PPDM versus type 1 diabetes mellitus [T1DM]), the groups were matched on age, sex, and calendar year of diabetes diagnosis. Multivariable Cox regression analyses were conducted to estimate risks of vascular, cancer, and non-vascular non-cancer mortality. Remaining life expectancy at age of diabetes diagnosis was estimated using the Chiang II method. A total of 15,848 individuals (1,132 PPDM, 3,396 T1DM, and 11,320 T2DM) were included. The risks of vascular mortality and non-vascular non-cancer mortality did not differ significantly between PPDM and T2DM or T1DM. PPDM was associated with a significantly higher risk of cancer mortality compared with T2DM (adjusted hazard ratio, 1.32; 95% confidence interval, 1.08–1.63) or T1DM (adjusted hazard ratio, 1.65; 95% confidence interval, 1.27–2.13). The risk of cancer mortality associated with PPDM (versus T2DM) was significantly higher in women than in men (p for interaction = 0.003). This sex difference in cancer mortality risk was also significant in the comparison between PPDM and T1DM (p for interaction = 0.006). Adults of both sexes with PPDM had the lowest remaining life expectancy (in comparison with T2DM or T1DM) up to 64 years of age. People with PPDM have a higher risk of cancer mortality compared with those with T2DM or T1DM. This is especially pronounced in women. Young and middle-aged adults with PPDM have a lower life expectancy compared with their counterparts with T2DM or T1DM.

ACS Style

Jaelim Cho; Stephen J. Pandol; Maxim S. Petrov. Risk of cause-specific death, its sex and age differences, and life expectancy in post-pancreatitis diabetes mellitus. Acta Diabetologica 2021, 58, 797 -807.

AMA Style

Jaelim Cho, Stephen J. Pandol, Maxim S. Petrov. Risk of cause-specific death, its sex and age differences, and life expectancy in post-pancreatitis diabetes mellitus. Acta Diabetologica. 2021; 58 (6):797-807.

Chicago/Turabian Style

Jaelim Cho; Stephen J. Pandol; Maxim S. Petrov. 2021. "Risk of cause-specific death, its sex and age differences, and life expectancy in post-pancreatitis diabetes mellitus." Acta Diabetologica 58, no. 6: 797-807.

Journal article
Published: 02 February 2021 in Pancreatology
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Current knowledge of the link between dietary carbohydrate intake and insulin regulation in individuals after an attack of pancreatitis is limited. We aimed to investigate the associations between dietary carbohydrate intake and insulin traits in post-pancreatitis versus healthy individuals, taking into account intrapancreatic fat deposition (IPFD). All participants underwent magnetic resonance imaging (using the same protocol and 3T scanner) to quantify IPFD. Dietary carbohydrate intake was assessed using a validated 131-item food frequency questionnaire. Insulin, HOMA-IR, HOMA-β were determined in the fasted state. Linear regression and effect modification analyses were conducted in unadjusted and adjusted models (accounting for age, sex, body mass index, daily energy intake, use of anti-diabetic medications, and recurrence of acute pancreatitis). The study included 111 post-pancreatitis individuals (categorized into low IPFD (n = 33), moderate IPFD (n = 40), high IPFD (n = 38)) and 47 healthy controls. In the high IPFD group, starch intake was negatively associated with fasting insulin and HOMA-β in both the unadjusted (p < 0.001 both) and fully adjusted models (p < 0.001 both); and with HOMA-IR in the fully adjusted model (p < 0.001) only. Total sugar intake was positively associated with fasting insulin (p = 0.015) and HOMA-β (p = 0.007) in the fully adjusted model but not associated with HOMA-IR. None of the above associations was statistically significant in the low IPFD, moderate IPFD, and healthy controls groups. The studied associations were more pronounced in the high IPFD group but not in the moderate IPFD or low IPFD groups (when compared with the healthy controls group). Dietary carbohydrate intake is differentially associated with insulin traits in individuals after an attack of pancreatitis and the associations are modified by IPFD. These findings will be helpful for the development of dietary guidelines specifically for individuals after an attack of pancreatitis.

ACS Style

Juyeon Ko; Wandia Kimita; Loren Skudder-Hill; Xinye Li; Sunitha Priya; Sakina H. Bharmal; Jaelim Cho; Maxim S. Petrov. Dietary carbohydrate intake and insulin traits in individuals after acute pancreatitis: Effect modification by intra-pancreatic fat deposition. Pancreatology 2021, 21, 353 -362.

AMA Style

Juyeon Ko, Wandia Kimita, Loren Skudder-Hill, Xinye Li, Sunitha Priya, Sakina H. Bharmal, Jaelim Cho, Maxim S. Petrov. Dietary carbohydrate intake and insulin traits in individuals after acute pancreatitis: Effect modification by intra-pancreatic fat deposition. Pancreatology. 2021; 21 (2):353-362.

Chicago/Turabian Style

Juyeon Ko; Wandia Kimita; Loren Skudder-Hill; Xinye Li; Sunitha Priya; Sakina H. Bharmal; Jaelim Cho; Maxim S. Petrov. 2021. "Dietary carbohydrate intake and insulin traits in individuals after acute pancreatitis: Effect modification by intra-pancreatic fat deposition." Pancreatology 21, no. 2: 353-362.

Journal article
Published: 22 November 2020 in Nutrients
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Dietary intake of iron is known to be associated with impaired glucose metabolism. However, its involvement in derangements of glucose metabolism after acute pancreatitis (AP) is not completely understood. The aim was to investigate the association between dietary iron intake and markers of glucose metabolism in individuals after an attack of AP. Fasting blood samples were collected to analyse markers of glucose metabolism (fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c)). The EPIC-Norfolk food frequency questionnaire was used to determine the habitual intake of dietary iron (total, haem, and non-haem). Multivariable linear regression analyses were conducted and six statistical models were built to adjust for covariates. A total of 109 individuals after AP were studied in a cross-sectional fashion. Total iron (β (95% confidence interval) = −0.19 (−0.35, −0.05); p = 0.01 in the most adjusted model) and non-haem iron (β (95% confidence interval) = −0.19 (−0.33, −0.04); p = 0.03 in the most adjusted model) were significantly associated with FPG, consistently in all adjusted model. Total iron and non-haem iron did not have consistent significant associations with HbA1c. Dietary haem iron intake was not associated with either FPG or HbA1c. Habitual intake of dietary iron is inversely associated with FPG in individuals after an attack of AP and may be involved in the pathogenesis of new-onset diabetes after pancreatitis. Prospective longitudinal studies are now warranted to unveil the specific mechanism underlying the involvement of dietary iron.

ACS Style

Wandia Kimita; Xinye Li; Juyeon Ko; Sakina H. Bharmal; David Cameron-Smith; Maxim S. Petrov. Association between Habitual Dietary Iron Intake and Glucose Metabolism in Individuals after Acute Pancreatitis. Nutrients 2020, 12, 3579 .

AMA Style

Wandia Kimita, Xinye Li, Juyeon Ko, Sakina H. Bharmal, David Cameron-Smith, Maxim S. Petrov. Association between Habitual Dietary Iron Intake and Glucose Metabolism in Individuals after Acute Pancreatitis. Nutrients. 2020; 12 (11):3579.

Chicago/Turabian Style

Wandia Kimita; Xinye Li; Juyeon Ko; Sakina H. Bharmal; David Cameron-Smith; Maxim S. Petrov. 2020. "Association between Habitual Dietary Iron Intake and Glucose Metabolism in Individuals after Acute Pancreatitis." Nutrients 12, no. 11: 3579.

Review
Published: 05 November 2020 in European Radiology
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To systematically review published studies on the use of radiomics of the pancreas. The search was conducted in the MEDLINE database. Human studies that investigated the applications of radiomics in diseases of the pancreas were included. The radiomics quality score was calculated for each included study. A total of 72 studies encompassing 8863 participants were included. Of them, 66 investigated focal pancreatic lesions (pancreatic cancer, precancerous lesions, or benign lesions); 4, pancreatitis; and 2, diabetes mellitus. The principal applications of radiomics were differential diagnosis between various types of focal pancreatic lesions (n = 19), classification of pancreatic diseases (n = 23), and prediction of prognosis or treatment response (n = 30). Second-order texture features were most useful for the purpose of differential diagnosis of diseases of the pancreas (with 100% of studies investigating them found a statistically significant feature), whereas filtered image features were most useful for the purpose of classification of diseases of the pancreas and prediction of diseases of the pancreas (with 100% of studies investigating them found a statistically significant feature). The median radiomics quality score of the included studies was 28%, with the interquartile range of 22% to 36%. The radiomics quality score was significantly correlated with the number of extracted radiomics features (r = 0.52, p < 0.001) and the study sample size (r = 0.34, p = 0.003). Radiomics of the pancreas holds promise as a quantitative imaging biomarker of both focal pancreatic lesions and diffuse changes of the pancreas. The usefulness of radiomics features may vary depending on the purpose of their application. Standardisation of image acquisition protocols and image pre-processing is warranted prior to considering the use of radiomics of the pancreas in routine clinical practice. • Methodologically sound studies on radiomics of the pancreas are characterised by a large sample size and a large number of extracted features. • Optimisation of the radiomics pipeline will increase the clinical utility of mineable pancreas imaging data. • Radiomics of the pancreas is a promising personalised medicine tool in diseases of the pancreas.

ACS Style

Bassam M. Abunahel; Beau Pontre; Haribalan Kumar; Maxim S. Petrov. Pancreas image mining: a systematic review of radiomics. European Radiology 2020, 31, 3447 -3467.

AMA Style

Bassam M. Abunahel, Beau Pontre, Haribalan Kumar, Maxim S. Petrov. Pancreas image mining: a systematic review of radiomics. European Radiology. 2020; 31 (5):3447-3467.

Chicago/Turabian Style

Bassam M. Abunahel; Beau Pontre; Haribalan Kumar; Maxim S. Petrov. 2020. "Pancreas image mining: a systematic review of radiomics." European Radiology 31, no. 5: 3447-3467.

Journal article
Published: 27 October 2020 in Clinical and Translational Gastroenterology
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INTRODUCTION: Future burden has been modeled from population-based data for several common gastrointestinal diseases. However, as we enter the third decade in the 21st century, there are no such data on diseases of the pancreas holistically. The study aimed to estimate future incidence of pancreatitis, pancreatic cancer, diabetes of the exocrine pancreas (DEP), and exocrine pancreatic dysfunction (EPD) as well as years of life lost (YLL) due to premature death in individuals with those diseases up to 2050. METHODS: Historical New Zealand nationwide data on hospital discharge, pharmaceutical dispensing, cancer, and mortality were obtained. Annual incidence of each disease and annual YLLs due to premature death in individuals with each disease were calculated. A time series analysis using the stepwise autoregressive method was conducted. RESULTS: Pancreatitis yielded the highest projected incidence (123.7 per 100,000; 95% confidence interval, 116.7–130.7) and YLL (14,709 years; 13,642–15,777) in 2050. The projected incidence and YLL of pancreatic cancer were 18.6 per 100,000 (95% confidence interval, 13.1–24.1) and 14,247 years (11,349–17,144) in 2050, respectively. Compared with pancreatitis and pancreatic cancer, DEP and EPD yielded lower but more steeply increasing projected incidence rates and YLLs. DISCUSSION: The findings suggest that the burden of pancreatitis, pancreatic cancer, DEP, and EPD will rise in the next 3 decades unless healthcare systems introduce effective prevention or early treatment strategies for diseases of the pancreas and their sequelae.

ACS Style

Jaelim Cho; Maxim S. Petrov. Pancreatitis, Pancreatic Cancer, and Their Metabolic Sequelae: Projected Burden to 2050. Clinical and Translational Gastroenterology 2020, 11, e00251 .

AMA Style

Jaelim Cho, Maxim S. Petrov. Pancreatitis, Pancreatic Cancer, and Their Metabolic Sequelae: Projected Burden to 2050. Clinical and Translational Gastroenterology. 2020; 11 (11):e00251.

Chicago/Turabian Style

Jaelim Cho; Maxim S. Petrov. 2020. "Pancreatitis, Pancreatic Cancer, and Their Metabolic Sequelae: Projected Burden to 2050." Clinical and Translational Gastroenterology 11, no. 11: e00251.

Journal article
Published: 26 October 2020 in HPB
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Background It is unknown whether cholecystectomy for acute pancreatitis (AP) affects the risk of post-pancreatitis diabetes mellitus (PPDM). We aimed to investigate the associations between cholecystectomy, recurrent biliary events prior to cholecystectomy, and the risk of PPDM in patients with AP. Methods Using New Zealand nationwide data from 2007 to 2016, patients with first admission for AP were identified (n = 10,870). Cholecystectomy was considered as a time-dependent exposure. Timing of cholecystectomy was categorized as same-admission, readmission, and delayed cholecystectomy. Recurrent biliary events prior to cholecystectomy were identified. Multivariable Cox regression analyses were conducted. Results Among 2147 patients who underwent cholecystectomy, 141 (6.6%) developed PPDM. Overall, cholecystectomy was not significantly associated with the risk of PPDM (adjusted hazard ratio, 1.14; 95% confidence interval, 0.94–1.38). Delayed cholecystectomy was significantly associated with an increased risk of PPDM (adjusted hazard ratio, 1.36; 95% confidence interval, 1.01–1.83). Patients who had 2 or ≥3 recurrent biliary events prior to cholecystectomy were at a significantly increased risk of PPDM. Conclusion Cholecystectomy in general was not associated with the risk of PPDM in patients with AP. Two or more repeated attacks of AP (or other biliary events) were associated with a significantly increased risk of PPDM.

ACS Style

Jaelim Cho; Robert Scragg; Maxim S. Petrov. The influence of cholecystectomy and recurrent biliary events on the risk of post-pancreatitis diabetes mellitus: a nationwide cohort study in patients with first attack of acute pancreatitis. HPB 2020, 23, 937 -944.

AMA Style

Jaelim Cho, Robert Scragg, Maxim S. Petrov. The influence of cholecystectomy and recurrent biliary events on the risk of post-pancreatitis diabetes mellitus: a nationwide cohort study in patients with first attack of acute pancreatitis. HPB. 2020; 23 (6):937-944.

Chicago/Turabian Style

Jaelim Cho; Robert Scragg; Maxim S. Petrov. 2020. "The influence of cholecystectomy and recurrent biliary events on the risk of post-pancreatitis diabetes mellitus: a nationwide cohort study in patients with first attack of acute pancreatitis." HPB 23, no. 6: 937-944.

Journal article
Published: 21 September 2020 in Nutrients
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Both type 2 prediabetes/diabetes (T2DM) and new-onset prediabetes/diabetes after acute pancreatitis (NODAP) are characterized by impaired tissue sensitivity to insulin action. Although the outcomes of NODAP and T2DM are different, it is unknown whether drivers of insulin resistance are different in the two types of diabetes. This study aimed to investigate the associations between abdominal fat phenotypes and indices of insulin sensitivity in non-obese individuals with NODAP, T2DM, and healthy controls. Indices of insulin sensitivity (homeostasis model assessment of insulin sensitivity (HOMA-IS), Raynaud index, triglyceride and glucose (TyG) index, Matsuda index) were calculated in fasting and postprandial states. Fat phenotypes (intra-pancreatic fat, intra-hepatic fat, skeletal muscle fat, visceral fat, and subcutaneous fat) were determined using magnetic resonance imaging and spectroscopy. Linear regression and relative importance analyses were conducted. Age, sex, and glycated hemoglobin A1c were adjusted for. A total of 78 non-obese individuals (26 NODAP, 20 T2DM, and 32 healthy controls) were included. Intra-pancreatic fat was significantly associated with all the indices of insulin sensitivity in the NODAP group, consistently in both the unadjusted and adjusted models. Intra-pancreatic fat was not significantly associated with any index of insulin sensitivity in the T2DM and healthy controls groups. The variance in HOMA-IS was explained the most by intra-pancreatic fat (R2 = 29%) in the NODAP group and by visceral fat (R2 = 21%) in the T2DM group. The variance in the Raynaud index was explained the most by intra-pancreatic fat (R2 = 18%) in the NODAP group and by visceral fat (R2 = 15%) in the T2DM group. The variance in the TyG index was explained the most by visceral fat in both the NODAP group (R2 = 49%) and in the T2DM group (R2 = 25%). The variance in the Matsuda index was explained the most by intra-pancreatic fat (R2 = 48%) in the NODAP group and by visceral fat (R2 = 38%) in the T2DM group. The differing association between intra-pancreatic fat and insulin resistance can be used to differentiate NODAP from T2DM. Insulin resistance in NODAP appears to be predominantly driven by increased intra-pancreatic fat deposition.

ACS Style

Juyeon Ko; Loren Skudder-Hill; Jaelim Cho; Sakina H. Bharmal; Maxim S. Petrov. The Relationship between Abdominal Fat Phenotypes and Insulin Resistance in Non-Obese Individuals after Acute Pancreatitis. Nutrients 2020, 12, 2883 .

AMA Style

Juyeon Ko, Loren Skudder-Hill, Jaelim Cho, Sakina H. Bharmal, Maxim S. Petrov. The Relationship between Abdominal Fat Phenotypes and Insulin Resistance in Non-Obese Individuals after Acute Pancreatitis. Nutrients. 2020; 12 (9):2883.

Chicago/Turabian Style

Juyeon Ko; Loren Skudder-Hill; Jaelim Cho; Sakina H. Bharmal; Maxim S. Petrov. 2020. "The Relationship between Abdominal Fat Phenotypes and Insulin Resistance in Non-Obese Individuals after Acute Pancreatitis." Nutrients 12, no. 9: 2883.

Article
Published: 21 July 2020 in Clinical and Translational Science
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It is well established that individuals with diabetes mellitus (DM) may develop exocrine pancreatic dysfunction (EPD) requiring pancreatic enzyme replacement therapy, whereas the converse relationship has been poorly studied. Pancreatitis is a disease that is well suited to investigate the latter as it is often characterized by the development of EPD and/or new‐onset DM. The aim was to investigate the association between EPD and the risk of new‐onset DM in individuals after the first attack of pancreatitis. Using nationwide pharmaceutical dispensing data and hospital discharge data, this cohort study included a total of 9,124 post‐pancreatitis individuals. EPD was defined as having two or more dispensing records of pancreatic enzymes. Considering EPD as a time‐dependent variable, multivariable Cox regression analysis was conducted. A 1‐year lag period between EPD and DM was introduced to minimize reverse causality. Age, sex, ethnicity, alcohol consumption, tobacco smoking, social deprivation index, Charlson comorbidity index, and use of proton pump inhibitors were adjusted for. In the overall cohort, EPD was associated with a significantly higher risk for new‐onset DM (adjusted hazard ratio, 3.83; 95% confidence interval, 2.37–6.18). The association remained statistically significant when a 1‐year lag period was applied (adjusted hazard ratio, 2.51; 95% confidence interval, 1.38–4.58), as well as when the analysis was constrained to mild acute pancreatitis (4.65; 2.18–9.93). The findings suggest that individuals with EPD, even those without extensive mechanistic destruction of the pancreas, are at an increased risk for new‐onset DM. Purposely designed studies are warranted to investigate mechanisms behind the association and if the mechanisms could be targeted therapeutically.

ACS Style

Jaelim Cho; Robert Scragg; Stephen J. Pandol; Maxim S. Petrov. Exocrine Pancreatic Dysfunction Increases the Risk of New‐Onset Diabetes Mellitus: Results of a Nationwide Cohort Study. Clinical and Translational Science 2020, 14, 170 -178.

AMA Style

Jaelim Cho, Robert Scragg, Stephen J. Pandol, Maxim S. Petrov. Exocrine Pancreatic Dysfunction Increases the Risk of New‐Onset Diabetes Mellitus: Results of a Nationwide Cohort Study. Clinical and Translational Science. 2020; 14 (1):170-178.

Chicago/Turabian Style

Jaelim Cho; Robert Scragg; Stephen J. Pandol; Maxim S. Petrov. 2020. "Exocrine Pancreatic Dysfunction Increases the Risk of New‐Onset Diabetes Mellitus: Results of a Nationwide Cohort Study." Clinical and Translational Science 14, no. 1: 170-178.

Original articles
Published: 13 July 2020 in Pancreas
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Objectives Tobacco smoking and alcohol consumption are established risk factors for pancreatitis. This study investigated the associations between tobacco smoking/alcohol consumption in people after an attack of pancreatitis and intrapancreatic fat deposition (IPFD), intrahepatic fat deposition (IHFD), and skeletal muscle (SMFD) fat deposition. Methods In this cross-sectional study, magnetic resonance imaging was used to quantify IPFD, IHFD, and SMFD by 2 independent raters. A validated questionnaire was used to determine tobacco smoking and alcohol consumption. Results A total of 119 individuals after an attack of pancreatitis were included. Average tobacco smoking contributed most to variance in IPFD (R2 = 6.5%) and least to variance in SMFD (R2 = 0.4%). Average alcohol consumption contributed most to variance in variance in IPFD (R2 = 2.8%) and least to IHFD (R2 = 1.1%). Packs/day contributed more than years of smoking to variance in IPFD (R2 = 4.9 and 0.2%, correspondingly), whereas years of drinking contributed more than average daily alcohol consumption (R2 = 3.9 and 3.2%, correspondingly). Conclusions Tobacco smoking and alcohol consumption contributed more to variance in IPFD than IHFD and SMFD. Smoking contributed more than drinking to variance in IPFD. The daily amount of tobacco smoked appeared to be more important than years of smoking for IPFD.

ACS Style

Charlotte E. Stuart; Juyeon Ko; Andre E. Modesto; Gisselle C. Alarcon Ramos; Sakina H. Bharmal; Jaelim Cho; Ruma G. Singh; Maxim S. Petrov. Implications of Tobacco Smoking and Alcohol Consumption on Ectopic Fat Deposition in Individuals After Pancreatitis. Pancreas 2020, 49, 1 .

AMA Style

Charlotte E. Stuart, Juyeon Ko, Andre E. Modesto, Gisselle C. Alarcon Ramos, Sakina H. Bharmal, Jaelim Cho, Ruma G. Singh, Maxim S. Petrov. Implications of Tobacco Smoking and Alcohol Consumption on Ectopic Fat Deposition in Individuals After Pancreatitis. Pancreas. 2020; 49 (7):1.

Chicago/Turabian Style

Charlotte E. Stuart; Juyeon Ko; Andre E. Modesto; Gisselle C. Alarcon Ramos; Sakina H. Bharmal; Jaelim Cho; Ruma G. Singh; Maxim S. Petrov. 2020. "Implications of Tobacco Smoking and Alcohol Consumption on Ectopic Fat Deposition in Individuals After Pancreatitis." Pancreas 49, no. 7: 1.

Journal article
Published: 02 July 2020 in Diabetes Care
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OBJECTIVE Pancreatitis and diabetes are established risk factors for pancreatic cancer. However, to date, studies have investigated only the risk associated with either of them alone. The aim of this study was to investigate the effect of pancreatitis and diabetes combined, as well as their temporal relationship, on the risk of pancreatic cancer. RESEARCH DESIGN AND METHODS Nationwide cancer registry was linked to hospital discharge and mortality data from 1998 to 2015 in New Zealand. Incidence of primary pancreatic cancer in the four study groups (type 2 diabetes [T2D] alone, pancreatitis alone, T2D followed by pancreatitis, and postpancreatitis diabetes mellitus [PPDM]) was identified. Multivariable Cox regression analyses were conducted, with T2D as the reference group. A head-to-head comparison between the T2D followed by pancreatitis and PPDM groups was also performed. RESULTS Among 139,843 individuals (735,541 person-years), 913 (0.7%) were diagnosed with pancreatic cancer. The proportion of pancreatic cancer was 3.1%, 2.3%, 2.0%, and 0.6% in individuals with PPDM, T2D followed by pancreatitis, pancreatitis alone, and T2D alone, respectively. PPDM (hazard ratio [HR] 6.94; 95% CI 4.09–11.77) and T2D followed by pancreatitis (HR 5.35; 95% CI 3.52–8.14) were associated with significantly higher risks of pancreatic cancer compared with T2D alone. In the head-to-head comparison, PPDM was associated with a higher risk of pancreatic cancer compared with T2D followed by pancreatitis (HR 2.35; 95% CI 1.12–4.93). CONCLUSIONS Pancreatitis significantly increases the risk of pancreatic cancer in individuals with diabetes. In particular, PPDM poses the highest risk for pancreatic cancer.

ACS Style

Jaelim Cho; Robert Scragg; Maxim S. Petrov. Postpancreatitis Diabetes Confers Higher Risk for Pancreatic Cancer Than Type 2 Diabetes: Results From a Nationwide Cancer Registry. Diabetes Care 2020, 43, 2106 -2112.

AMA Style

Jaelim Cho, Robert Scragg, Maxim S. Petrov. Postpancreatitis Diabetes Confers Higher Risk for Pancreatic Cancer Than Type 2 Diabetes: Results From a Nationwide Cancer Registry. Diabetes Care. 2020; 43 (9):2106-2112.

Chicago/Turabian Style

Jaelim Cho; Robert Scragg; Maxim S. Petrov. 2020. "Postpancreatitis Diabetes Confers Higher Risk for Pancreatic Cancer Than Type 2 Diabetes: Results From a Nationwide Cancer Registry." Diabetes Care 43, no. 9: 2106-2112.

Journal article
Published: 01 July 2020 in Diseases
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Background: Skeletal muscle has been implicated in the pathogenesis of type 2 diabetes but it has never been investigated in diabetes after pancreatitis. The aim was to investigate the relationship between psoas muscle volume (PMV) and diabetes in individuals after pancreatitis, as well as its associations with ectopic fat phenotypes and insulin traits. Methods: Individuals after an attack of pancreatitis and healthy individuals were studied in a cross-sectional fashion. All participants underwent magnetic resonance imaging, based on which PMV, skeletal muscle fat deposition (SMFD), as well as liver and intra-pancreatic fat depositions were derived. Fasting and postprandial blood samples were collected to calculate indices of insulin sensitivity and secretion. Linear regression analyses were conducted, adjusting for possible confounders (age, sex, body composition, comorbidities, use of insulin, and others). Results: A total of 153 participants were studied. PMV was significantly decreased in the diabetes group compared with healthy controls (β = -30.0, p =.034 in the most adjusted model). SMFD was significantly inversely associated with PMV (β = -3.1, p < 0.001 in the most adjusted model). The Matsuda index of insulin sensitivity was significantly directly associated with PMV (β = 1.6, p = 0.010 in the most adjusted model). Conclusions: Diabetes in individuals after pancreatitis is characterized by reduced PMV. Reduced PMV is associated with increased SMFD and decreased insulin sensitivity in individuals after pancreatitis.

ACS Style

Andre E. E. Modesto; Juyeon Ko; Charlotte E. E. Stuart; Sakina H. H. Bharmal; Jaelim Cho; Maxim S. Petrov. Reduced Skeletal Muscle Volume and Increased Skeletal Muscle Fat Deposition Characterize Diabetes in Individuals after Pancreatitis: A Magnetic Resonance Imaging Study. Diseases 2020, 8, 25 .

AMA Style

Andre E. E. Modesto, Juyeon Ko, Charlotte E. E. Stuart, Sakina H. H. Bharmal, Jaelim Cho, Maxim S. Petrov. Reduced Skeletal Muscle Volume and Increased Skeletal Muscle Fat Deposition Characterize Diabetes in Individuals after Pancreatitis: A Magnetic Resonance Imaging Study. Diseases. 2020; 8 (3):25.

Chicago/Turabian Style

Andre E. E. Modesto; Juyeon Ko; Charlotte E. E. Stuart; Sakina H. H. Bharmal; Jaelim Cho; Maxim S. Petrov. 2020. "Reduced Skeletal Muscle Volume and Increased Skeletal Muscle Fat Deposition Characterize Diabetes in Individuals after Pancreatitis: A Magnetic Resonance Imaging Study." Diseases 8, no. 3: 25.

Review
Published: 28 June 2020 in Current Opinion in Gastroenterology
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Purpose of review To provide an overview of mediators involved in the pathogenesis of postacute pancreatitis diabetes mellitus. Recent findings The ‘holistic prevention of pancreatitis’ framework has brought to the fore the sequelae of not only end-stage chronic pancreatitis and extensive pancreatic necrosis but also mild acute pancreatitis. Insights from the DORADO project have provided a wealth of information on the signalling molecules that do and do not affect glucose metabolism in individuals after mild acute pancreatitis and have challenged conventional views of the pathogenesis of postpancreatitis diabetes mellitus. Summary Growing evidence compels a reconsideration of the dogma that mechanical β-cell destruction (and the resulting insulin deficiency) is the only underlying mechanism of postpancreatitis diabetes mellitus. Chronic low-grade inflammation, β-cell compensation, lipolysis, altered secretion of gut hormones, and changes in iron metabolism characterize postacute pancreatitis diabetes mellitus. Some of these are druggable targets that offer novel opportunities to reduce the burden of pancreatitis through tertiary prevention.

ACS Style

Maxim S. Petrov. Panorama of mediators in postpancreatitis diabetes mellitus. Current Opinion in Gastroenterology 2020, 36, 443 -451.

AMA Style

Maxim S. Petrov. Panorama of mediators in postpancreatitis diabetes mellitus. Current Opinion in Gastroenterology. 2020; 36 (5):443-451.

Chicago/Turabian Style

Maxim S. Petrov. 2020. "Panorama of mediators in postpancreatitis diabetes mellitus." Current Opinion in Gastroenterology 36, no. 5: 443-451.

Journal article
Published: 03 June 2020 in Journal of Gastroenterology
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New-onset diabetes is the most common sequela of acute pancreatitis (AP). Yet, prospective changes in glycaemia over time have never been investigated comprehensively in this study population. The primary aim was to determine the cumulative incidence of new-onset prediabetes and new-onset diabetes after AP over 24 months of follow-up in a prospective cohort study. The secondary aim was to identify trajectories of glycaemia during follow-up and their predictors at the time of hospitalisation. Patients with a prospective diagnosis of AP and no diabetes based on the American Diabetes Association criteria were followed up every 6 months up to 24 months after hospital discharge. Incidence of new-onset prediabetes/diabetes over each follow-up period was calculated. Group-based trajectory modelling was used to identify common changes in glycaemia. Multinomial regression analyses were conducted to investigate the associations between a wide array of routinely available demographic, anthropometric, laboratory, imaging, and clinical factors and membership in the trajectory groups. A total of 152 patients without diabetes were followed up. The cumulative incidence of new-onset prediabetes and diabetes was 20% at 6 months after hospitalisation and 43% over 24 months of follow-up (p trend < 0.001). Three discrete trajectories of glycaemia were identified: normal-stable glycaemia (32%), moderate-stable glycaemia (60%), and high-increasing glycaemia (8%). Waist circumference was a significant predictor of moderate-stable glycaemia. None of the studied predictors were significantly associated with high-increasing glycaemia. This first prospective cohort study of changes in glycaemia (determined at structured time points in unselected AP patients) showed that at least one out of five patients develops new-onset prediabetes or diabetes at 6 months of follow-up and more than four out of ten—in the first 2 years. Changes in glycaemia after AP follow three discrete trajectories. This may inform prevention or early detection of critical changes in blood glucose metabolism following an attack of AP and, hence, reduce the burden of new-onset diabetes after acute pancreatitis.

ACS Style

Sakina Huseni Bharmal; Jaelim Cho; Gisselle Charlott Alarcon Ramos; Juyeon Ko; Charlotte Elizabeth Stuart; Andre Eto Modesto; Ruma Girish Singh; Maxim Sergey Petrov. Trajectories of glycaemia following acute pancreatitis: a prospective longitudinal cohort study with 24 months follow-up. Journal of Gastroenterology 2020, 55, 775 -788.

AMA Style

Sakina Huseni Bharmal, Jaelim Cho, Gisselle Charlott Alarcon Ramos, Juyeon Ko, Charlotte Elizabeth Stuart, Andre Eto Modesto, Ruma Girish Singh, Maxim Sergey Petrov. Trajectories of glycaemia following acute pancreatitis: a prospective longitudinal cohort study with 24 months follow-up. Journal of Gastroenterology. 2020; 55 (8):775-788.

Chicago/Turabian Style

Sakina Huseni Bharmal; Jaelim Cho; Gisselle Charlott Alarcon Ramos; Juyeon Ko; Charlotte Elizabeth Stuart; Andre Eto Modesto; Ruma Girish Singh; Maxim Sergey Petrov. 2020. "Trajectories of glycaemia following acute pancreatitis: a prospective longitudinal cohort study with 24 months follow-up." Journal of Gastroenterology 55, no. 8: 775-788.

Hepatobiliary pancreas
Published: 10 February 2020 in European Radiology
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Pancreatitis often represents a continuous inflammatory process, from the first episode of acute pancreatitis (FAP) to recurrent acute pancreatitis (RAP) to chronic pancreatitis (CP). Psoas muscle size is a validated surrogate for global skeletal mass, changes in which are associated with inflammation. The objective was to investigate psoas muscle size in individuals following FAP, RAP, and CP, as well as its associations with pro-inflammatory cytokines. Individuals following pancreatitis and healthy individuals were recruited. All participants underwent magnetic resonance imaging, from which psoas muscle volume was derived independently by two raters in a blinded fashion. Circulating levels of four major cytokines (interleukin-6, tumour necrosis factor-α, C-C motif chemokine ligand 2, and leptin) were measured. Five linear regression additive models were built to adjust for possible confounders (age, sex, body composition, physical activity, tobacco smoking, alcohol consumption, comorbidities, and endocrine and exocrine pancreatic functions). A total of 145 participants were enrolled. A significant downward trend in psoas muscle volume was observed between healthy controls and individuals following FAP, RAP, and CP in all adjusted models (p = 0.047, 0.005, 0.004, and < 0.001). Leptin was significantly associated with psoas muscle volume in all models (β = − 0.16, p = 0.030 in the most adjusted model). The other studied cytokines were not significantly associated with psoas muscle volume. Psoas muscle size is significantly reduced along the continuum from FAP to RAP to CP. Leptin appears to be one of the factors implicated in this. Further studies are warranted to investigate the relationship between skeletal muscle and inflammation of the pancreas. • First acute pancreatitis, recurrent acute pancreatitis, and chronic pancreatitis were associated with progressively reduced psoas muscle size. • The findings were independent of age, sex, body fat composition, physical activity, tobacco smoking, alcohol consumption, comorbidities, and exocrine and endocrine functions of the pancreas. • The mechanism underlying the observed findings may involve hyperleptinaemia.

ACS Style

Andre E. Modesto; Charlotte E. Stuart; Jaelim Cho; Juyeon Ko; Ruma G. Singh; Maxim S. Petrov. Psoas muscle size as a magnetic resonance imaging biomarker of progression of pancreatitis. European Radiology 2020, 30, 2902 -2911.

AMA Style

Andre E. Modesto, Charlotte E. Stuart, Jaelim Cho, Juyeon Ko, Ruma G. Singh, Maxim S. Petrov. Psoas muscle size as a magnetic resonance imaging biomarker of progression of pancreatitis. European Radiology. 2020; 30 (5):2902-2911.

Chicago/Turabian Style

Andre E. Modesto; Charlotte E. Stuart; Jaelim Cho; Juyeon Ko; Ruma G. Singh; Maxim S. Petrov. 2020. "Psoas muscle size as a magnetic resonance imaging biomarker of progression of pancreatitis." European Radiology 30, no. 5: 2902-2911.

Journal article
Published: 01 February 2020 in Clinical and Translational Gastroenterology
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OBJECTIVE: New-onset diabetes is an important sequela of acute pancreatitis, but there are no biomarkers to differentiate it from the much more common type 2 diabetes. The objective was to investigate whether postprandial circulating levels of gut hormones can serve this purpose. METHODS: This was a case-control study nested into a prospective longitudinal cohort study that included 42 insulin-naive cases with new-onset prediabetes/diabetes after acute pancreatitis (NODAP) and prediabetes/diabetes followed by acute pancreatitis (T2D-AP), sex matched with 21 healthy controls. All individuals underwent a standardized mixed-meal test, and blood samples were assayed for gut hormones (glucose-dependent insulinotropic peptide, glucagon-like peptide-1, oxyntomodulin, and peptide YY). Analysis of variance and linear regression analysis were conducted in unadjusted and adjusted models (accounting for age, homeostatic model assessment of β-cell function, and magnetic resonance imaging–derived body fat composition). RESULTS: Oxyntomodulin levels were significantly lower in NODAP compared with T2D-AP and healthy controls (P = 0.027 and P = 0.001, respectively, in the most adjusted model). Glucagon-like peptide-1 and peptide YY were significantly lower in NODAP compared with T2D-AP (P = 0.001 and P = 0.014, respectively, in the most adjusted model) but not compared with healthy controls (P = 1.000 and P = 0.265, respectively, in the most adjusted model). Glucose-dependent insulinotropic peptide levels were not significantly different between NODAP and T2D-AP. DISCUSSION: Oxyntomodulin is a promising biomarker to guide the differential diagnosis of new-onset diabetes after acute pancreatitis. However, external validation studies are warranted before it can be recommended for routine use in clinical practice.

ACS Style

Sakina H. Bharmal; Jaelim Cho; Charlotte E. Stuart; Gisselle C. Alarcon Ramos; Juyeon Ko; Maxim S. Petrov. Oxyntomodulin May Distinguish New-Onset Diabetes After Acute Pancreatitis From Type 2 Diabetes. Clinical and Translational Gastroenterology 2020, 11, e00132 .

AMA Style

Sakina H. Bharmal, Jaelim Cho, Charlotte E. Stuart, Gisselle C. Alarcon Ramos, Juyeon Ko, Maxim S. Petrov. Oxyntomodulin May Distinguish New-Onset Diabetes After Acute Pancreatitis From Type 2 Diabetes. Clinical and Translational Gastroenterology. 2020; 11 (2):e00132.

Chicago/Turabian Style

Sakina H. Bharmal; Jaelim Cho; Charlotte E. Stuart; Gisselle C. Alarcon Ramos; Juyeon Ko; Maxim S. Petrov. 2020. "Oxyntomodulin May Distinguish New-Onset Diabetes After Acute Pancreatitis From Type 2 Diabetes." Clinical and Translational Gastroenterology 11, no. 2: e00132.

Review
Published: 30 January 2020 in Expert Review of Gastroenterology & Hepatology
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Introduction: Motilin was first alluded to nearly a century ago. But it remains a rather abstruse peptide, in the shadow of its younger but more lucid ‘cousin’ ghrelin. Areas covered: The review aimed to bring to the fore multifarious aspects of motilin research with a view to aiding prioritization of future studies on this gastrointestinal peptide. Expert opinion: Growing evidence indicates that rodents (mice, rats, guinea pigs) do not have functional motilin system and, hence, studies in these species are likely to have a minimal translational impact. Both the active peptide and motilin receptor were initially localized to the upper gastrointestinal tract only but more recently – also to the brain (in both humans and other mammals with functional motilin system). Motilin is now indisputably implicated in interdigestive contractile activity of the gastrointestinal tract (in particular, gastric phase III of the migrating motor complex). Beyond this role, evidence is building that there is a cross-talk between motilin system and the brain-pancreas axis, suggesting that motilin exerts not only contractile but also orexigenic and insulin secretagogue actions.

ACS Style

Kanageswari Singaram; Fuchsia D. Gold-Smith; Maxim S. Petrov. Motilin: a panoply of communications between the gut, brain, and pancreas. Expert Review of Gastroenterology & Hepatology 2020, 14, 103 -111.

AMA Style

Kanageswari Singaram, Fuchsia D. Gold-Smith, Maxim S. Petrov. Motilin: a panoply of communications between the gut, brain, and pancreas. Expert Review of Gastroenterology & Hepatology. 2020; 14 (2):103-111.

Chicago/Turabian Style

Kanageswari Singaram; Fuchsia D. Gold-Smith; Maxim S. Petrov. 2020. "Motilin: a panoply of communications between the gut, brain, and pancreas." Expert Review of Gastroenterology & Hepatology 14, no. 2: 103-111.