A multicenter inquiry into the etiology of pancreatic diseases

A multicenter study on the etiology and diet of patients with pancreatic diseases has been realized with the collaboration of 36 centers in 19 countries having widely different climatic and racial conditions. 2,478 cases were studied: acute pancreatitis (AP), 222 males, 208 females; calcified chronic pancreatitis (CCP), 801 males, 134 females; non-calcified chronic pancreatitis (NCCP), 525 males, 155 females; pancreatic cancer (PK), 69 males, 14 females; controls, 281 males, 62 females. The analysis of mutual information and the factorial analysis of correspondences have been used. With regard to chronic pancreatitis, the 19 countries could be classified into 4 classes presenting relative similarities. (A) Southern Europe: The diet is rich in carbohydrates, protein and lipids, alcohol intake is primarily in the form of wine and the pathology is dominated by CCP. There are much fewer women than men with chronic pancreatitis. (B) Northern Europe, to which may be added Argentina and Chile, is characterized by a protein- and lipid-rich diet, a beer-based alcohol consumption and a distinct prevalence of AP and NCCP. The prevalence of males with chronic pancreatitis is less marked than in southern Europe. (C) Japan has a lipid-poor diet and a low frequency of CCP and NCCP. (D) A fourth group is mostly composed of tropical countries with mixed races. It may be divided into 2 subclasses: (a) India is the most characteristic country of the first type with low fat, low protein diet, no alcoholism, high frequency of CCP (at an early age); (b) Brasil and South Africa are representative of the second subclass with very high alcohol intake in the form of spirits and a high frequency of CCP.