Obesity alters metabolic profiles in children with acute pancreatitis, but not disease severity and recurrence: a Romanian cohort study.

Childhood obesity has been increasingly recognized as a risk factor for acute pancreatitis (AP). This study investigates the impact of obesity and a novel composite metabolic risk variable (MAC - Metabolic at Risk in Context) on the biochemical, inflammatory, and clinical profiles of Romanian children with AP.

Material and methods: A retrospective cohort study included 90 pediatric patients hospitalized for a first episode of AP at Grigore Alexandrescu Children's Emergency Clinical Hospital in Bucharest over a three-year period. Patients were classified as obese or non-obese based on BMI percentiles. The MAC variable was defined as positive if the patient had at least one of the following: total cholesterol >170 mg/dL, GGT >40 U/L, or total lipids >500 mg/dL. Associations between obesity, MAC, inflammatory markers, disease severity, and recurrence were analyzed using regression models.

Results: Nineteen patients (21.1%) were obese, and 35 (38.9%) were MAC-positive. Obese patients were older (median age 15 vs. 9.5 years) and had significantly higher total cholesterol, GGT, and total lipid levels. MAC positivity was more frequent in obese patients (68.4% vs. 26.8%, p < 0.001). Biliary pancreatitis was significantly more common among obese patients (p = 0.0043), while no association was found between MAC and biliary etiology. Neither obesity nor MAC predicted severity or recurrence. In contrast, lower lymphocyte counts were inversely associated with severity (p<0.01), suggesting that lymphopenia may serve as a biomarker of severe disease.

Conclusions: Obesity and metabolic abnormalities are frequent in pediatric AP and are associated with biliary etiology, but not with increased severity or recurrence. The use of the MAC variable provides a novel approach to identify children at metabolic risk beyond BMI status. Additionally, lymphocyte counts may serve as a practical biomarker for identifying children at risk for severe AP. These findings highlight the need for integrated metabolic and immune assessments in pediatric AP management.