Metabolic Syndrome Components and Acute Pancreatitis: A Case-Control Study in China

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Recent evidence has shown that metabolic syndrome is positively correlated with the severity of AP. However, only a few studies have revealed the relationship between metabolic syndrome and the occurrence of AP. We therefore elucidated the association between metabolic syndrome and the occurrence of AP. Methods: A hospital-based case-control study was conducted. A total of 705 patients admitted to our hospital from January 2016 to December 2018 were included in the study. Subjects were divided into case and control groups according to their diagnosis: (1) According to the revised Atlanta classification from 2012, patients diagnosed with AP were enrolled in the case group. (2) Patients without a history of AP or any disease related to metabolic syndrome were allocated into the control group. Controls were matched to cases individually by sex and age (control/case ratio=1). Results: The incidence rate of metabolic syndrome in AP patients was 30.9%, which was more frequent than that in controls (13.2%) (OR=2.837; 95% CI 1.873-4.298, p <0.001). In the multivariate regression analysis, a history of smoking or alcohol consumption and biliary stones were significantly associated with AP (OR=2.441; 95% CI 1.865-5.172, p <0.001; OR=1.777; 95% CI 1.060-2.977, p =0.029; OR=28.995; 95% CI 13.253-63.435, p <0.001). In addition, the occurrence of AP was significantly associated with total cholesterol (TC) (OR=1.992; 95% CI 1.246-3.183, p =0.004), triglyceride (TG) (OR=2.134; 95% CI 1.403-3.245, p <0.001), hyperglycaemia (OR=2.261; 95% CI 1.367-3.742, p =0.001), and apolipoprotein A (Apo A) (OR=0.270; 95% CI 0.163-0.447, p <0.001). Conclusions: Metabolic syndrome and its components were associated with AP occurrence. Gastroenterology & Hepatology Acute pancreatitis Metabolic syndrome Hyperglycaemia Hyperlipidaemia Obesity Hypertension Figures Figure 1 Figure 2 Background Acute pancreatitis (AP) is a pancreatic inflammatory disorder that may cause life-threatening consequences due to severe inflammatory responses[1]. According to a survey, the annual incidence rate of AP has increased by 100% over the past several decades[2]. This has posed a great threat to human health and become one of the largest contributors to aggregate medical costs[3]. The main pathogenic causes of AP are biliary stones and alcohol consumption. Other factors, such as smoking and genetic factors, are also considered to be related to the occurrence of AP[3]. However, the pathogenic immune mechanism of AP remains elusive, and the potential factors related to the stimulus of inflammation are still under investigation. Due to the huge economic development and social progress made in China over past decades, the lifestyles and daily diets of Chinese people have changed substantially. In turn, this has led to the high prevalence of metabolic syndrome in China (27.9% in men and 26.8% in women) and has caused serious public health problems[4]. Metabolic syndrome is defined as four interconnected factors: hyperglycaemia, hyperlipidaemia (particularly increased triglycerides [TGs] and low high-density lipoprotein [HDL] cholesterol), obesity and hypertension. It is generally considered a risk factor for cardiovascular diseases[5]. Although there is still no universally accepted mechanism of metabolic syndrome[6], the best evidence suggests that the four components of metabolic syndrome may be intercorrelated with each other by sharing common pathophysiological processes. These processes mainly consist of insulin resistance, visceral adiposity, atherogenic dyslipidaemia and endothelial dysfunction[7]. In addition, given that the four components are more likely to appear together more than might be expected by chance, metabolic syndrome should thus be considered an overall concept. It can gradually lead patients to a proinflammatory state that is associated with a series of diseases, such as venous thrombosis and psoriasis[7-9]. Since it is well believed that there is an interrelation between metabolic syndrome and inflammation[10, 11], we suspect that metabolic syndrome may also have a significant impact on AP. Although some studies have demonstrated that metabolic syndrome is positively associated with the severity of AP[1, 12], there is still a lack of data showing the relationship between metabolic syndrome and the occurrence of AP in the Chinese population. Although there were studies about the association between metabolic syndrome and AP, most of them involved mainly the single component of metabolic syndrome, such as obesity or hyperglycaemia, rather than as an overall concept[1, 13-16, 20]. Moreover, these studies were mainly conducted on western countries, which may differ from those in eastern populations. To address these issues, we examined relevant data to investigate (1) the association between metabolic syndrome and the occurrence of AP, (2) the association between each metabolic syndrome component and the occurrence of AP, (3) the association between the number of metabolic syndrome components and the occurrence of AP. Methods Ethical approval The study was conducted according to the Declaration of Helsinki and approved by the institutional research board of Jinshan Hospital (IEC-2020-S21). Informed consent was waived. Study Population A hospital-based case-control study was conducted. A total of 705 patients (349 AP patients and 356 controls) admitted to our hospital from January 2016 to December 2018 were included in the study. According to the revised Atlanta classification from 2012[17], AP was defined if at least two of the following three criteria were presented: acute attack of severe upper abdominal pain with or without radiating to the back; serum amylase or lipase elevation at least 3 times above the upper limit of normal level; and typical acute pancreatitis imaging found on computed tomography (CT) scan. Only patients with a first attack of AP were included, while patients with relapse of AP or chronic pancreatitis were excluded. The controls were selected from patients admitted to department of anorectal surgery, department of otorhinolaryngology head and neck surgery and department of orthopedics. Their diagnosis mainly consisted of haemorrhoids, sudden sensorineural hearing loss, tonsil hypertrophy, epiglottic cyst and disc herniation. The controls were frequency matched to cases by sex and exact age. Control subjects were excluded if they had AP history. Participants who had histories of any cardiovascular disease (except hypertension) or psoriasis were not enrolled in the two groups. Last, subjects were excluded if they were younger than 18 years, pregnant, underwent surgery within 1 month or had a cancer history. All patients admitted were given standard medical treatment. In AP group, patients received treatment including fasting, early fluid resuscitation, analgesia, and nutritional support. In non-AP group, patients mainly received pre-operation examinations such as ECG (Electrocardiogram) and chest X-Ray after admission since most of the patients were about to undergo surgery in the next few days. Clinical data collection Data were collected by researchers who were not informed of the detailed information of the study until collection was completed. The collected data were from computer-based case reports and were checked by another two researchers to ensure that there were no inconsistencies or errors. The following data of patients were collected: sex; age; smoking history; alcohol drinking history (>14 drinks/week in women or >21 drinks/week in men); biliary stones history; history of hepatitis B or hepatitis C; body mass index (BMI); blood pressure; and laboratory tests, including total cholesterol (TC), TG, HDL, low-density lipoprotein (LDL), apolipoprotein A (Apo A), apolipoprotein B (Apo B), and fasting plasma glucose (FPG). BMI was calculated as body weight (kg) divided by square of the height (m). Blood pressure was measured by a mercury sphygmomanometer when patients were in a supine position and after 20 min of rest. Blood samples were collected from the median cubital vein of each patient after eight hours of fasting. Fasting venous blood was collected in polystyrene tubes and rapidly transmitted to the laboratory to ensure the accuracy of our indexes. Metabolic Syndrome Components The diagnostic criteria for metabolic syndrome were defined according to National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III)[18] and modified by the Asia–Pacific criteria[19]. The criteria include (1) hypertension (blood pressure≥130/85 mmHg or ongoing anti-hypertensive treatment), (2) hyperlipidaemia (TG≥150 mg/dL or HDL≤40 mg/dL in men and 50 mg/dL in women or ongoing anti-lipidaemic treatment), (3) hyperglycaemia (FPG≥110 mg/dL, previously physician-diagnosed type 2 diabetes mellitus [T2DM] or ongoing antidiabetic treatment) and (4) obesity (BMI≥25 kg/m² or waist circumference≥90 cm for men and 80 cm for women). Statistical Analysis Quantitative data were expressed with mean± standard deviation (SD) or median with 25 th and 75 th percentiles as appropriate. For normal distributed quantitative data, independent sample t-test was used to compare the differences between the two groups. For non-parametric quantitative data, Mann-Whitney test was used to detect the statistical significance. Qualitative data were expressed in number (n) and percentage (%). Fisher’s exact test or chi-square test was used to compare the differences. Univariate logistic regression analysis was used to preliminarily assess whether these individual variables were predictive factors of AP occurrence. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated. Univariate and multivariate logistic regression were used to further test the OR value. The accuracy of each marker in predicting the occurrence of AP was assessed by using receiver operating characteristic (ROC) curves. A P value<0.05 was defined as statistically significant. IBM SPSS v22 (SPSS, Chicago, Illinois, USA) and MedCalc statistical software packages, version 10 (MedCalc, Mariakerke, Belgium), were used for statistical analysis. Results Characteristics of Study Subjects Based on the inclusion and exclusion criteria, 705 subjects, including 349 AP patients and 356 non-AP patients, were enrolled in our study. Table 1 shows the characteristics of the subjects. No significant differences between AP patients and non-AP patients were found with respect to age ( p =0.989), gender ( p =0.923), hepatitis C ( p =0.349) and Apo B ( p =0.198). However, we noted that AP patients were significantly associated with cigarette smoking ( p <0.001), alcohol consumption ( p <0.001), biliary stones history ( p <0.001), hepatitis B ( p= 0.049), and BMI ( p <0.001) and TC ( p <0.001), TG ( p <0.001), HDL ( p <0.001), LDL ( p= 0.030), Apo A ( p <0.001), and FPG ( p <0.001) than controls. In patients with diabetes mellitus, 27 patients (79.4%) received anti-diabetic therapy in control group, while 59 patients (64.8%) received treatment in case group. There were no significant differences ( p= 0.118) between the two groups regarding the anti-diabetic therapy. Table 1. Basic Characteristics Non-AP patients (n=356) AP patients (n=349) p Mean age, years (SD) 51.2±15.9 51.2±15.9 0.989 Gender, n (%) Female 140 (39.3) 136 (39.0) Male 216 (60.7) 213 (61.0) 0.923 Smoking history, n (%) 62 (17.4) 125 (35.8) ＜ 0.001 Alcohol drinking history, n (%) 53 (14.9) 101 (28.9) ＜ 0.001 Biliary stones, n (%) 8 (2.3) 101 (28.9) ＜ 0.001 Hepatitis B , n (%) 17 (4.8) 7 (2.0) 0.049 Hepatitis C, n (%) 3 (0.8) 1 (0.3) 0.349 BMI, kg/m 2 (IQR) 23.8±3.5 24.8±3.7 ＜ 0.001 TC, mg/dL (IQR) 178.0 (153.7, 209.3) 180.3 (145.6, 235.1) ＜ 0.001 TG, mg/dL (IQR) 101.8 (77.0, 157.5) 131.9 (81.4, 349.6) ＜ 0.001 HDL, mg/dL (IQR) 99.1 (86.7, 117.7) 90.3 (74.3, 112.4) ＜ 0.001 LDL, mg/dL (IQR) 269.9 (224.8, 318.6) 258.4 (198.2, 236.3) 0.030 Apo A, g/L (IQR) 1.2 (1.1, 1.4) 1.1 (0.9, 1.3) ＜ 0.001 Apo B, g/L (IQR) 0.9 (0.7, 1.0) 0.8 (0.7, 1.0) 0.198 FPG, mg/dL (IQR) 97.8 (89.4, 112.1) 132.8 (107.4, 172.7) ＜ 0.001 Anti-diabetic therapy, n (%) 27 (79.4) 59 (64.8) 0.118 Data were numbers and percentages, or median (25 th , 75 th percentile), as appropriate. Abbreviations: n, number; IQR, interquartile range; BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); TC, total cholesterol; TG, triglyceride; HDL, high density lipoprotein; LDL, low density lipoprotein; Apo A, apolipoprotein A; Apo B, apolipoprotein B; FPG, fasting plasma glucose. SI conversion factors: TC: 1 mg/dL =0.0259 mmol/L; HDL, LDL, TG:1 mg/dL= 0.0113 mmol/L; FPG :1mg/dL= 0.0555mmol/L. Effect of Metabolic Syndrome Components on AP In univariate analysis, both of increased values of TG and decreased values of HDL were associated with the occurrence of AP (OR=2.313; 95% CI 1.690-3.167, p <0.001; OR=0.582; 95% CI 0.431-0.786, p<0.001) (Table 2). Additionally, significant differences were observed between the two groups in patients with obesity, hyperglycaemia and hypertension(OR=1.608; 95% CI 1.186-2.181, p =0.002; OR=3.209; 95% CI 2.112-4.876, p<0.001; OR=1.473; 95% CI 1.089-1.991, p=0.012). In multivariate logistic regression models, after adjustment for smoking and alcohol drinking history, biliary stones history, Apo A and the components of metabolic syndrome, the results revealed that AP was associated with smoking history; alcohol consumption history; biliary stones history; elevated levels of TC, TG; hyperglycaemia and lower values of Apo A (OR=2.441; 95% CI 1.865-5.172, p <0.001; OR=1.777; 95% CI 1.060-2.977, p =0.029; OR=28.995; 95% CI 13.253-63.435, p <0.001; OR=1.992; 95% CI 1.246-3.183, p =0.004; OR=2.134; 95% CI 1.403-3.245, p <0.001; OR=2.261; 95% CI 1.367-3.742, p =0.001 and OR=0.270; 95% CI 0.163-0.447, p <0.001, respectively). However, obesity was not observed to be associated with the occurrence of AP ( p =0.246) (shown in Table 3). After adjusting for smoking and alcohol drinking history, biliary stones, the prevalence of metabolic syndrome was more common in AP patients (30.9%) than in those without AP (13.2%) (OR=2.837; 95% CI 1.873-4.298, p <0.001) (shown in Table 4). As shown in Table 5 and Figure 1, for all AP patients, increased values of TG and low Apo A and FPG predicted AP with statistical significance ( p <0.001, p <0.001, p <0.001); their AUCs were 0.620, 0.679 and 0.767, respectively. Among the three indicators, FPG had the best sensitivity (67.54%), and TG had the best specificity (90.17%) when the indicators were at their best cut-off values (shown in Table 5). Table 2. Univariate Analysis Examining the Components of the Metabolic Syndrome Non-AP patients (n=356) AP patients (n=349) OR (95% CI) p TG≥150 mg/dL, n (%) 97 (27.2) 162 (46.4) 2.313 (1.690-3.167) ＜ 0.001 HDL≥40 mg/dL (M) or ≥50 mg/dL (F), n (%) 183 (51.4) 133 (38.1) 0.582 (0.431-0.786) ＜ 0.001 Obesity, n (%) 120 (33.7) 157 (45.0) 1.608 (1.186-2.181) 0.002 Hyperglycaemia, n (%) 37 (10.4) 93 (26.7) 3.209 (2.112-4.876) ＜ 0.001 Hypertension, n (%) 129 (36.2) 159 (45.6) 1.473 (1.089-1.991) 0.012 Abbreviations: OR, odds ratio ; TG, triglyceride; HDL, high density lipoprotein. SI conversion factors: HDL, TG:1 mg/dL= 0.0113 mmol/L; Table 3. Multivariate Analysis Examining the Components of the Metabolic Syndrome Non-AP patients (n=356) AP patients (n=349) OR (95% CI) p Smoking, n (%) 62 (17.4) 125 (35.8) 2.441 (1.865-5.172) ＜ 0.001 Alcohol drinking, n (%) 53 (14.9) 101 (28.9) 1.777 (1.060-2.977) 0.029 Biliary stone, n (%) 8 (2.3) 101 (28.9) 28.995 (13.253-63.435) ＜ 0.001 Hepatitis B, n (%) 17 (4.8) 7 (2.0) 0.439 (0.145-1.327) 0.145 Obesity, n (%) 120 (33.7) 157 (45.0) 1.258 (0.854-1.855) 0.246 TC≥220 mg/dL, n (%) 61 (17.1) 106 (30.4) 1.992 (1.246-3.183) 0.004 TG≥150 mg/dL, n (%) 97 (27.2) 162 (46.4) 2.134 (1.403-3.245) ＜ 0.001 HDL≥40 mg/dL (M) or ≥50 mg/dL (F) , n (%) 183 (51.4) 133 (38.1) 0.784 (0.522-1.176) 0.240 Apo A≥1 g/L, n (%) 321 (90.2) 230 (65.9) 0.270 (0.163-0.447) ＜ 0.001 Hyperglycaemia, n (%) 37 (10.4) 93 (26.7) 2.261 (1.367-3.742) 0.001 Hypertension, n (%) 129 (36.2) 159 (45.6) 1.189 (0.817-1.732) 0.366 Abbreviations: OR, odds ratio ; TC, total cholesterol; TG, triglyceride; HDL, high density lipoprotein; Apo A, apolipoprotein A. SI conversion factors: TC: 1 mg/dL =0.0259 mmol/L ; HDL, TG:1 mg/dL= 0.0113 mmol/L; Table 4. Association Between the Metabolic Syndrome and AP Prevalence of Metabolic syndrome OR (95%CI) p AP patients, n (%) 108 (30.9) 2.837 ( 1.873 - 4.298 ) ＜ 0.001 Non-AP patients, n (%) 47 (13.2) Abbreviations: OR, odds ratio; AP, acute pancreatitis; CI, confidence interval. Table 5. Identification of TG, Apo A and FPG in the patients with AP Variable AUC p Cut-off Sensitivity(%) Specificity(%) +LR -LR TG, mg/dL 0.620 ＜ 0.001 218.6 39.08 90.17 3.98 0.68 Apo A, g/L 0.679 ＜ 0.001 1.15 63.16 66.85 1.91 0.55 FPG, mg/dL 0.767 ＜ 0.001 115.1 67.54 78.93 3.21 0.41 Abbreviations: AUC , area under curve; LR, likelihood ratio; TG, triglyceride; Apo A, apolipoprotein A; FPG, fasting plasma glucose. SI conversion factors: TG:1 mg/dL= 0.0113 mmol/L; FPG :1mg/dL= 0.0555mmol/L. Association Between the Number of Metabolic Syndrome Components and AP As shown in Figure 2, the incidence rates of AP obviously increased when there were more than three components of metabolic syndrome present. Moreover, the incidence rates of AP significantly declined when there were no components of metabolic syndrome present. Discussion To our knowledge, this is the first case-control study demonstrating the relationship between metabolic syndrome and the occurrence of AP in an Asian population. Our results showed that metabolic syndrome was positively associated with the occurrence of AP. Among components of metabolic syndromes, we revealed that hyperglycaemia and hyperlipidaemia were independently associated with AP. Hyperglycaemia has been considered to be associated with AP for decades[20]. However, only a few studies have shown a higher incidence rate of AP among patients with hyperglycaemia[13-16]. Our results revealed that hyperglycaemia had positively correlation with AP (OR=2.261; 95% CI 1.367-3.742, p =0.001). Although the exact mechanism between hyperglycaemia and AP remains unclear, several underlying biological theories have been proposed. High plasma glucose enhances mitochondrial oxidative stress by promoting the production of reactive oxygen species (ROS) and lipid oxidation through cytosolic Ca 2+ accumulation[21-23]. Furthermore, owing to the dysfunction of beta cells and resultant hyperinsulinaemia, beta cells may lose their sensitivity to the inhibitory hormone somatostatin, which may be an important factor in inducing AP[24]. Moreover, insulin resistance, as a crucial pathophysiological factor of hyperglycaemia, has been reported to be involved in AP development. Various proinflammatory factors or cytokines are activated due to insulin resistance, including nuclear factor-kappaB (NF κB), tumour necrosis factor-alpha (TNF-α), amylin and interleukin-6, and these proinflammatory factors may be responsible for the initiation and progression of AP[25-29]. It is well known that hypertriglyceridaemia is associated with the morbidity and mortality of AP[30-32]. Our study showed that TG was associated with AP. Furthermore, we found that TC and Apo A values were also correlated with the occurrence of AP, which demonstrated that atherogenic lipid profiles also participated in the development of AP. Triantafilou M et al. reported that cholesterol may trigger inflammatory responses that could lead to chronic inflammation and insulin resistance via Toll-like receptor 4 (TLR4) and ultimately cause lysosomal damage, ROS generation and proinflammatory cytokine secretion[33, 34]. This theory may explain why acinar injury is induced by hypercholesterolaemia through the inflammatory response. Furthermore, as a lipoprotein, HDL often opposes cholesterol accumulation and reduces inflammation by the ATP-binding cassette transporter A1 (ABCA1) pathway[35]. This ability may be impaired if Apo A is oxidized by macrophage myeloperoxidase (MPO). Shao B et al. reported impaired function of HDL and Apo An in patients with atherosclerosis[36], which may be similar in AP. However, our results only showed that the value of Apo A was negatively associated with the occurrence of AP, while we did not observe an association between HDL and AP. Based on our present study, it is hard to tease out the exact role of HDL in AP. In future studies, it will be important to determine the exact function that HDL and Apo A exert in AP development. Currently, obesity is considered a global pandemic that poses a great threat to human health. Some studies have shown that obesity is positively correlated with the severity of AP[37, 38, 12]. However, due to the paucity of studies between obesity and the incidence of AP, their relationship has been a matter of dispute. Blomgren et al. found that the crude risk ratio (RR) between obesity and the occurrence of AP was 1.8 (95% CI: 1.3 to 2.6), while the authors did not display the results after adjustment[39]. In contrast to previous beliefs, our current study did not find an association between obesity and AP ( p =0.246), which is consistent with the findings of a recent large-scale prospective cohort study (RR=1.02, 95% CI: 0.68 to 1.53)[40]. In an animal model, obesity was shown to be related to an inflammatory status by secreting proinflammatory cytokines such as TNF-α and interleukin-6[41]. Moreover, the level of adiponectin, an anti-inflammatory cytokine, is reduced in an obese environment. Therefore, combined with previous data and our results [12], we suppose that obesity may aggravate the severity of AP but is not enough to initiate the development of AP without other risk factors in a non-AP person. Recently, visceral obesity, a subtype of obesity, is considered as a metabolically active status. Previous study suggested that occurrence of biliary pancreatitis was positively correlated with intrapancreatic fat. It may be caused by saturation of cholesterol in bile, which could consequently induce gallstone formation[42]. Moreover, visceral fat was also associated with the severity of AP[43]. The level of adiponectin would paradoxically decrease due to excess viscera fat, which would subsequently increase the secretion of proinflammatory cytokines such as TNF-α and interleukin-6, and thus amplify the inflammatory response[44,45]. Meanwhile, severe lipo-toxicity caused by visceral obesity could also induce the organ failure in AP patients[46]. However, our data did not show the significant difference between obesity and AP since only general obesity was measured in the current study. The different clinical outcomes that induced by general obesity and visceral obesity may be a kind of obesity paradox, even though its mechanism is still unclear. Therefore, future studies need to focus on this obesity paradox. The limitations of our study are as follows: (1) Our study is a retrospective hospital-based case-control study, which can only assess the association. Prospective studies are needed to evaluate the causation between metabolic syndrome and AP in the future. (2) The visceral adiposity was not assessed and obesity was only measured by BMI in the current study. (3) Although we found a strong association between metabolic syndrome components and AP, we did not evaluate the effect of the treatment of each component on individuals, which may have an impact on the results. The major strengths are as follows: (1) This is the first study to illustrate the association between metabolic syndrome and the development of AP in an Asian population. (2) Given the completeness of behavioural and epidemiologic data, we can ensure the accuracy of clinical diagnosis and high quality of data and minimize recall bias. Conclusions The study revealed that patients with metabolic syndrome were associated with high incidence rates of AP. Regarding metabolic syndrome components, high levels of TC, TG, and FPG and low values of Apo A were independently associated with the development of AP. Since metabolic syndrome can be treated by lifestyle alterations or pharmacological treatment, we are looking forward to exploring this potential method to impede the increasing incidence rates of AP. Abbreviations AP: Acute pancreatitis CT: Computed tomography ECG: Electrocardiogram BMI: Body mass index TC: Total cholesterol TG: Triglyceride HDL: High density lipoprotein LDL: Low density lipoprotein Apo A: Apolipoprotein A Apo B: Apolipoprotein B FPG: Fasting plasma glucose T2DM : Type 2 diabetes mellitus OR: Odds ratio CI: Confidence interval AUC: Area under curve LR: likelihood ratio ROS : Reactive oxygen species NF-κB: Nuclear factor-kappaB TNF-α : Tumour necrosis factor-alpha TLR4: Toll-like receptor 4 ABCA1: ATP-binding cassette transporter A1 MPO: Macrophage myeloperoxidase RR: Risk ratio ROC: Receiver operating characteristic Declarations Ethics approval and consent to participate The study was conducted according to the Declaration of Helsinki and approved by the institutional research board of Jinshan Hospital (IEC-2020-S21). Informed consent was waived due to the retrospective nature of this study and the fact that patients were deidentified. Consent to publish Not applicable. Availability of data and materials The datasets generated during the current study are not publicly available due to confidentiality of human subjects but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The study received no funding. Author s’ Contributions PLS proposed and designed the study. ZMS and XQW contributed equally to the article in the aspects of writing the manuscript and statistical analysis; ZLZ and YW also made essential contribution to data acquisition, analysis and interpretation. All authors were involved in critical revision of the manuscript and have read and approved the final manuscript. Acknowledgements Not applicable. References Sawalhi S, Al-Maramhy H, Abdelrahman AI, Allah SE, Al-Jubori S. Does the presence of obesity and/or metabolic syndrome affect the course of acute pancreatitis?: A prospective study. 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AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY COMPREHENSIVE CLINICAL PRACTICE GUIDELINES FOR MEDICAL CARE OF PATIENTS WITH OBESITY. Endocr Pract. 2016;22 Suppl 3:1-203. Shumacker HB. ACUTE PANCREATITIS AND DIABETES. Ann Surg. 1940;112(2):177-200. Kamboj SS, Sandhir R. Protective effect of N-acetylcysteine supplementation on mitochondrial oxidative stress and mitochondrial enzymes in cerebral cortex of streptozotocin-treated diabetic rats. Mitochondrion. 2011;11(1):214-22. Yu T, Jhun BS, Yoon Y. High-glucose stimulation increases reactive oxygen species production through the calcium and mitogen-activated protein kinase-mediated activation of mitochondrial fission. Antioxid Redox Signal. 2011;14(3):425-37. Sugimoto R, Enjoji M, Kohjima M, Tsuruta S, Fukushima M, Iwao M, et al. High glucose stimulates hepatic stellate cells to proliferate and to produce collagen through free radical production and activation of mitogen-activated protein kinase. Liver Int. 2005;25(5):1018-26. Stumvoll M, Goldstein BJ, van Haeften TW. Type 2 diabetes: principles of pathogenesis and therapy. Lancet. 2005;365(9467):1333-46. Rakonczay Z, Jr., Hegyi P, Takacs T, McCarroll J, Saluja AK. The role of NF-kappaB activation in the pathogenesis of acute pancreatitis. Gut. 2008;57(2):259-67. Grewal HP, Kotb M, el Din AM, Ohman M, Salem A, Gaber L, et al. Induction of tumor necrosis factor in severe acute pancreatitis and its subsequent reduction after hepatic passage. Surgery. 1994 ;115(2):213-21. Nieto-Vazquez I, Fernandez-Veledo S, Kramer DK, Vila-Bedmar R, Garcia-Guerra L, Lorenzo M. Insulin resistance associated to obesity: the link TNF-alpha. Arch Physiol Biochem. 2008;114(3):183-94. Phillips AR, Abu-Zidan FM, Bonham MJ, Cooper GJ, Windsor JA. Amylin and severe acute pancreatitis. Pancreas. 2000;20(1):105-6. Jambrik Z, Gyongyosi M, Hegyi P, Czako L, Takacs T, Farkas A, et al. Plasma levels of IL-6 correlate with hemodynamic abnormalities in acute pancreatitis in rabbits. Intensive Care Med. 2002;28(12):1810-8. Fortson MR, Freedman SN, Webster PD 3rd. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol. 1995 Dec;90(12):2134-9. Tsuang W, Navaneethan U, Ruiz L, Palascak JB, Gelrud A. Hypertriglyceridemic pancreatitis: presentation and management. Am J Gastroenterol. 2009;104(4):984-91. Valdivielso P, Ramirez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med. 2014;25(8):689-94. Triantafilou M, Miyake K, Golenbock DT, Triantafilou K. Mediators of innate immune recognition of bacteria concentrate in lipid rafts and facilitate lipopolysaccharide-induced cell activation. J Cell Sci. 2002 Jun 15;115(Pt 12):2603-11. Li HB, Jin C, Chen Y, Flavell RA. Inflammasome activation and metabolic disease progression. Cytokine Growth Factor Rev. 2014;25(6):699-706. Moore KJ, Tabas I. Macrophages in the pathogenesis of atherosclerosis. Cell. 2011;145(3):341-55. Shao B, Tang C, Sinha A, Mayer PS, Davenport GD, Brot N, et al. Humans with atherosclerosis have impaired ABCA1 cholesterol efflux and enhanced high-density lipoprotein oxidation by myeloperoxidase. Circ Res. 2014;114(11):1733-42. Funnell IC, Bornman PC, Weakley SP, Terblanche J, Marks IN. Obesity: an important prognostic factor in acute pancreatitis. The British journal of surgery. 1993;80(4):484-6. Martínez J, Sánchez-Payá J, Palazón JM, Aparicio JR, Picó A, Pérez-Mateo M. Obesity: a prognostic factor of severity in acute pancreatitis. Pancreas. 1999;19(1):15-20. Blomgren KB, Sundström A, Steineck G, Wiholm BE. Obesity and treatment of diabetes with glyburide may both be risk factors for acute pancreatitis. Diabetes Care. 2002;25(2):298-302. Sadr-Azodi O, Orsini N, Andren-Sandberg A, Wolk A. Abdominal and total adiposity and the risk of acute pancreatitis: a population-based prospective cohort study. Am J Gastroenterol. 2013;108(1):133-9. Lee YH, Pratley RE. The evolving role of inflammation in obesity and the metabolic syndrome. Curr Diab Rep. 2005;5(1):70-5. Singh RG, Cervantes A, Kim JU, Nguyen NN, DeSouza SV, Dokpuang D, et al. Intrapancreatic fat deposition and visceral fat volume are associated with the presence of diabetes after acute pancreatitis. Am J Physiol Gastrointest Liver Physiol. 2019;316(6):806-15. Natu A, Stevens T, Kang L, Yasinow S, Mansoor E, Lopez R, et al. Visceral Adiposity Predicts Severity of Acute Pancreatitis. Pancreas. 2017;46(6):776-81. Lara-Castro C, Fu Y, Chung BH, Garvey WT. Adiponectin and the metabolic syndrome: mechanisms mediating risk for metabolic and cardiovascular disease. Curr Opin Lipidol. 2007;18(3):263-70. Karpavicius A, Dambrauskas Z, Sileikis A, Vitkus D, Strupas K. Value of adipokines in predicting the severity of acute pancreatitis: comprehensive review. World J Gastroenterol. 2012;18(45):6620-7. Patel K, Trivedi RN, Durgampudi C, Noel P, Cline RA, DeLany JP, et al. Lipolysis of visceral adipocyte triglyceride by pancreatic lipases converts mild acute pancreatitis to severe pancreatitis independent of necrosis and inflammation. Am J Pathol. 2015;185(3):808-19. Cite Share Download PDF Status: Published Journal Publication published 06 Jan, 2021 Read the published version in BMC Gastroenterology → Version 3 posted Submission checks completed at journal 09 Dec, 2020 Editorial decision: Accept 08 Dec, 2020 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-45027","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":6170458,"identity":"1ed67aec-f734-4aa0-9453-c90d1b26f18c","order_by":0,"name":"Zhemin Shen","email":"","orcid":"","institution":"Jinshan hospital, Fudan university","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhemin","middleName":"","lastName":"Shen","suffix":""},{"id":6170459,"identity":"8a24ff82-bb3b-4390-950a-2e83dc1135f3","order_by":1,"name":"Xueqiao Wang","email":"","orcid":"","institution":"Jinshan hospital, Fudan university","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xueqiao","middleName":"","lastName":"Wang","suffix":""},{"id":6170460,"identity":"7fffc3e1-0c06-4ef7-b496-b7ddf7284a93","order_by":2,"name":"Zili Zhen","email":"","orcid":"","institution":"Jinshan hospital, university","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zili","middleName":"","lastName":"Zhen","suffix":""},{"id":6170461,"identity":"502170fa-8cd6-47d6-9eb4-2b7c89c13e9c","order_by":3,"name":"Yao Wang","email":"","orcid":"","institution":"Jinshan hospital, Fudan university","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yao","middleName":"","lastName":"Wang","suffix":""},{"id":6170462,"identity":"16fb4fe3-779e-40e7-8fe9-e24cf694fba9","order_by":4,"name":"Peilong Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYNACAwsgwXzgAwMbhEuMFgkgwZY4gwQtDCAtPIbEaZGfkXvswYcCCTlz/jUfm3nK7PIY2Ju3STDU3MHtpBt56YYzDCSMLWe83djMcy65mIHnWJkEw7FneHyRYybNYyCRuOHG2e2PeduYExuAIhKMDYfxOAyo5Q9Yy5mHzbxt9YkN8m/wa2G4AdTCANJyvocRqOUw0BYe/FoMzrwxN+wB+sXgBpth45xzxxPbeNKKLRKO4XFYe47Zgx9/bOQMzh9+2PCmrDqxn/3wxhsfavA4jAEaFwwSCUjcBHwa4Fr4D+BXNgpGwSgYBSMXAABEu1OMGUcpYQAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Peilong","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2020-07-17 11:57:14","currentVersionCode":3,"declarations":"","doi":"10.21203/rs.3.rs-45027/v3","doiUrl":"https://doi.org/10.21203/rs.3.rs-45027/v3","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12876-020-01579-3","type":"published","date":"2021-01-06T15:01:44+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":4267074,"identity":"24d2612e-6615-4036-98c3-767061b84dfc","added_by":"auto","created_at":"2020-12-15 11:31:52","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":253277,"visible":true,"origin":"","legend":"Receiver operating characteristic (ROC) curve analysis for predicting the occurrence of AP by TG, Apo A and FPG in the estimation cohorts. Abbreviations: AP, acute pancreatitis; TG, triglyceride; Apo A, apolipoprotein A; FPG, fasting plasma glucose.","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-45027/v3/b8802f317ee289eb38aa2759.jpg"},{"id":4267075,"identity":"626ea686-7345-41f5-ac8a-1c215663878b","added_by":"auto","created_at":"2020-12-15 11:31:52","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":165794,"visible":true,"origin":"","legend":"The number of Metabolic Syndrome components in relation to the occurrence of AP. Abbreviations: AP, acute pancreatitis.","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-45027/v3/c1ea59b8621ccdd7dc406299.jpg"},{"id":13631836,"identity":"ffbe8ff1-9e0f-4821-9464-ae09b087a4a8","added_by":"auto","created_at":"2021-09-17 08:18:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":479028,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-45027/v3/d2bd4f97-e58a-49b4-bc86-00cc8b414776.pdf"}],"financialInterests":"","formattedTitle":"Metabolic Syndrome Components and Acute Pancreatitis: A Case-Control Study in China","fulltext":[{"header":"Background","content":"\u003cp\u003eAcute pancreatitis (AP) is a pancreatic inflammatory disorder that may cause life-threatening consequences due to severe inflammatory responses[1]. According to a survey, the annual incidence rate of AP has increased by 100% over the past several decades[2]. This has posed a great threat to human health and become one of the largest contributors to aggregate medical costs[3]. The main pathogenic causes of AP are biliary stones and alcohol consumption. Other factors, such as smoking and genetic factors, are also considered to be related to the occurrence of AP[3]. However, the pathogenic immune mechanism of AP remains elusive, and the potential factors related to the stimulus of inflammation are still under investigation.\u003c/p\u003e\n\u003cp\u003eDue to the huge economic development and social progress made in China over past decades, the lifestyles and daily diets of Chinese people have changed substantially. In turn, this has led to the high prevalence of metabolic syndrome in China (27.9% in men and 26.8% in women) and has\u0026nbsp;caused serious public health problems[4]. Metabolic syndrome is defined as four interconnected factors: hyperglycaemia, hyperlipidaemia (particularly increased triglycerides [TGs] and low high-density lipoprotein [HDL] cholesterol), obesity and hypertension. It is generally considered a risk factor for cardiovascular diseases[5]. Although there is still no universally accepted mechanism of metabolic syndrome[6], the best evidence suggests that the four components of metabolic syndrome may be intercorrelated with each other by sharing common pathophysiological processes. These processes mainly consist of insulin resistance, visceral adiposity, atherogenic dyslipidaemia and endothelial dysfunction[7]. In addition, given that the four components are more likely to appear together more than might be expected by chance, metabolic syndrome should thus be considered an overall concept. It can gradually lead patients to a proinflammatory state that is associated with a series of diseases, such as venous thrombosis and psoriasis[7-9]. Since it is well believed that there is an interrelation between metabolic syndrome and inflammation[10, 11], we suspect that metabolic syndrome may also have a significant impact on AP. Although some studies have demonstrated that metabolic syndrome is positively associated with the severity of AP[1, 12], there is still a lack of data showing the relationship between metabolic syndrome and the occurrence of AP in the Chinese population. Although there were studies about the association between metabolic syndrome and AP, most of them involved mainly the single component of metabolic syndrome, such as obesity or hyperglycaemia, rather than as an overall concept[1, 13-16, 20]. Moreover, these studies were mainly conducted on western countries, which may differ from those in eastern populations. To address these issues, we examined relevant data to investigate (1) the association between metabolic syndrome and the occurrence of AP, (2) the association between each metabolic syndrome component and the occurrence of AP, (3) the association between the number of metabolic syndrome components and the occurrence of AP.\u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted according to the Declaration of Helsinki and approved by the institutional research board of Jinshan Hospital (IEC-2020-S21). Informed consent was waived.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA hospital-based case-control study was conducted. A total of 705 patients (349 AP patients and 356 controls) admitted to our hospital from January 2016 to December 2018 were included in the study. According to the revised Atlanta classification from 2012[17], AP was defined if at least two of the following three criteria were presented: acute attack of severe upper abdominal pain with or without radiating to the back; serum amylase or lipase elevation at least 3 times above the upper limit of normal level; and typical acute pancreatitis imaging found on computed tomography (CT) scan. Only patients with a first attack of AP were included, while patients with relapse of AP or chronic pancreatitis were excluded. The controls were selected from patients admitted to department of anorectal surgery, department of otorhinolaryngology head and neck surgery and department of orthopedics. Their diagnosis mainly consisted of haemorrhoids, sudden sensorineural hearing loss, tonsil hypertrophy, epiglottic cyst and disc herniation. The controls were frequency matched to cases by sex and exact age. Control subjects were excluded if they had AP history. Participants who had histories of any cardiovascular disease (except hypertension) or psoriasis were not enrolled in the two groups. Last, subjects were excluded if they were younger than 18 years, pregnant, underwent surgery within 1 month or had a cancer history.\u003c/p\u003e\n\u003cp\u003eAll patients admitted were given standard medical treatment. In AP group, patients received treatment including fasting, early fluid resuscitation, analgesia, and nutritional support. In non-AP group, patients mainly received pre-operation examinations such as ECG (Electrocardiogram) and chest X-Ray after admission since most of the patients were about to undergo surgery in the next few days.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical data collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected by researchers who were not informed of the detailed information of the study until collection was completed. The collected data were from computer-based case reports and were checked by another two researchers to ensure that there were no inconsistencies or errors. The following data of patients were collected: sex; age; smoking history; alcohol drinking history (\u0026gt;14 drinks/week in women or \u0026gt;21 drinks/week in men); biliary stones history; history of hepatitis B or hepatitis C; body mass index (BMI); blood pressure; and laboratory tests, including total cholesterol (TC), TG, HDL, low-density lipoprotein (LDL), apolipoprotein A (Apo A), apolipoprotein B (Apo B), and fasting plasma glucose (FPG). BMI was calculated as body weight (kg) divided by square of the height (m). Blood pressure was measured by a mercury sphygmomanometer when patients were in a supine position and after 20 min of rest. Blood samples were collected from the median cubital vein of each patient after eight hours of fasting. Fasting venous blood was collected in polystyrene tubes and rapidly transmitted to the laboratory to ensure the accuracy of our indexes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMetabolic Syndrome Components\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe diagnostic criteria for metabolic syndrome were defined according to National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III)[18] and modified by the Asia\u0026ndash;Pacific criteria[19]. The criteria include (1) hypertension (blood pressure\u0026ge;130/85 mmHg or ongoing anti-hypertensive treatment), (2) hyperlipidaemia (TG\u0026ge;150 mg/dL or HDL\u0026le;40 mg/dL in men and 50 mg/dL in women or ongoing anti-lipidaemic treatment), (3) hyperglycaemia (FPG\u0026ge;110 mg/dL, previously physician-diagnosed type 2 diabetes mellitus [T2DM] or ongoing antidiabetic treatment) and (4) obesity (BMI\u0026ge;25 kg/m\u0026sup2; or waist circumference\u0026ge;90 cm for men and 80 cm for women).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative data were expressed with mean\u0026plusmn; standard deviation (SD) or median with 25\u003csup\u003eth\u003c/sup\u003e and 75\u003csup\u003eth\u003c/sup\u003e percentiles as appropriate. For normal distributed quantitative data, independent sample t-test was used to compare the differences between the two groups. For non-parametric quantitative data, Mann-Whitney test was used to detect the statistical significance. Qualitative data were expressed in number (n) and percentage (%). Fisher\u0026rsquo;s exact test or chi-square test was used to compare the differences. Univariate logistic regression analysis was used to preliminarily assess whether these individual variables were predictive factors of AP occurrence. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated. Univariate and multivariate logistic regression were used to further test the OR value. The accuracy of each marker in predicting the occurrence of AP was assessed by using receiver operating characteristic (ROC) curves. A \u003cem\u003eP \u003c/em\u003evalue\u0026lt;0.05 was defined as statistically significant. IBM SPSS v22 (SPSS, Chicago, Illinois, USA) and MedCalc statistical software packages, version 10 (MedCalc, Mariakerke, Belgium), were used for statistical analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of Study Subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the inclusion and exclusion criteria, 705 subjects, including 349 AP patients and 356 non-AP patients, were enrolled in our study. Table 1 shows the characteristics of the subjects. No significant differences between AP patients and non-AP patients were found with respect to age (\u003cem\u003ep\u003c/em\u003e=0.989), gender (\u003cem\u003ep\u003c/em\u003e=0.923), hepatitis C (\u003cem\u003ep\u003c/em\u003e=0.349) and Apo B (\u003cem\u003ep\u003c/em\u003e=0.198). However, we noted that AP patients were significantly associated with cigarette smoking (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), alcohol consumption (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), biliary stones history (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), hepatitis B (\u003cem\u003ep=\u003c/em\u003e0.049), and BMI (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001) and TC (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), TG (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), HDL (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), LDL (\u003cem\u003ep=\u003c/em\u003e0.030), Apo A (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), and FPG (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001) than controls. In patients with diabetes mellitus, 27 patients (79.4%) received anti-diabetic therapy in control group, while 59 patients (64.8%) received treatment in case group. There were no significant differences (\u003cem\u003ep=\u003c/em\u003e0.118) between the two groups regarding the anti-diabetic therapy.\u003c/p\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;text-indent:-.1pt;vertical-align:middle;'\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Basic Characteristics\u003c/p\u003e\n\u003ctable style=\"width: 4.5e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154.6pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003eNon-AP patients\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e(n=356)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003eAP patients\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e(n=349)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;p\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eMean age, years (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e51.2\u0026plusmn;15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e51.2\u0026plusmn;15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154.6pt;border: none;padding: 0in 5.4pt;height: 11.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eGender, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;height: 11.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 11.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 11.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-indent:-17.1pt;'\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e140 (39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e136 (39.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-indent:-17.1pt;'\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e216 (60.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e213 (61.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSmoking history, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e62 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e125 (35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eAlcohol drinking history, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e53 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e101 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154.6pt;border: none;padding: 0in 5.4pt;height: 19.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eBiliary stones, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;height: 19.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e8 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 19.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e101 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 19.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHepatitis B , n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e17 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e7 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHepatitis C, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e3 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.349\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e23.8\u0026plusmn;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e24.8\u0026plusmn;3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154.6pt;border: none;padding: 0in 5.4pt;height: 9.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eTC, mg/dL\u0026nbsp;(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;height: 9.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e178.0 (153.7, 209.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 9.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:14.25pt;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align: right;text-indent:-5.4pt;'\u003e180.3 (145.6, 235.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 9.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.6pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:5.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:22.0pt;margin-bottom: 0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eTG, mg/dL\u0026nbsp;(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.3pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:5.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e101.8 (77.0, 157.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:5.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:13.85pt;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:right;'\u003e131.9 (81.4, 349.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:70.85pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:5.05pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.6pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHDL, mg/dL\u0026nbsp;(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.3pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e99.1 (86.7, 117.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e90.3 (74.3, 112.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:70.85pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.6pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eLDL, mg/dL\u0026nbsp;(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.3pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e269.9 (224.8, 318.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e258.4 (198.2, 236.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:70.85pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154.6pt;border: none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eApo A,\u0026nbsp;g/L (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e1.2 (1.1, 1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e1.1 (0.9, 1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.6pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eApo B,\u0026nbsp;g/L (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.3pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.9 (0.7, 1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.8 (0.7, 1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:70.85pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.6pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eFPG, mg/dL\u0026nbsp;(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.3pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e97.8 (89.4, 112.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e132.8 (107.4, 172.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:70.85pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.6pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eAnti-diabetic therapy, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.3pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e27 (79.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e59 (64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:70.85pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:17.1pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:-27.0pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-indent:27.0pt;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003eData were numbers and percentages, or median (25\u003csup\u003eth\u003c/sup\u003e, 75\u003csup\u003eth\u003c/sup\u003e percentile), as appropriate.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003eAbbreviations:\u003c/span\u003e\u003c/strong\u003e \u003cspan style=\"font-size:13px;\"\u003en, number; IQR, interquartile range; BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); TC, total cholesterol; TG, triglyceride; HDL, high density lipoprotein; LDL, low density lipoprotein; Apo A, apolipoprotein A; Apo B, apolipoprotein B; FPG, fasting plasma glucose.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003eSI conversion factors:\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;TC: 1 mg/dL =0.0259 mmol/L; HDL, LDL, TG:1 mg/dL= 0.0113 mmol/L; FPG\u003c/span\u003e:1mg/dL=\u003cspan style=\"font-size:13px;\"\u003e0.0555mmol/L.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\u003cbr\u003e\u003cp\u003e\u003cstrong\u003eEffect of Metabolic Syndrome Components on AP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn univariate analysis, both of increased values of TG and decreased values of HDL\u0026nbsp; were associated with the occurrence of AP (OR=2.313; 95% CI 1.690-3.167, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001; OR=0.582; 95% CI 0.431-0.786, p\u0026lt;0.001) (Table 2). Additionally, significant differences were observed between the two groups in patients with obesity, hyperglycaemia and hypertension(OR=1.608; 95% CI 1.186-2.181, \u003cem\u003ep\u003c/em\u003e=0.002; OR=3.209; 95% CI 2.112-4.876, p\u0026lt;0.001; OR=1.473; 95% CI 1.089-1.991, p=0.012). In multivariate logistic regression models, after adjustment for smoking and alcohol drinking history, biliary stones history, Apo A and the components of metabolic syndrome, the results revealed that AP was associated with smoking history; alcohol consumption history; biliary stones history; elevated levels of TC, TG; hyperglycaemia and lower values of Apo A (OR=2.441; 95% CI 1.865-5.172, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001; OR=1.777; 95% CI 1.060-2.977, \u003cem\u003ep\u003c/em\u003e=0.029; OR=28.995; 95% CI 13.253-63.435, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001; OR=1.992; 95% CI 1.246-3.183, \u003cem\u003ep\u003c/em\u003e=0.004; OR=2.134; 95% CI 1.403-3.245, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001; OR=2.261; 95% CI 1.367-3.742,\u003cem\u003e p\u003c/em\u003e=0.001 and OR=0.270; 95% CI 0.163-0.447, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001, respectively). However, obesity was not observed to be associated with the occurrence of AP (\u003cem\u003ep\u003c/em\u003e=0.246) (shown in Table 3). After adjusting for smoking and alcohol drinking history, biliary stones, the prevalence of metabolic syndrome was more common in AP patients (30.9%) than in those without AP (13.2%) (OR=2.837; 95% CI 1.873-4.298,\u003cem\u003e p\u003c/em\u003e\u0026lt;0.001) (shown in Table 4). As shown in Table 5 and Figure 1, for all AP patients, increased values of TG and low Apo A and FPG predicted AP with statistical significance (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001,\u003cem\u003e p\u003c/em\u003e\u0026lt;0.001); their AUCs were 0.620, 0.679 and 0.767, respectively. Among the three indicators, FPG had the best sensitivity (67.54%), and TG had the best specificity (90.17%) when the indicators were at their best cut-off values (shown in Table 5).\u003c/p\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eUnivariate Analysis Examining the Components of the Metabolic Syndrome\u003c/p\u003e\n\u003ctable style=\"width:481.95pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.6pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 29.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 29.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003eNon-AP patients\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e(n=356)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.05pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 29.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003eAP patients\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e(n=349)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.4pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 29.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003eOR\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.75pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 29.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eTG\u0026ge;150 mg/dL, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e97 (27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.05pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e162 (46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e2.313 (1.690-3.167)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:63.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.6pt;border: none;padding: 0in 5.4pt;height: 52.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHDL\u0026ge;40 mg/dL (M) \u0026nbsp;or \u0026ge;50 mg/dL (F), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border: none;padding: 0in 5.4pt;height: 52.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e183 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.05pt;border: none;padding: 0in 5.4pt;height: 52.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e133 (38.1)\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.4pt;border: none;padding: 0in 5.4pt;height: 52.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.582 (0.431-0.786)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.75pt;border: none;padding: 0in 5.4pt;height: 52.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eObesity, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e120 (33.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.05pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e157 (45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e1.608 (1.186-2.181)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:63.75pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHyperglycaemia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.15pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e37 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e93 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e3.209 (2.112-4.876)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.75pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHypertension, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.15pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e129 (36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e159 (45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.4pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e1.473 (1.089-1.991)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.75pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003eAbbreviations:\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003eOR, odds ratio\u003cspan style=\"font-size:13px;\"\u003e; TG, triglyceride; HDL, high density lipoprotein.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003eSI conversion factors:\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;HDL, TG:1 mg/dL= 0.0113 mmol/L;\u003c/span\u003e\u003c/p\u003e\u003cbr\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Multivariate Analysis Examining the Components of the Metabolic Syndrome\u003c/p\u003e\n\u003ctable style=\"width:496.15pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.7pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003eNon-AP patients\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e(n=356)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.25pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003eAP patients\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e(n=349)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141.75pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;OR\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSmoking, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e62 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e125 (35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e2.441 (1.865-5.172)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:56.7pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eAlcohol drinking, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e53 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e101 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e1.777 (1.060-2.977)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eBiliary stone, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e8 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e101 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;28.995 (13.253-63.435)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:56.7pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHepatitis B, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e17 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e7 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.439 (0.145-1.327)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eObesity, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e120 (33.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e157 (45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e1.258 (0.854-1.855)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eTC\u0026ge;220 mg/dL, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:89.7pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e61 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:89.25pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e106 (30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e1.992 (1.246-3.183)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eTG\u0026ge;150 mg/dL, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e97 (27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e162 (46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 2.134 (1.403-3.245)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHDL\u0026ge;40 mg/dL (M)\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;or\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026ge;50 mg/dL (F) , n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e183 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e133 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.784 (0.522-1.176)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.240\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eApo A\u0026ge;1 g/L, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:89.7pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e321 (90.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:89.25pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e230 (65.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.270 (0.163-0.447)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:56.7pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHyperglycaemia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:89.7pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e37 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:89.25pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e93 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141.75pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 2.261 (1.367-3.742)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.75pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHypertension, n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:89.7pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e129 (36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:89.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e159 (45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141.75pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e1.189 (0.817-1.732)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.7pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e0.366\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003eAbbreviations:\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003eOR, odds ratio\u003cspan style=\"font-size:13px;\"\u003e; TC, total cholesterol; TG, triglyceride; HDL, high density lipoprotein; Apo A, apolipoprotein A.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003eSI conversion factors:\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;TC: 1 mg/dL =0.0259 mmol/L ; HDL, TG:1 mg/dL= 0.0113 mmol/L;\u003c/span\u003e\u003c/p\u003e\u003cbr\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eAssociation Between the Metabolic Syndrome and AP\u003c/p\u003e\n\u003ctable style=\"width: 4.2e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003ePrevalence of Metabolic syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141.75pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; OR\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eAP patients, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e108 (30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:16px;line-height:150%;\"\u003e2.837\u003c/span\u003e (\u003cspan style=\"font-size:16px;line-height:150%;\"\u003e1.873\u003c/span\u003e-\u003cspan style=\"font-size:16px;line-height:150%;\"\u003e4.298\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:56.7pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003cspan style=\"font-family: DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNon-AP patients, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;47 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 56.7pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:107%;font-family:\"Calibri\",sans-serif;'\u003eAbbreviations:\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;line-height:107%;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;OR, odds ratio; \u0026nbsp;AP, acute pancreatitis; CI, confidence interval.\u003c/span\u003e\u003c/p\u003e\n\u003cbr\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003eTable 5.\u003c/strong\u003e Identification of TG, Apo A and FPG in the patients with AP\u003c/p\u003e\n\u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.9pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eAUC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.7pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47.05pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eCut-off\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSensitivity(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.55pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSpecificity(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47.05pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e+LR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47.05pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e-LR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.9pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eTG, mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.7pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47.05pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e218.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e39.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.55pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e90.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47.05pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e3.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47.05pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.9pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eApo A,\u0026nbsp;g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.7pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47.05pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e63.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.55pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e66.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47.05pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47.05pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eFPG, mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.7pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-family:DengXian;\"\u003e＜\u003c/span\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47.05pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e115.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e67.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.55pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e78.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47.05pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47.05pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:107%;font-family:\"Calibri\",sans-serif;'\u003eAbbreviations:\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;line-height:107%;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:15px;line-height:107%;font-family:\"Calibri\",sans-serif;'\u003eAUC\u003c/span\u003e\u003cspan style='font-size:13px;line-height:107%;font-family:\"Calibri\",sans-serif;'\u003e, area under curve; LR, \u0026nbsp;likelihood ratio; TG, triglyceride; Apo A, apolipoprotein A; \u0026nbsp;FPG, fasting plasma glucose.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;line-height:107%;\"\u003eSI conversion factors:\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size:13px;line-height:107%;\"\u003e\u0026nbsp;TG:1 mg/dL= 0.0113 mmol/L; FPG\u003c/span\u003e:1mg/dL=\u003cspan style=\"font-size:13px;line-height:107%;\"\u003e0.0555mmol/L.\u003c/span\u003e\u003c/p\u003e\n\n\u003cbr\u003e\u003cp\u003e\u003cstrong\u003eAssociation Between the Number of Metabolic Syndrome Components and AP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 2, the incidence rates of AP obviously increased when there were more than three components of metabolic syndrome present. Moreover, the incidence rates of AP significantly declined when there were no components of metabolic syndrome present.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this is the first case-control study demonstrating the relationship between metabolic syndrome and the occurrence of AP in an Asian population. Our results showed that metabolic syndrome was positively associated with the occurrence of AP. Among components of metabolic syndromes, we revealed that hyperglycaemia and hyperlipidaemia were independently associated with AP.\u003c/p\u003e\n\u003cp\u003eHyperglycaemia has been considered to be associated with AP for decades[20]. However, only a few studies have shown a higher incidence rate of AP among patients with hyperglycaemia[13-16]. Our results revealed that hyperglycaemia had positively correlation with AP (OR=2.261; 95% CI 1.367-3.742,\u003cem\u003e p\u003c/em\u003e=0.001). Although the exact mechanism between hyperglycaemia and AP remains unclear, several underlying biological theories have been proposed. High plasma glucose enhances mitochondrial oxidative stress by promoting the production of reactive oxygen species (ROS) and lipid oxidation through cytosolic Ca\u003csup\u003e2+ \u003c/sup\u003eaccumulation[21-23]. Furthermore, owing to the dysfunction of beta cells and resultant hyperinsulinaemia, beta cells may lose their sensitivity to the inhibitory hormone somatostatin, which may be an important factor in inducing AP[24]. Moreover, insulin resistance, as a crucial pathophysiological factor of hyperglycaemia, has been reported to be involved in AP development. Various proinflammatory factors or cytokines are activated due to insulin resistance, including nuclear factor-kappaB (NF \u0026kappa;B), tumour necrosis factor-alpha (TNF-\u0026alpha;), amylin and interleukin-6, and these proinflammatory factors may be responsible for the initiation and progression of AP[25-29].\u003c/p\u003e\n\u003cp\u003eIt is well known that hypertriglyceridaemia is associated with the morbidity and mortality of AP[30-32]. Our study showed that TG was associated with AP. Furthermore, we found that TC and Apo A values were also correlated with the occurrence of AP, which demonstrated that atherogenic lipid profiles also participated in the development of AP. Triantafilou M et al. reported that cholesterol may trigger inflammatory responses that could lead to chronic inflammation and insulin resistance via Toll-like receptor 4 (TLR4) and ultimately cause lysosomal damage, ROS generation and proinflammatory cytokine secretion[33, 34]. This theory may explain why acinar injury is induced by hypercholesterolaemia through the inflammatory response. Furthermore, as a lipoprotein, HDL often opposes cholesterol accumulation and reduces inflammation by the ATP-binding cassette transporter A1 (ABCA1) pathway[35]. This ability may be impaired if Apo A is oxidized by macrophage myeloperoxidase (MPO). Shao B et al. reported impaired function of HDL and Apo An in patients with atherosclerosis[36], which may be similar in AP. However, our results only showed that the value of Apo A was negatively associated with the occurrence of AP, while we did not observe an association between HDL and AP. Based on our present study, it is hard to tease out the exact role of HDL in AP. In future studies, it will be important to determine the exact function that HDL and Apo A exert in AP development.\u003c/p\u003e\n\u003cp\u003eCurrently, obesity is considered a global pandemic that poses a great threat to human health. Some studies have shown that obesity is positively correlated with the severity of AP[37, 38, 12]. However, due to the paucity of studies between obesity and the incidence of AP, their relationship has been a matter of dispute. Blomgren et al. found that the crude risk ratio (RR) between obesity and the occurrence of AP was 1.8 (95% CI: 1.3 to 2.6), while the authors did not display the results after adjustment[39]. In contrast to previous beliefs, our current study did not find an association between obesity and AP (\u003cem\u003ep\u003c/em\u003e=0.246), which is consistent with the findings of a recent large-scale prospective cohort study (RR=1.02, 95% CI: 0.68 to 1.53)[40]. In an animal model, obesity was shown to be related to an inflammatory status by secreting proinflammatory cytokines such as TNF-\u0026alpha; and interleukin-6[41]. Moreover, the level of adiponectin, an anti-inflammatory cytokine, is reduced in an obese environment. Therefore, combined with previous data and our results [12], we suppose that obesity may aggravate the severity of AP but is not enough to initiate the development of AP without other risk factors in a non-AP person.\u003c/p\u003e\n\u003cp\u003eRecently, visceral obesity, a subtype of obesity, is considered as a metabolically active status. Previous study suggested that occurrence of biliary pancreatitis was positively correlated with intrapancreatic fat. It may be caused by saturation of cholesterol in bile, which could consequently induce gallstone formation[42]. Moreover, visceral fat was also associated with the severity of AP[43]. The level of adiponectin would paradoxically decrease due to excess viscera fat, which would subsequently increase the secretion of proinflammatory cytokines such as TNF-\u0026alpha; and interleukin-6, and thus amplify the inflammatory response[44,45]. Meanwhile, severe lipo-toxicity caused by visceral obesity could also induce the organ failure in AP patients[46]. However, our data did not show the significant difference between obesity and AP since only general obesity was measured in the current study. The different clinical outcomes that induced by general obesity and visceral obesity may be a kind of obesity paradox, even though its mechanism is still unclear. Therefore, future studies need to focus on this obesity paradox.\u003c/p\u003e\n\u003cp\u003eThe limitations of our study are as follows: (1) Our study is a retrospective hospital-based case-control study, which can only assess the association. Prospective studies are needed to evaluate the causation between metabolic syndrome and AP in the future. (2) The visceral adiposity was not assessed and obesity was only measured by BMI in the current study. (3) Although we found a strong association between metabolic syndrome components and AP, we did not evaluate the effect of the treatment of each component on individuals, which may have an impact on the results. The major strengths are as follows: (1) This is the first study to illustrate the association between metabolic syndrome and the development of AP in an Asian population. (2) Given the completeness of behavioural and epidemiologic data, we can ensure the accuracy of clinical diagnosis and high quality of data and minimize recall bias.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe study revealed that patients with metabolic syndrome were associated with high incidence rates of AP. Regarding metabolic syndrome components, high levels of TC, TG, and FPG and low values of Apo A were independently associated with the development of AP. Since metabolic syndrome can be treated by lifestyle alterations or pharmacological treatment, we are looking forward to exploring this potential method to impede the increasing incidence rates of AP.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAP: Acute pancreatitis\u003c/p\u003e\n\u003cp\u003eCT: Computed tomography\u003c/p\u003e\n\u003cp\u003eECG: Electrocardiogram\u003c/p\u003e\n\u003cp\u003eBMI: Body mass index\u003c/p\u003e\n\u003cp\u003eTC: Total cholesterol\u003c/p\u003e\n\u003cp\u003eTG: Triglyceride\u003c/p\u003e\n\u003cp\u003eHDL: High density lipoprotein\u003c/p\u003e\n\u003cp\u003eLDL: Low density lipoprotein\u003c/p\u003e\n\u003cp\u003eApo A: Apolipoprotein A\u003c/p\u003e\n\u003cp\u003eApo B: Apolipoprotein B\u003c/p\u003e\n\u003cp\u003eFPG: \u0026nbsp;Fasting plasma glucose\u003c/p\u003e\n\u003cp\u003eT2DM : Type 2 diabetes mellitus\u003c/p\u003e\n\u003cp\u003eOR: Odds ratio\u003c/p\u003e\n\u003cp\u003eCI: Confidence interval\u003c/p\u003e\n\u003cp\u003eAUC: Area under curve\u003c/p\u003e\n\u003cp\u003eLR: likelihood ratio\u003c/p\u003e\n\u003cp\u003eROS : Reactive oxygen species\u003c/p\u003e\n\u003cp\u003eNF-\u0026kappa;B: Nuclear factor-kappaB\u003c/p\u003e\n\u003cp\u003eTNF-\u0026alpha;\u003cstrong\u003e: \u003c/strong\u003eTumour necrosis factor-alpha\u003c/p\u003e\n\u003cp\u003eTLR4: Toll-like receptor 4\u003c/p\u003e\n\u003cp\u003eABCA1: ATP-binding cassette transporter A1\u003c/p\u003e\n\u003cp\u003eMPO: Macrophage myeloperoxidase\u003c/p\u003e\n\u003cp\u003eRR: Risk ratio\u003c/p\u003e\n\u003cp\u003eROC: Receiver operating characteristic\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted according to the Declaration of Helsinki and approved by the institutional research board of Jinshan Hospital (IEC-2020-S21). Informed consent was waived due to the retrospective nature of this study and the fact that patients were deidentified.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during the current study are not publicly available due to confidentiality of human subjects but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u003c/strong\u003e \u003cstrong\u003es\u0026rsquo; \u0026nbsp;Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePLS proposed and designed the study. ZMS and XQW contributed equally to the article in the aspects of writing the manuscript and statistical analysis; ZLZ and YW also made essential contribution to data acquisition, analysis and interpretation. All authors were involved in critical revision of the manuscript and have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSawalhi S, Al-Maramhy H, Abdelrahman AI, Allah SE, Al-Jubori S. Does the presence of obesity and/or metabolic syndrome affect the course of acute pancreatitis?: A prospective study. Pancreas. 2014;43(4):565-70.\u003c/li\u003e\n\u003cli\u003eLowenfels AB, Maisonneuve P, Sullivan T. The changing character of acute pancreatitis: epidemiology, etiology, and prognosis. Curr Gastroenterol Rep. 2009;11(2):97-103.\u003c/li\u003e\n\u003cli\u003eLankisch PG, Apte M, Banks PA. 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Diabetes Obes Metab. 2010;12(9):766-71.\u003c/li\u003e\n\u003cli\u003eLai SW, Muo CH, Liao KF, Sung FC, Chen PC. Risk of acute pancreatitis in type 2 diabetes and risk reduction on anti-diabetic drugs: a population-based cohort study in Taiwan. Am J Gastroenterol. 2011;106(9):1697-704.\u003c/li\u003e\n\u003cli\u003eGarg R, Chen W, Pendergrass M. Acute pancreatitis in type 2 diabetes treated with exenatide or sitagliptin: a retrospective observational pharmacy claims analysis. Diabetes Care. 2010;33(11):2349-54.\u003c/li\u003e\n\u003cli\u003eNoel RA, Braun DK, Patterson RE, Bloomgren GL. Increased risk of acute pancreatitis and biliary disease observed in patients with type 2 diabetes: a retrospective cohort study. Diabetes Care. 2009;32(5):834-8.\u003c/li\u003e\n\u003cli\u003eBanks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis\u0026mdash;2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11.\u003c/li\u003e\n\u003cli\u003eExecutive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). Jama. 2001;285(19):2486-97.\u003c/li\u003e\n\u003cli\u003eGarvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY COMPREHENSIVE CLINICAL PRACTICE GUIDELINES FOR MEDICAL CARE OF PATIENTS WITH OBESITY. Endocr Pract. 2016;22 Suppl 3:1-203.\u003c/li\u003e\n\u003cli\u003eShumacker HB. ACUTE PANCREATITIS AND DIABETES. Ann Surg. 1940;112(2):177-200.\u003c/li\u003e\n\u003cli\u003eKamboj SS, Sandhir R. Protective effect of N-acetylcysteine supplementation on mitochondrial oxidative stress and mitochondrial enzymes in cerebral cortex of streptozotocin-treated diabetic rats. Mitochondrion. 2011;11(1):214-22.\u003c/li\u003e\n\u003cli\u003eYu T, Jhun BS, Yoon Y. High-glucose stimulation increases reactive oxygen species production through the calcium and mitogen-activated protein kinase-mediated activation of mitochondrial fission. Antioxid Redox Signal. 2011;14(3):425-37.\u003c/li\u003e\n\u003cli\u003eSugimoto R, Enjoji M, Kohjima M, Tsuruta S, Fukushima M, Iwao M, et al. High glucose stimulates hepatic stellate cells to proliferate and to produce collagen through free radical production and activation of mitogen-activated protein kinase. Liver Int. 2005;25(5):1018-26.\u003c/li\u003e\n\u003cli\u003eStumvoll M, Goldstein BJ, van Haeften TW. Type 2 diabetes: principles of pathogenesis and therapy. Lancet. 2005;365(9467):1333-46.\u003c/li\u003e\n\u003cli\u003eRakonczay Z, Jr., Hegyi P, Takacs T, McCarroll J, Saluja AK. The role of NF-kappaB activation in the pathogenesis of acute pancreatitis. Gut. 2008;57(2):259-67.\u003c/li\u003e\n\u003cli\u003eGrewal HP, Kotb M, el Din AM, Ohman M, Salem A, Gaber L, et al. Induction of tumor necrosis factor in severe acute pancreatitis and its subsequent reduction after hepatic passage. Surgery. 1994 ;115(2):213-21.\u003c/li\u003e\n\u003cli\u003eNieto-Vazquez I, Fernandez-Veledo S, Kramer DK, Vila-Bedmar R, Garcia-Guerra L, Lorenzo M. Insulin resistance associated to obesity: the link TNF-alpha. Arch Physiol Biochem. 2008;114(3):183-94.\u003c/li\u003e\n\u003cli\u003ePhillips AR, Abu-Zidan FM, Bonham MJ, Cooper GJ, Windsor JA. Amylin and severe acute pancreatitis. Pancreas. 2000;20(1):105-6.\u003c/li\u003e\n\u003cli\u003eJambrik Z, Gyongyosi M, Hegyi P, Czako L, Takacs T, Farkas A, et al. Plasma levels of IL-6 correlate with hemodynamic abnormalities in acute pancreatitis in rabbits. Intensive Care Med. 2002;28(12):1810-8.\u003c/li\u003e\n\u003cli\u003eFortson MR, Freedman SN, Webster PD 3rd. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol. 1995 Dec;90(12):2134-9.\u003c/li\u003e\n\u003cli\u003eTsuang W, Navaneethan U, Ruiz L, Palascak JB, Gelrud A. Hypertriglyceridemic pancreatitis: presentation and management. Am J Gastroenterol. 2009;104(4):984-91.\u003c/li\u003e\n\u003cli\u003eValdivielso P, Ramirez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med. 2014;25(8):689-94.\u003c/li\u003e\n\u003cli\u003eTriantafilou M, Miyake K, Golenbock DT, Triantafilou K. Mediators of innate immune recognition of bacteria concentrate in lipid rafts and facilitate lipopolysaccharide-induced cell activation. J Cell Sci. 2002 Jun 15;115(Pt 12):2603-11.\u003c/li\u003e\n\u003cli\u003eLi HB, Jin C, Chen Y, Flavell RA. Inflammasome activation and metabolic disease progression. Cytokine Growth Factor Rev. 2014;25(6):699-706.\u003c/li\u003e\n\u003cli\u003eMoore KJ, Tabas I. Macrophages in the pathogenesis of atherosclerosis. Cell. 2011;145(3):341-55.\u003c/li\u003e\n\u003cli\u003eShao B, Tang C, Sinha A, Mayer PS, Davenport GD, Brot N, et al. Humans with atherosclerosis have impaired ABCA1 cholesterol efflux and enhanced high-density lipoprotein oxidation by myeloperoxidase. Circ Res. 2014;114(11):1733-42.\u003c/li\u003e\n\u003cli\u003eFunnell IC, Bornman PC, Weakley SP, Terblanche J, Marks IN. Obesity: an important prognostic factor in acute pancreatitis. The British journal of surgery. 1993;80(4):484-6.\u003c/li\u003e\n\u003cli\u003eMart\u0026iacute;nez J, S\u0026aacute;nchez-Pay\u0026aacute; J, Palaz\u0026oacute;n JM, Aparicio JR, Pic\u0026oacute; A, P\u0026eacute;rez-Mateo M. Obesity: a prognostic factor of severity in acute pancreatitis. Pancreas. 1999;19(1):15-20.\u003c/li\u003e\n\u003cli\u003eBlomgren KB, Sundstr\u0026ouml;m A, Steineck G, Wiholm BE. Obesity and treatment of diabetes with glyburide may both be risk factors for acute pancreatitis. Diabetes Care. 2002;25(2):298-302.\u003c/li\u003e\n\u003cli\u003eSadr-Azodi O, Orsini N, Andren-Sandberg A, Wolk A. Abdominal and total adiposity and the risk of acute pancreatitis: a population-based prospective cohort study. Am J Gastroenterol. 2013;108(1):133-9.\u003c/li\u003e\n\u003cli\u003eLee YH, Pratley RE. The evolving role of inflammation in obesity and the metabolic syndrome. Curr Diab Rep. 2005;5(1):70-5.\u003c/li\u003e\n\u003cli\u003eSingh RG, Cervantes A, Kim JU, Nguyen NN, DeSouza SV, Dokpuang D, et al. Intrapancreatic fat deposition and visceral fat volume are associated with the presence of diabetes after acute pancreatitis. Am J Physiol Gastrointest Liver Physiol. 2019;316(6):806-15.\u003c/li\u003e\n\u003cli\u003eNatu A, Stevens T, Kang L, Yasinow S, Mansoor E, Lopez R, et al. Visceral Adiposity Predicts Severity of Acute Pancreatitis. Pancreas. 2017;46(6):776-81.\u003c/li\u003e\n\u003cli\u003eLara-Castro C, Fu Y, Chung BH, Garvey WT. Adiponectin and the metabolic syndrome: mechanisms mediating risk for metabolic and cardiovascular disease. Curr Opin Lipidol. 2007;18(3):263-70.\u003c/li\u003e\n\u003cli\u003eKarpavicius A, Dambrauskas Z, Sileikis A, Vitkus D, Strupas K. Value of adipokines in predicting the severity of acute pancreatitis: comprehensive review. World J Gastroenterol. 2012;18(45):6620-7.\u003c/li\u003e\n\u003cli\u003ePatel K, Trivedi RN, Durgampudi C, Noel P, Cline RA, DeLany JP, et al. Lipolysis of visceral adipocyte triglyceride by pancreatic lipases converts mild acute pancreatitis to severe pancreatitis independent of necrosis and inflammation. Am J Pathol. 2015;185(3):808-19.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Acute pancreatitis, Metabolic syndrome, Hyperglycaemia, Hyperlipidaemia, Obesity, Hypertension","lastPublishedDoi":"10.21203/rs.3.rs-45027/v3","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-45027/v3","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eBackground: \u003c/em\u003e\u003c/strong\u003eAcute pancreatitis (AP) is a common inflammatory disorder of the pancreas. Recent evidence has shown that metabolic syndrome is positively correlated with the severity of AP. However, only a few studies have revealed the relationship between metabolic syndrome and the occurrence of AP. We therefore elucidated the association between metabolic syndrome and the occurrence of AP. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMethods: \u003c/em\u003e\u003c/strong\u003eA hospital-based case-control study was conducted. A total of 705 patients admitted to our hospital from January 2016 to December 2018 were included in the study. Subjects were divided into case and control groups according to their diagnosis: (1) According to the revised Atlanta classification from 2012, patients diagnosed with AP were enrolled in the case group. (2) Patients without a history of AP or any disease related to metabolic syndrome were allocated into the control group. Controls were matched to cases individually by sex and age (control/case ratio=1). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cem\u003eResults:\u003c/em\u003e\u003c/strong\u003e The incidence rate of metabolic syndrome in AP patients was 30.9%, which was more frequent than that in controls (13.2%) (OR=2.837; 95% CI 1.873-4.298, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001). In the multivariate regression analysis, a history of smoking or alcohol consumption and biliary stones were significantly associated with AP (OR=2.441; 95% CI 1.865-5.172, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001; OR=1.777; 95% CI 1.060-2.977, \u003cem\u003ep\u003c/em\u003e=0.029; OR=28.995; 95% CI 13.253-63.435, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001). In addition, the occurrence of AP was significantly associated with total cholesterol (TC) (OR=1.992; 95% CI 1.246-3.183, \u003cem\u003ep\u003c/em\u003e=0.004), triglyceride (TG) (OR=2.134; 95% CI 1.403-3.245, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), hyperglycaemia (OR=2.261; 95% CI 1.367-3.742, \u003cem\u003ep\u003c/em\u003e=0.001), and apolipoprotein A (Apo A) (OR=0.270; 95% CI 0.163-0.447, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConclusions:\u003c/em\u003e\u003c/strong\u003e Metabolic syndrome and its components were associated with AP occurrence.\u003c/p\u003e","manuscriptTitle":"Metabolic Syndrome Components and Acute Pancreatitis: A Case-Control Study in China","msid":"","msnumber":"","nonDraftVersions":[{"code":3,"date":"2020-12-15 11:31:50","doi":"10.21203/rs.3.rs-45027/v3","editorialEvents":[{"type":"communityComments","content":0},{"type":"checksComplete","content":"","date":"2020-12-09T20:59:44+00:00","index":"","fulltext":""},{"type":"decision","content":"Accept","date":"2020-12-09T00:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2020-10-29 18:54:38","doi":"10.21203/rs.3.rs-45027/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2020-11-26T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-11-25T00:00:00+00:00","index":2,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nThe authors have modified the manuscript in a better way as per the suggestions. Following are my comments:\n\n1. What is the total patient population from which cases and controls were chosen after age and sex matching?\n\n2. Need to mention in the manuscript that it is a retrospective case control study.\n\n3. In the statistical analysis part please replace the word abnormally distributed data with non-parametric data.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **No**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **No**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **No**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"editorInvitedReview","content":"","date":"2020-11-15T00:00:00+00:00","index":1,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\n\nThe manuscript has been revised and relevant changes have been incorporated. However, i still have a few concerns.\n\n\nThe biggest limitation of the study is its retrospective design, and hence the ability to only comment on association and not causation. Prospective cohort studies are needed to comment on true incidence rates. This should be clearly mentioned in the limitation section.\n \nThe novelty of the study is depiction of association of metabolic syndrome components in AP patients amongst chinese population. However, there are studies showing such association from other parts of the world. Authors should mention clearly the lacunae in existing literature and a ground for their research in introduction section.\n\n\nThe assumption by authors in discussion line 305/306, page 14 regarding visceral obesity being difficult to distinguish from general obesity is not entirely right. CT scans and DEXA scans are being used to evaluate visceral obesity, due to it being the metabolically active fat. It is quite possible that visceral obesity has an association with AP occurence whereas general AP does not.\n\nVisceral fat was not assessed and obesity was defined only on the basis of BMI should be mentioned as a limitation.\n\nThe concept of \"obesity paradox\" can find mention in your discussion.\n\nLine 263 and 264 page 12 is is not clear and needs rectification \"TC and Apo A values were correlated with TC and Apo A\"\n\nLine 319, \"were\" should be used instead of \"was\" since you are referring to a plural that is patients.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-10-30T00:00:00+00:00","index":2,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-10-24T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-10-23T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-10-19T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-10-18T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-10-18T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-08-03 15:14:48","doi":"10.21203/rs.3.rs-45027/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-08-31T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-08-30T12:00:00+00:00","index":1,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nManuscript Review\n\nIt is a planned case control study evaluating the association between acute pancreatitis and and various components of metabolic syndrome . However, i have few queries and comments.\n1. Since it is a since it is a single center case control study, one can only assert association and not causation.\n2. In the methodology section, there is no mention of treatment received by the patients\n3. In table 1, instead of cases and controls, you may specify acute pancreatitis patients and controls for better clarity.\n4. A subgroup analysis of patients whose diabetes/dyslipidmia is controlled with diet/medicines could have been done with those who have uncontrolled sugars/lipid profile for drawing stronger conclusions\n5. Discussion, page 11, line 227, authors state that obesity may aggrevate the severity of AP whereas it is not enough to initiate AP. Conclusion regarding aggrevation of severity cannot be made on their study results because severity of AP was not assessed in their study. Moreover, how would they justify association with diabetes, dyslipidemia but not with obesity as association with AP since all these factors usually go together.\n6. Authors can comment upon increasing role of visceral fat which is believed to be the metabolically active fat and its association with AP. Several publications in the recent past have talked about their association.\n\n7. Multiple grammatical errors need to be rectified for example\neg. line 199 and line 200 \"1.831 fold increases and 0.247-fold decreases in risk\" . It should be increased and decreased risk instead\n\nUse \"were not\" instead of \"would not be\" in material and methods section, page 5, line 93,94, line 99 and line 100.\n\nUse of English language expert should be taken\n\n\n8. Figure legends are missing\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"editorInvitedReview","content":"","date":"2020-08-28T12:00:00+00:00","index":2,"fulltext":"Recommendation: Reject\nForm responses:\n---\n\nComments to Author:\n---\nI would like to congratulate the authors to make such an exhaustive effort to conduct this study. However I have following concerns\n\n1. The aim of the study was association of metabolic syndrome and incidence rate of acute pancreatitis. The study design was case- control study. However if we want to see incidence rate of acute pancreatitis and consider metabolic syndrome as a risk factor, then we have to do a cohort study design. We have estimate incidence rate over a time period and see presence of metabolic syndrome prior to occurrence of events. Only in a case control study we can assess risk factors when the event is rare. For this we have to take healthy control and not the diseased control. The reason being some patients admitted to hospitals have chronic diseases like inflammatory bowel disease or other chronic inflammatory diseases which may itself result in weight loss and result in low BMI after admission.\n\n2. In table 1. the baseline characters of the case and controls should be given and what were the diagnosis of controls?\n\n3.What were the variables for multivariate logistic regression analysis? Was comorbidity,diabetes were included for logistic regression? What was the cutoff of age for multivariate logistic regression.\n\nOver all the study lacks proper study design and selection of controls to answer the research question. The multivariate analysis needs to be performed again and needs more clarity about the selected variables.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **None**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. 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