{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:12:52Z","timestamp":1760058772302,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T00:00:00Z","timestamp":1745625600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Radiological imaging has improved our insight into how obesity and sarcopenia impacts acute pancreatitis via several measured variables. However, we lack understanding of the association between social determinants of health and these variables within the acute pancreatitis population. Methods: This study included patients at a single tertiary care center between 1 January 2008 and 31 December 2021. Measurements of visceral adiposity (VA), subcutaneous adiposity (SA), the ratio of visceral to total adiposity (VA\/TA), and degree of sarcopenia via psoas muscle Hounsfield unit average calculation (HUAC) were obtained on CT scans performed at presentation. Using geocoded patient data, we calculated the social vulnerability index (SVI) from CDC metrics. Descriptive and regression analyses were performed utilizing clinical and radiological data. Results: In 484 patients with 592 acute pancreatitis-related hospitalization, median (IQR) VA was 176 (100\u2013251), SA was 209.5 (138.5\u2013307), VA\/TA ratio was 43.5 (32.3\u201355.3), and HUAC was 51.3 (44.4\u201358.9). For our primary outcome, geospatial analyses showed a reverse association between VA and SVI with a coefficient of \u22129.0 (p = 0.04) after adjustment for age, health care behaviors (i.e., active smoking and drinking), and CCI, suggesting residence in areas with higher SVI is linked to lower VA. However, VA\/TA, SA, and HUAC showed no significant association with SVI. The SVI subdomain of socioeconomic status had significant association with VA (\u221239.78 (95% CI: \u221275.88\u2013\u22123.70), p = 0.03) after adjustments. For our secondary outcome, acute pancreatitis severity had significant association with higher VA (p \u2264 0.001), VA\/TA (p \u2264 0.001), and lower HUAC (p \u2264 0.001). When comparing single vs. recurrent hospitalization patients, there was significantly higher median VA with recurrences (VA-single acute pancreatitis: 149 (77.4\u2013233) vs. VA-recurrent acute pancreatitis: 177 (108\u2013256); p = 0.04). Conclusions: In this study we found that patients residing in more socially vulnerable areas had lower visceral adiposity. This paradoxical result potentially conferred a protective effect against severe and recurrent acute pancreatitis; however, this was not found to be statistically significant.<\/jats:p>","DOI":"10.3390\/jcm14093005","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T09:39:47Z","timestamp":1745833187000},"page":"3005","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Visceral Adiposity and Sarcopenia with Geospatial Analysis and Outcomes in Acute Pancreatitis"],"prefix":"10.3390","volume":"14","author":[{"given":"Ankit","family":"Chhoda","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manisha","family":"Bohara","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anabel","family":"Liyen Cartelle","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7386-0384","authenticated-orcid":false,"given":"Matthew Antony","family":"Manoj","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5510-9765","authenticated-orcid":false,"given":"Marco A.","family":"Noriega","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6386-3039","authenticated-orcid":false,"given":"Miriam","family":"Olivares","sequence":"additional","affiliation":[{"name":"Geographical Information System Library, Yale University, New Haven, CT 06520, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill","family":"Kelly","sequence":"additional","affiliation":[{"name":"Geographical Information System Library, Yale University, New Haven, CT 06520, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga","family":"Brook","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven D.","family":"Freedman","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abraham F.","family":"Bezuidenhout","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil G.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1053\/j.gastro.2021.10.017","article-title":"Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2021","volume":"162","author":"Peery","year":"2022","journal-title":"Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1016\/S0140-6736(20)31310-6","article-title":"Acute pancreatitis","volume":"396","author":"Boxhoorn","year":"2020","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1097\/SLA.0000000000002766","article-title":"Determinants of Severity in Acute Pancreatitis: A Nation-wide Multicenter Prospective Cohort Study","volume":"270","author":"Sternby","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1053\/j.gastro.2021.09.043","article-title":"Global Incidence of Acute Pancreatitis Is Increasing Over Time: A Systematic Review and Meta-Analysis","volume":"162","author":"Iannuzzi","year":"2022","journal-title":"Gastroenterology"},{"key":"ref_5","unstructured":"NCD (Noncommunicable diseases) Risk Factor Collaboration (2024). Worldwide trends in underweight and obesity from 1990 to 2022: A pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet, 403, 1027\u20131050."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.1001\/archinte.162.18.2074","article-title":"Body mass index, waist circumference, and health risk: Evidence in support of current National Institutes of Health guidelines","volume":"162","author":"Janssen","year":"2002","journal-title":"Arch. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"107ra110","DOI":"10.1126\/scitranslmed.3002573","article-title":"Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity","volume":"3","author":"Navina","year":"2011","journal-title":"Sci. Transl. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1016\/j.ajpath.2014.11.019","article-title":"Lipolysis of visceral adipocyte triglyceride by pancreatic lipases converts mild acute pancreatitis to severe pancreatitis independent of necrosis and inflammation","volume":"185","author":"Patel","year":"2015","journal-title":"Am. J. Pathol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1038\/s41574-019-0310-7","article-title":"Waist circumference as a vital sign in clinical practice: A Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity","volume":"16","author":"Ross","year":"2020","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_10","first-page":"1104","article-title":"Relationship of computed tomography quantified visceral adiposity with the severity and complications of acute pancreatitis: A systematic review","volume":"41","author":"Tan","year":"2023","journal-title":"Jacute Pancreatitisanese J. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2825","DOI":"10.1007\/s00268-023-07122-1","article-title":"Sarcopenia and Sarcopenic Obesity on Body Composition Analysis is a Significant Predictor of Mortality in Severe Acute Pancreatitis: A Longitudinal Observational Study","volume":"47","author":"Farquhar","year":"2023","journal-title":"World J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"W255","DOI":"10.2214\/AJR.15.14635","article-title":"Sarcopenia: Current Concepts and Imaging Implications","volume":"205","author":"Boutin","year":"2015","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_13","unstructured":"Boutin, R.D., Katz, J., and Chaudhari, A. (2014, January 2). Significance of sarcopenia in soft-tissue sarcoma patients: Do skeletal muscle and fat measures of body composition on routine CT exams help predict clinical outcomes?. Proceedings of the Radiological Society of North America Meeting (RSNA 2014), Chicago, IL, USA. Available online: http:\/\/archive.rsna.org\/2014\/14011743.html."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1097\/PCC.0000000000002986","article-title":"Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated With Pediatric Intensive Care Use for Acute Respiratory Failure Requiring Mechanical Ventilation","volume":"23","author":"Najjar","year":"2022","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e029769","DOI":"10.1161\/JAHA.123.029769","article-title":"Geogracute pancreatitishic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018","volume":"12","author":"Chang","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_16","unstructured":"(2024, January 31). Centers for Disease Control and Prevention\/Agency for Toxic Substances and Disease Registry\/Geospatial Research, Analysis, and Services Program. CDC\/ATSDR Social Vulnerability Index [2020] Database US, Available online: https:\/\/www.atsdr.cdc.gov\/place-health\/php\/svi\/index.html."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"335","author":"Altman","year":"2007","journal-title":"BMJ"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of acute pancreatitis-2012: Revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1097\/MPA.0000000000002160","article-title":"Racial Variations in Pain Management and Outcomes in Hospitalized Patients With Acute Pancreatitis","volume":"51","author":"McHenry","year":"2022","journal-title":"Pancreas"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1097\/MPA.0000000000002159","article-title":"Evaluating the Clinical Characteristics and Outcomes of Idiopathic Acute Pancreatitis: Comparison With Nonidiopathic Acute Pancreatitis Over a 10-Year Period","volume":"51","author":"Anderson","year":"2022","journal-title":"Pancreas"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1136\/gut.2008.152702","article-title":"The early prediction of mortality in acute pancreatitis: A large population-based study","volume":"57","author":"Wu","year":"2008","journal-title":"Gut"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Gao, W., Yang, H.X., and Ma, C.E. (2015). The Value of BISAP Score for Predicting Mortality and Severity in Acute Pancreatitis: A Systematic Review and Meta-Analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0142025"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.surg.2017.03.014","article-title":"Computed tomography measured psoas density predicts outcomes in trauma","volume":"162","author":"Yoo","year":"2017","journal-title":"Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jss.2016.08.015","article-title":"Sarcopenia in emergency abdominal surgery","volume":"207","author":"Dirks","year":"2017","journal-title":"J. Surg. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e024414","DOI":"10.1161\/JAHA.121.024414","article-title":"Association Between Social Vulnerability Index and Cardiovascular Disease: A Behavioral Risk Factor Surveillance System Study","volume":"11","author":"Jain","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Park, E., and Ko, Y. (2021). Socioeconomic Vulnerability Index and Obesity among Korean Adults. Int. J. Env. Res. Public Health, 18.","DOI":"10.3390\/ijerph182413370"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wild, L.E., Walters, M., Powell, A., James, K.A., Corlin, L., and Alderete, T.L. (2022). County-Level Social Vulnerability Is Positively Associated with Cardiometabolic Disease in Colorado. Int. J. Environ. Res. Public Health., 19.","DOI":"10.3390\/ijerph19042202"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1742-7622-11-18","article-title":"The individualistic fallacy, ecological studies and instrumental variables: A causal interpretation","volume":"11","author":"Loney","year":"2014","journal-title":"Emerg. Themes Epidemiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1093\/ije\/18.1.269","article-title":"Ecological bias, confounding, and effect modification","volume":"18","author":"Greenland","year":"1989","journal-title":"Int. J. Epidemiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1016\/S0140-6736(14)61132-6","article-title":"The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations","volume":"384","author":"Fazel","year":"2014","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e213837","DOI":"10.1001\/jamanetworkopen.2021.3837","article-title":"Health Care for People Experiencing Homelessness-What Outcomes Matter?","volume":"4","author":"Doran","year":"2021","journal-title":"JAMA Netw. 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