Association of Peptic Ulcer Disease with Obesity, Serum Insulin Level and Lipid Prole

Background: PUD is a common and important type of gastrointestinal disease. Determination of contributing factors for PUD is an important issue for the development of preventive approaches. In this study, the association of Peptic Ulcer Disease with Obesity and Serum Insulin and Lipid Prole was studied. Methods: In this case-control study in Modarres Hospital in Tehran in 2019 among 170 consecutive subjects including 90 patients with PUD and 80 cases without it were enrolled and sampling tools were checklists. Serum Insulin and Lipid Prole and BMI were compared across the groups Results: The results in this study demonstrated that Serum Insulin and Lipid Prole and BMI had no statistically signicant difference between those patients with and without presence of PUD (P > 0.05). Conclusion: This study showed no statistically signicant difference between those patients with and without the presence of PUD from points of Serum Insulin and Lipid Prole and BMI. this study conducted through a case-control design. this study assessed the prole lipid, insulin serum level and obesity in relationship with PUD. Two groups containing conrmed PUD by endoscopy in the case


Background
Peptic ulcer disease (PUD) is a common severe condition in gastrointestinal tract with 4.1% global prevalence. Despite the controversy, recent studies show a relationship between PUD and environmental factors such as lifestyle, stress, obesity, and nutrition in terms of triggering or the chronicity of the disease. (1, 2) About 10% of the global population experience PUD at least once in their lives. (2) to achieve around 15 thousand death a year and waste billion dollars each year paid for the direct and indirect burden of PUD. (7) Lots of studies tried to assess the relationship between PUD and anthropometric factors as well as individual manners and lifestyle to suggest body mass index (BMI), waist/height-ratio (WHER), and waist circumference (WC) as causative factors (1,(4)(5)(6) but some deny this claim (7,8).
Despite many studies guess that PUD may associate with obesity, insulin intolerance and lipid pro le, there is no global acceptance in this regard directing the current study to the reassessment of the named factors in terms of any causative potential for PUD among our patients.

Participants:
Having obtained the approval from the University of Shahid Beheshti review board and the research ethics committee of Shahid Modarres Hospital under the code 1397.622, this study was conducted through a case-control design. this study assessed the pro le lipid, insulin serum level and obesity in relationship with PUD. Two groups containing con rmed PUD by endoscopy in the case group and healthy people in the control group were compared regarding the named risk factor. People who referred to the gastrointestinal clinic at Modarres hospital in Tehran enrolled in the study regarding inclusion and exclusion criteria. Dyspepsia was the chief complaint of our patients to lead them to experience endoscopy based on the relevant indications and the patients participated in case or control group based on the endoscopy results. People with PUD enrolled the case group and the rest made up the control group. Previous history or treatment of PUD, diabetes mellitus, hyperlipidemia, Lipitor tablet intake, using diabetes medications, smoking and addiction were our main exclusion criteria in addition to antiplatelets, anticoagulants, and NSAIDs while diseases such as COPD, chronic renal failure (CRF), and cirrhosis were also excluded.

Outcome measures:
Fasting blood sugar (FBS), serum insulin, triglyceride, cholesterol, LDL, and HDL were checked after endoscopy results were clear and the participants contributed to their suitable groups. Demographics as well as weight, height, and BMI were also recorded. All the data were gathered for cases and controls.

Statistics:
The variables were checked by Kolmogorov-Smirnov test regarding normal distribution before being analyzed through an independent-two-sample t-test and Mann-Whitney test as a parametric test for normally distributed and non-normal distributed variables, respectively. The association of the variables was checked by Pearson's and Spearman's correlation parameters. The current study used a 95% con dence interval beside type one error of α = 0.05 and a signi cance of 0.05 to have 0.8 power.

Results
The total number of the participants was 170 including 90 PUD patients as case and 80 patients without PUD as control. There was no statistical difference between the groups regarding age and sex distribution. The mean age was 44.74 ± 16 and 48.18 ± 15.6 years in the case and control group, respectively (P > 0.05). Males made up 46.7% and 47.5% of cases and controls while 53.3% of cases and 52.5% of controls were females (P > 0.05). The Chi-square test showed no difference between the groups in terms of past medical history or recently administered medications. Although some points in this regard would be discussed later as can be concluded from Fig. 3, BMI did not statistically differ comparing the studied groups. Underweight participants as diagram Fasting blood sugar, total cholesterol, LDL, HDL, TG, and serum insulin were measured and compared but no one was different between the groups (P > 0.05) (Fig. 1). Tables 1 and 2 summarize the ndings. Although the chi-square test showed the same ndings in terms of PUD and past medical history, the rate of PUD was a bit more in the group of people who had no comorbidities as can be seen in Fig. 2. Drug history showed no difference between the groups.

Discussion
The current study tried to nd any correlation between obesity, lipid pro le, serum insulin, and PUD. There was no correlation in this matter although many studies declare and some regret such a relationship.
Studies believe that increased serum lipids or atherogenic lipid pro les may be resulted by infections and consequent in ammatory reactions in the body but there is no performance to investigate this relationship directly between PUD and lipid pro le (9).
In 2019, Pyo et al. published an article following a study focused on obesity and PUD among more than 32,000 through a big cohort between 2005 and 2017. They found that obesity did not correlate with a gastric ulcer when adjusted for smoking habits, physical activity, alcohol intake, fasting blood sugar, TG, HDL, LDL, H. pylori status, and some medications. This was while duodenal ulcer had a lower rate in obese patients than in non-obese individuals. The current study, despite many supportive types of research, found no correlation between PUD and obesity, serum insulin, and lipid pro le. This means the fact that there is no need to monitor or control the mentioned factors as the main risk factors of PUD. However, this is worth thinking about a multicentral cohort study for decades in order to put an end to the controversy in this regard.

Study Limitations
The current study was done in a short time at a single hospital resulting in a limited sample size. Also, many of the patients declined to participate due to blood sampling and time wasting such as elongated hospital stay or later serial medical visits. for the patients. A written consent for this study was obtained from participants. There was no obligation to participate or maintain the study and the patients were free to quit the study without penalty whenever they wished.

Consent for publications
As there are no images/videos/details on individuals reported within this manuscript so consent for publication of images may not be required.

Availability of data and material
Raw data were generated at Modarres Hospital. Derived data supporting the ndings of this study are available from the corresponding author [F.Forghani] on request. The data are not publicly available due to the privacy of research participants.
Competing Interest