Obesity as a risk and prognostic factor for disease progression in intraductal papillary mucinous neoplasm (IPMN): A systematic review and meta-analysis

INTRODUCTION: Intraductal papillary mucinous neoplasms (IPMN) are a common precancerous condition for pancreatic cancer. Obesity is an increasingly prevalent condition globally and has shown to contribute to carcinogenesis in pancreatic cancer. A potential effect of overweight and obesity on disease progression in IPMN is unexplored. METHODS: A systematic search of databases was performed up to April 2025. Inclusion criteria were original English studies reporting data on the prevalence of overweight and obesity in IPMN patients. Two independent reviewers performed study screening, data extraction and quality assessment using Covidence. Risk of bias assessment was done by using the Newcastle-Ottawa scale. Meta-analysis was performed of hazards ratios (HR) and odds ratios (OR) using a random-effects model with generic inverse variance method. RESULTS: After screening 695 studies a total of 15 cohort studies were included, entailing data on 6149 patients with IPMN. Four studies reported HR for progression of IPMN using different categories to report body-mass-index (BMI). The pooled HR for IPMN progression for obese versus normal-weight individuals was 1.87 (95 % confidence interval (CI) 1.42-2.45). Four studies reported OR for the association between obesity and malignancy in surgically treated IPMN patients. The pooled OR for malignancy was 2.48 (95 % CI 1.01-6.11). CONCLUSIONS: This meta-analysis reveals that obesity and overweight may be associated with the risk of progression of IPMN, as well as to the likelihood of malignancy in patients undergoing surgery for IPMN. Surveillance programs should therefore take obesity into account as a potential risk factor for progression of IPMNs.