Targeting obesity and lipid metabolism profiles to prevent perianal abscesses: A case-control study and Mendelian randomization analysis

BACKGROUND: Perianal abscesses (PAs) are associated with significant complications, such as recurrent infections, pain, anal fistulas, rectovaginal fistulas, rectourethral fistulas, and rectovesical fistulas. However, established primary and secondary prevention strategies for PAs are lacking. AIM: To explore the relationships between obesity and lipid metabolites, including perianal abscess onset. METHODS: We conducted two independent studies under a unified research question. Case-control analysis was conducted at a single hospital between May 2023 and November 2023. Inpatients diagnosed with a perianal abscess and matched healthy controls were included. Body dimensions and serum metabolites were measured. Genome-wide association study data regarding genetic variants of PAs, obesity, and serum metabolites were obtained for the Mendelian randomization (MR) analysis. The study outcomes were perianal abscess onset and the number and location of PAs. RESULTS: In the case-control study, higher body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), blood glucose levels, uric acid (UA) levels, total cholesterol levels, triglyceride levels, and low-density lipoprotein (LDL) levels were associated with increased risk of PAs. Higher high-density lipoprotein levels were associated with reduced risk of PAs. The BMI, WHR, WHtR, UA level, triglyceride level, and LDL level were associated with the number and severity of PAs. In MR analysis, the BMI, WHR, body fat percentage, whole body fat mass, limb fat percentage, limb fat mass, and various lipid profiles were significantly associated with the risk of PAs. CONCLUSION: A hospital-based case-control study and an independent MR analysis consistently support obesity and lipid metabolism profiles are associated with an increased risk of perianal abscess. These findings provide a basis for developing primary and secondary prevention strategies for perianal abscess.