Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.113855
Revised: October 11, 2025
Accepted: November 19, 2025
Published online: January 27, 2026
Processing time: 137 Days and 21.8 Hours
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.
To explore the relationships between obesity and lipid metabolites, including perianal abscess onset.
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.
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.
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.
Core Tip: Our case-control study revealed that the risk of perianal abscesses (PAs) was significantly correlated with various obesity/metabolic markers, including higher body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio, glucose levels, uric acid levels, cholesterol levels, triglyceride levels, and low-density lipoprotein (LDL) cholesterol levels, as well as lower levels of high-density lipoprotein cholesterol. The mendelian randomization analysis further confirmed relationships between the PA risk and factors such as BMI, WHR, large and medium LDLs, and lipid ratios. These findings suggest that lipid levels, body fat distribution, and metabolic markers are crucial to the understanding of PA risk.