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Mi W, Zhang Y, Wang Q, Ding W, Mao X, Sun Y, Li X, Liu C, Xu S. Triglyceride-glucose index is independently associated with fatty pancreas disease in Chinese elderly. BMC Endocr Disord 2025; 25:74. [PMID: 40102915 PMCID: PMC11916974 DOI: 10.1186/s12902-025-01900-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 03/10/2025] [Indexed: 03/20/2025] Open
Abstract
OBJECTIVE To determine the prevalence of fatty pancreas disease (FPD) diagnosed by transabdominal ultrasound in Chinese elderly aged 65 years and above to explore the correlation between triglyceride glucose index (TyG index) and FPD and its severity, and to evaluate the ability of TyG index to identify FPD and its severity. METHODS The study population was derived from the Thyroid Diseases in Older Population: Screening, Surveillance, and Intervention (TOPS) study conducted in the iodine-adapted areas of Jiangsu Province from May to July 2021. A total of 567 participants aged 65 years and above in rural areas were included in the final analysis. TyG index was calculated by the established formula: Ln [TG (mg/dL) × FBG (mg/dL)/2]. FPD and the degree of intra-pancreatic fat deposition (IPFD) were diagnosed by abdominal ultrasound. The logistic regression model was performed to determine the correlation between clinical parameters, including TyG index, and FPD and its severity. The diagnostic power of TyG index was assessed by receiver operating characteristic curve (ROC). RESULTS Overall, 72.66% (412/567) of subjects had FPD, of which over half had moderate to severe FPD. The proportions of overweight, obesity, NAFLD, and dyslipidemia were significantly higher in the moderate-to-severe FPD group than in the mild FPD group. Multivariate logistic regression showed that TyG index was independently associated with FPD in the elderly population, but was not significantly associated with the severity of IPFD. As the level of TyG index increased, the metabolic disorders in the population worsened and the prevalence of FPD increased significantly. TyG index had a good diagnostic performance for FPD. The combination of BMI or NAFLD and TyG index improved the diagnostic ability for FPD. CONCLUSION The prevalence of FPD diagnosed by abdominal ultrasound is high in the elderly aged 65 years and above in rural areas in China. TyG index has good identification of FPD but poor recognition of the severity of IPFD. TyG index, when combined with other clinical parameters, may have more diagnostic advantages.
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Affiliation(s)
- Weinuo Mi
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuzhi Zhang
- Department of Ultrasound, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qifeng Wang
- Key Laboratory of TCM Syndrome and Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Wenbo Ding
- Department of Ultrasound, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaodong Mao
- Key Laboratory of TCM Syndrome and Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Yu Sun
- The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Xingjia Li
- Key Laboratory of TCM Syndrome and Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China.
| | - Chao Liu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory of TCM Syndrome and Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Shuhang Xu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.
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Li J, Chen Y, Li S, Lyu G, Yan F, Guo J, Cheng J, Chen Y, Lin J, Zeng Y. NAFPD exacerbation by hyperlipidemia combined with hyperuricemia: a pilot rat experiment in lipidomics. Front Nutr 2025; 11:1437373. [PMID: 39839297 PMCID: PMC11746073 DOI: 10.3389/fnut.2024.1437373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 12/18/2024] [Indexed: 01/23/2025] Open
Abstract
Background Hyperuricemia and non-alcoholic fatty pancreas disease (NAFPD) are prevalent metabolic diseases, but the relationship between them remains underexplored. Methods Eighteen Sprague-Dawley rats were randomly assigned to three groups: normal (CON), high-fat (PO), and high-fat high-uric acid (PH). After 12 weeks, serum uric acid (SUA) and triacylglycerol levels were measured. Pathological changes in the pancreas were assessed using hematoxylin-eosin (HE) staining. Serum samples were analyzed using lipidomics technology, and multivariate statistical analysis was employed to identify differences in lipid metabolism. Results SUA levels in the PO group were not significantly different from those in the CON group (p > 0.05). However, from the 4th week onward, SUA levels in the PH group were significantly higher than those in both the PO and CON groups (p < 0.05). HE staining revealed that most rats in the CON group exhibited normal pancreatic islet and acinar cell morphology. The pathological NAFPD score in the PH group was higher than that in the PO group. Lipidomics analysis identified 34 potential serum biomarkers in the CON and PO groups, 38 in the CON and PH groups, and 32 in the PH and PO groups. These metabolites primarily included sphingolipids, cholesterol esters, fatty acids, triacylglycerols, phosphatidylcholines, lysophosphatidylcholine, phosphatidylethanolamine, and lysophosphatidylethanolamine. Conclusion Hyperlipidemia combined with hyperuricemia might exacerbates NAFPD. Glycerophospholipids may serve as key biomarkers in this process, potentially linked to a chronic inflammatory response mediated by glycerophospholipids.
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Affiliation(s)
- Jingyun Li
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
- Department of Medical Imaging, Quanzhou Medical College, Quanzhou, Fujian, China
| | - Yongjian Chen
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Shilin Li
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Guorong Lyu
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
- Department of Medical Imaging, Quanzhou Medical College, Quanzhou, Fujian, China
| | - Furong Yan
- Department of Molecular Diagnostics Research Center, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Jiajing Guo
- Department of Pathology, The 910th Hospital of the People's Liberation Army, Quanzhou, Fujian, China
| | - Jing Cheng
- Department of Animal Experimental Center, Quanzhou Medical College, Quanzhou, Fujian, China
| | - Yun Chen
- Department of Internal Medicine, Quanzhou Medical College, Quanzhou, Fujian, China
| | - Jiaojiao Lin
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Yating Zeng
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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Della Pepa G, Salamone D, Testa R, Bozzetto L, Costabile G. Intrapancreatic fat deposition and nutritional treatment: the role of various dietary approaches. Nutr Rev 2024; 82:1820-1834. [PMID: 38153345 DOI: 10.1093/nutrit/nuad159] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Ectopic fat accumulation in various organs and tissues, such as the liver, muscle, kidney, heart, and pancreas, is related to impaired capacity of adipose tissue to accumulate triglycerides, as a consequence of overnutrition and an unhealthy lifestyle. Ectopic fat promotes organ dysfunction and is a key factor in the development and progression of cardiometabolic diseases. Interest in intrapancreatic fat deposition (IPFD) has developed in the last few years, particularly in relation to improvement in methodological techniques for detection of fat in the pancreas, and to growing evidence for the role that IPFD might have in glucose metabolism disorders and cardiometabolic disease. Body weight reduction represents the main option for reducing fat, and the evidence consistently shows that hypocaloric diets are effective in reducing IPFD. Changes in diet composition, independently of changes in energy intake, might offer a more feasible and safe alternative treatment to energy restriction. This current narrative review focused particularly on the possible beneficial role of the diet and its nutrient content, in hypocaloric and isocaloric conditions, in reducing IPFD in individuals with high cardiometabolic risk, highlighting the possible effects of differences in calorie quantity and calorie quality. This review also describes plausible mechanisms by which the various dietary approaches could modulate IPFD.
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Affiliation(s)
- Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy
| | - Dominic Salamone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberta Testa
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppina Costabile
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Habas E, Farfar K, Habas E, Rayani A, Elzouki AN. Extended Review and Updates of Nonalcoholic Fatty Pancreas Disease. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:284-291. [PMID: 39539795 PMCID: PMC11556510 DOI: 10.4103/sjmms.sjmms_526_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 11/16/2024]
Abstract
Non-alcoholic fatty pancreatic disease (NAFPD), also known as pancreatic steatosis, is a benign condition characterized by deposition of lipids in the pancreas and is associated with insulin resistance, malnutrition, obesity, metabolic syndrome, aging, and absence of heavy alcohol intake or infection. Similar to nonalcoholic fatty liver disease, NAFPD is a phenotypic entity that includes fat buildup in the pancreas, pancreatic inflammation, and subsequent fibrosis. The extent to which pancreatic fat infiltration is clinically important remains unclear. Despite these clinical associations, most of the clinical effects of NAFPD are not known. NAFPD may be identified by transabdominal and elastography ultrasound, computed tomography scan, or magnetic resonance imaging modalities, but a confirmatory diagnosis can only be made through tissue histology. In addition to complications such as acute and chronic pancreatitis, NAFPD may progress to pancreatic ductal adenocarcinoma. However, further research is required to fully understand the associations, pathophysiology, and effects of NAFPD. This review provides a narrative synthesis of the current literature on the epidemiology, pathophysiology, complications, diagnostic and imaging tools, and management of NAFPD.
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Affiliation(s)
- Elmukhtar Habas
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, College of Medicine, Qatar University, Doha, Qatar
| | - Kalifa Farfar
- Department of Medicine, Alwakra General Hospital, Alwakra, Qatar
| | - Eshrak Habas
- Department of Medicine, Tripoli Central Hospital, Tripoli, Libya
| | - Amnna Rayani
- Tripoli Children Hospital, Medical College, Tripoli University, Tripoli, Libya
| | - Abdul-Naser Elzouki
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, College of Medicine, Qatar University, Doha, Qatar
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Matboli M, Al-Amodi HS, Hamady S, Ali M, Roushdy MM, Hasanin AH, Aboul-Ela YM, Albadawy R, Gomaa E, Kamel HFM, ELsawi HA, Farid LM, Abouelkhair MB, Elmakromy GM, Fawzy NM. Experimental investigation for nonalcoholic fatty pancreas management using probiotics. Diabetol Metab Syndr 2024; 16:147. [PMID: 38961451 PMCID: PMC11223304 DOI: 10.1186/s13098-024-01378-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Nonalcoholic fatty pancreatitis (NAFP) presents a pressing challenge within the domain of metabolic disorders, necessitating further exploration to unveil its molecular intricacies and discover effective treatments. Our focus was to delve into the potential therapeutic impact of ZBiotic, a specially engineered strain of probiotic B. subtilis, in managing NAFP by targeting specific genes linked with necroptosis and the TNF signaling pathway, including TNF, ZBP1, HSPA1B, and MAPK3, along with their upstream epigenetic regulator, miR-5192, identified through bioinformatics. METHODS Rats were subjected to either a standard or high-fat, high-sucrose diet (HFHS) for eight weeks. Subsequently, they were divided into groups: NAFP model, and two additional groups receiving daily doses of ZBiotic (0.5 ml and 1 ml/kg), and the original B. subtilis strain group (1 ml/kg) for four weeks, alongside the HFHS diet. RESULTS ZBiotic exhibited remarkable efficacy in modulating gene expression, leading to the downregulation of miR-5192 and its target mRNAs (p < 0.001). Treatment resulted in the reversal of fibrosis, inflammation, and insulin resistance, evidenced by reductions in body weight, serum amylase, and lipase levels (p < 0.001), and decreased percentages of Caspase and Nuclear Factor Kappa-positive cells in pancreatic sections (p < 0.01). Notably, high-dose ZBiotic displayed superior efficacy compared to the original B. subtilis strain, highlighting its potential in mitigating NAFP progression by regulating pivotal pancreatic genes. CONCLUSION ZBiotic holds promise in curbing NAFP advancement, curbing fibrosis and inflammation while alleviating metabolic and pathological irregularities observed in the NAFP animal model. This impact was intricately linked to the modulation of necroptosis/TNF-mediated pathway-related signatures.
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Affiliation(s)
- Marwa Matboli
- Medical biochemistry and molecular biology department, Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt.
| | - Hiba S Al-Amodi
- Biochemistry Department, Faculty of Medicine, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Shaimaa Hamady
- Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo, 11566, Egypt.
| | - Marwa Ali
- Medical biochemistry and molecular biology department, Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt
| | - Marian Ms Roushdy
- Medical biochemistry and molecular biology department, Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt
| | - Amany Helmy Hasanin
- Clinical pharmacology department, Faculty of medicine, Ain Shams University, Cairo, Egypt
| | - Yasmin M Aboul-Ela
- Clinical pharmacology department, Faculty of medicine, Ain Shams University, Cairo, Egypt
| | - Reda Albadawy
- Department of Gastroenterology, Hepatology & Infectious Disease, Faculty of Medicine, Benha University, Benha, 13518, Egypt
| | - Eman Gomaa
- Histology and Cell biology department, Faculty of Medicine, Ain Shams University, Giza, Egypt
| | - Hala F M Kamel
- Medical biochemistry and molecular biology department, Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt
- Biochemistry Department, Faculty of Medicine, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Hind A ELsawi
- Department of Internal Medicine, Badr University in Cairo, Badr City, Egypt
| | - Laila M Farid
- Pathology department Faculty of Medicine, Ain Shams University, Giza, Egypt
| | | | - Gena M Elmakromy
- Endocrinology & Diabetes mellitus unit, Department of Internal Medicine, Badr University in Cairo, Badr City, Egypt
| | - Nesma Mohamed Fawzy
- Medical biochemistry and molecular biology department, Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt
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Mak AL, Wassenaar N, van Dijk AM, Troelstra M, Houttu V, van Son K, Driessen S, Zwirs D, van den Berg-Faay S, Shumbayawonda E, Runge J, Doukas M, Verheij J, Beuers U, Nieuwdorp M, Cahen DL, Nederveen A, Gurney-Champion O, Holleboom A. Intrapancreatic fat deposition is unrelated to liver steatosis in metabolic dysfunction-associated steatotic liver disease. JHEP Rep 2024; 6:100998. [PMID: 38379586 PMCID: PMC10877191 DOI: 10.1016/j.jhepr.2023.100998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/21/2023] [Accepted: 12/21/2023] [Indexed: 02/22/2024] Open
Abstract
Background & Aims Individuals with obesity may develop intrapancreatic fat deposition (IPFD) and fatty pancreas disease (FPD). Whether this causes inflammation and fibrosis and leads to pancreatic dysfunction is less established than for liver damage in metabolic dysfunction-associated steatotic liver disease (MASLD). Moreover, the interrelations of FPD and MASLD are poorly understood. Therefore, we aimed to assess IPFD and fibro-inflammation in relation to pancreatic function and liver disease severity in individuals with MASLD. Methods Seventy-six participants from the Amsterdam MASLD-MASH cohort (ANCHOR) study underwent liver biopsy and multiparametric MRI of the liver and pancreas, consisting of proton-density fat fraction sequences, T1 mapping and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI). Results The prevalence of FPD was 37.3%. There was a clear correlation between pancreatic T1 relaxation time, which indicates fibro-inflammation, and parameters of glycemic dysregulation, namely HbA1c (R = 0.59; p <0.001), fasting glucose (R = 0.51; p <0.001) and the presence of type 2 diabetes (mean 802.0 ms vs. 733.6 ms; p <0.05). In contrast, there was no relation between IPFD and hepatic fat content (R = 0.03; p = 0.80). Pancreatic IVIM diffusion (IVIM-D) was lower in advanced liver fibrosis (p <0.05) and pancreatic perfusion (IVIM-f), reflecting vessel density, inversely correlated to histological MASLD activity (p <0.05). Conclusions Consistent relations exist between pancreatic fibro-inflammation on MRI and endocrine function in individuals with MASLD. However, despite shared dysmetabolic drivers, our study suggests IPFD is a separate pathophysiological process from MASLD. Impact and implications Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and 68% of people with type 2 diabetes have MASLD. However, fat infiltration and inflammation in the pancreas are understudied in individuals with MASLD. In this cross-sectional MRI study, we found no relationship between fat accumulation in the pancreas and liver in a cohort of patients with MASLD. However, our results show that inflammatory and fibrotic processes in the pancreas may be interrelated to features of type 2 diabetes and to the severity of liver disease in patients with MASLD. Overall, the results suggest that pancreatic endocrine dysfunction in individuals with MASLD may be more related to glucotoxicity than to lipotoxicity. Clinical trial number NTR7191 (Dutch Trial Register).
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Affiliation(s)
- Anne Linde Mak
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nienke Wassenaar
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Anne-Marieke van Dijk
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marian Troelstra
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Veera Houttu
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Koen van Son
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, The Netherlands
| | - Stan Driessen
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Diona Zwirs
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Sandra van den Berg-Faay
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Jurgen Runge
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michail Doukas
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joanne Verheij
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Djuna L. Cahen
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aart Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Oliver Gurney-Champion
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Adriaan Holleboom
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Kiemen AL, Dbouk M, Diwan EA, Forjaz A, Dequiedt L, Baghdadi A, Madani SP, Grahn MP, Jones C, Vedula S, Wu P, Wirtz D, Kern S, Goggins M, Hruban RH, Kamel IR, Canto MI. Magnetic Resonance Imaging-Based Assessment of Pancreatic Fat Strongly Correlates With Histology-Based Assessment of Pancreas Composition. Pancreas 2024; 53:e180-e186. [PMID: 38194643 PMCID: PMC10872776 DOI: 10.1097/mpa.0000000000002288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE The aim of the study is to assess the relationship between magnetic resonance imaging (MRI)-based estimation of pancreatic fat and histology-based measurement of pancreatic composition. MATERIALS AND METHODS In this retrospective study, MRI was used to noninvasively estimate pancreatic fat content in preoperative images from high-risk individuals and disease controls having normal pancreata. A deep learning algorithm was used to label 11 tissue components at micron resolution in subsequent pancreatectomy histology. A linear model was used to determine correlation between histologic tissue composition and MRI fat estimation. RESULTS Twenty-seven patients (mean age 64.0 ± 12.0 years [standard deviation], 15 women) were evaluated. The fat content measured by MRI ranged from 0% to 36.9%. Intrapancreatic histologic tissue fat content ranged from 0.8% to 38.3%. MRI pancreatic fat estimation positively correlated with microanatomical composition of fat (r = 0.90, 0.83 to 0.95], P < 0.001); as well as with pancreatic cancer precursor ( r = 0.65, P < 0.001); and collagen ( r = 0.46, P < 0.001) content, and negatively correlated with pancreatic acinar ( r = -0.85, P < 0.001) content. CONCLUSIONS Pancreatic fat content, measurable by MRI, correlates to acinar content, stromal content (fibrosis), and presence of neoplastic precursors of cancer.
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Affiliation(s)
- Ashley L. Kiemen
- Departments of Pathology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
- Departments of Chemical and Biomolecular Engineering, The Johns Hopkins University; 3400 N Charles St, Baltimore, Maryland 21218, USA
- Oncology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
| | - Mohamad Dbouk
- Departments of Pathology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
- Department of Medicine, Washington University St. Louis, St. Louis, USA; 1 Brookings Dr, St. Louis, MO 63130
| | - Elizabeth Abou Diwan
- Department of Medicine, Washington University St. Louis, St. Louis, USA; 1 Brookings Dr, St. Louis, MO 63130
| | - André Forjaz
- Departments of Chemical and Biomolecular Engineering, The Johns Hopkins University; 3400 N Charles St, Baltimore, Maryland 21218, USA
| | - Lucie Dequiedt
- Departments of Chemical and Biomolecular Engineering, The Johns Hopkins University; 3400 N Charles St, Baltimore, Maryland 21218, USA
| | - Azarakhsh Baghdadi
- Radiology and Radiological Science, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
| | - Seyedeh Panid Madani
- Radiology and Radiological Science, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
| | - Mia P. Grahn
- Departments of Chemical and Biomolecular Engineering, The Johns Hopkins University; 3400 N Charles St, Baltimore, Maryland 21218, USA
| | - Craig Jones
- Computer Science, The Johns Hopkins University; 3400 N Charles St, Baltimore, Maryland 21218, USA
- Malone Center for Engineering in Healthcare, The Johns Hopkins University; 3400 N Charles St, Baltimore, Maryland 21218, USA
| | - Swaroop Vedula
- Malone Center for Engineering in Healthcare, The Johns Hopkins University; 3400 N Charles St, Baltimore, Maryland 21218, USA
| | - PeiHsun Wu
- Departments of Chemical and Biomolecular Engineering, The Johns Hopkins University; 3400 N Charles St, Baltimore, Maryland 21218, USA
| | - Denis Wirtz
- Departments of Pathology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
- Departments of Chemical and Biomolecular Engineering, The Johns Hopkins University; 3400 N Charles St, Baltimore, Maryland 21218, USA
- Oncology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
- Materials Science and Engineering, The Johns Hopkins University; 3400 N Charles St, Baltimore, Maryland 21218, USA
| | - Scott Kern
- Departments of Pathology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
- Oncology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
| | - Michael Goggins
- Departments of Pathology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
- Oncology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
| | - Ralph H. Hruban
- Departments of Pathology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
- Oncology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
| | - Ihab R. Kamel
- Radiology and Radiological Science, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
| | - Marcia Irene Canto
- Oncology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine; 600 North Wolfe Street, Baltimore, Maryland 21287, USA
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Wongtrakul W, Untaaveesup S, Pausawadi N, Charatcharoenwitthaya P. Bidirectional association between non-alcoholic fatty liver disease and fatty pancreas: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2023; 35:1107-1116. [PMID: 37665612 DOI: 10.1097/meg.0000000000002625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Accumulating evidence suggests a potential relationship between non-alcoholic fatty liver disease (NAFLD) and fatty pancreas, as both conditions are associated with fat deposition in the liver and pancreas, respectively. The meta-analysis aimed to investigate the bidirectional association between NAFLD and fatty pancreas, as well as their respective effects on disease severity. METHODS A systematic search of the EMBASE and MEDLINE databases, from inception to August 2022, was conducted to identify observational studies examining the association between NAFLD and fatty pancreas, as well as their impact on disease severity. The pooled odds ratio (OR) with a 95% confidence interval (CI) was estimated using a random-effects model. RESULTS Our analysis included 26 case-control or cross-sectional studies, comprising 67,803 participants. We observed a significant association between NAFLD and an increased odds of having fatty pancreas (OR, 6.18; 95% CI, 4.49-8.51; I2 = 92%). Similarly, fatty pancreas was significantly associated with an increased odds of having NAFLD (OR, 9.56; 95% CI, 5.09-17.95; I2 = 83%). Furthermore, the presence of fatty pancreas was associated with a 1.75-fold increased risk of severe NAFLD based on ultrasonographic classification (95% CI, 1.46-2.10; I2 = 0%). Among NAFLD patients, the coexistence of fatty pancreas was associated with a trend towards increased odds of having non-alcoholic steatohepatitis (OR, 3.52; 95% CI, 0.65-18.93; I2 = 82%) and advanced fibrosis (OR, 2.47; 95% CI, 0.52-11.80; I2 = 76%). CONCLUSION This meta-analysis discloses a bidirectional association between NAFLD and fatty pancreas, emphasizing the importance of understanding the intricate relationship between these two conditions.
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Affiliation(s)
- Wasit Wongtrakul
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
- Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suvijak Untaaveesup
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
| | - Nonthalee Pausawadi
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
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9
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Mahyoub MA, Elhoumed M, Maqul AH, Almezgagi M, Abbas M, Jiao Y, Wang J, Alnaggar M, Zhao P, He S. Fatty infiltration of the pancreas: a systematic concept analysis. Front Med (Lausanne) 2023; 10:1227188. [PMID: 37809324 PMCID: PMC10556874 DOI: 10.3389/fmed.2023.1227188] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
Fatty infiltration of the pancreas (FIP) has been recognized for nearly a century, yet many aspects of this condition remain unclear. Regular literature reviews on the diagnosis, consequences, and management of FIP are crucial. This review article highlights the various disorders for which FIP has been established as a risk factor, including type 2 diabetes mellitus (T2DM), pancreatitis, pancreatic fistula (PF), metabolic syndrome (MS), polycystic ovary syndrome (PCOS), and pancreatic duct adenocarcinoma (PDAC), as well as the new investigation tools. Given the interdisciplinary nature of FIP research, a broad range of healthcare specialists are involved. This review article covers key aspects of FIP, including nomenclature and definition of pancreatic fat infiltration, history and epidemiology, etiology and pathophysiology, clinical presentation and diagnosis, clinical consequences, and treatment. This review is presented in a detailed narrative format for accessibility to clinicians and medical students.
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Affiliation(s)
- Mueataz A. Mahyoub
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Clinical Medical Research Center for Digestive Diseases (Oncology) of Shaanxi Province, Xi'an, China
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Gastroenterology, Faculty of Medicine, Thamar University, Dhamar, Yemen
| | - Mohamed Elhoumed
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- National Institute of Public Health Research (INRSP), Nouakchott, Mauritania
| | - Abdulfatah Hassan Maqul
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Medical Imaging, Sahan Diagnostic Center, Mogadishu, Somalia
| | - Maged Almezgagi
- The Key Laboratory of High-altitude Medical Application of Qinghai Province, Xining, Qinghai, China
- Department of Immunology, Qinghai University, Xining, Qinghai, China
- Department of Medical Microbiology, Faculty of Sciences, Ibb University, Ibb, Yemen
| | - Mustafa Abbas
- Department of Internal Medicine, Faculty of Medicine, Thamar University, Dhamar, Yemen
| | - Yang Jiao
- Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinhai Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mohammed Alnaggar
- Department of Oncology, South Hubei Cancer Hospital, Xianning, Hubei, China
- Department of Internal Medicine, Clinic Medical College, Hubei University of Science and Technology, Xianning, Hubei, China
| | - Ping Zhao
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuixiang He
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Clinical Medical Research Center for Digestive Diseases (Oncology) of Shaanxi Province, Xi'an, China
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10
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Otsuka N, Shimizu K, Taniai M, Tokushige K. Risk factors for fatty pancreas and effects of fatty infiltration on pancreatic cancer. Front Physiol 2023; 14:1243983. [PMID: 37664430 PMCID: PMC10470060 DOI: 10.3389/fphys.2023.1243983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Objective: This study clarified the risk factors and pathophysiology of pancreatic cancer by examining the factors associated with fatty pancreas. Methods: The degree of fatty pancreas, background factors, and incidence of pancreatic cancer were examined among nonalcoholic fatty liver disease (NAFLD) patients (n = 281) and intraductal papillary mucinous neoplasm (IPMN) patients with a family history of pancreatic cancer (n = 38). The presence of fatty pancreas was confirmed by the pancreatic CT value/splenic CT value ratio (P/S ratio). Immunohistochemical staining was performed on 10 cases with fatty pancreas, confirmed via postoperative pathology. Results: Fatty pancreas occurred in 126 patients (44.8%) in the NAFLD group who were older (p = 0.0002) and more likely to have hypertension (p < 0.0001). The IPMN group had 18 patients (47.4%) with fatty pancreas, included more men than women (p = 0.0056), and was more likely to have patients with hypertension (p = 0.0010). On histological examination, a significant infiltration of adipocytes into the acini from the pancreatic interstitium induced atrophy of the pancreatic parenchyma, and both M1 and M2 macrophages were detected in the area where adipocytes invaded the pancreatic parenchyma. Accumulation of p62 and increased positive staining of NQO1 molecules related to autophagy dysfunction were detected in pancreatic acinar cells in the fatty area, acinar-ductal metaplasia, and pancreatic cancer cells. The rate of p62-positive cell area and that of NQO1-positive cell area were significantly higher in the fatty pancreatic region than those in the control lesion (pancreatic region with few adipocyte infiltration). Furthermore, the rate of p62-positive cell area or that of NQO1-positive cell area showed strong positive correlations with the rate of fatty pancreatic lesion. These results suggest that adipocyte invasion into the pancreatic parenthyme induced macrophage infiltration and autophagy substrate p62 accumulation. High levels of NQO1 expression in the fatty area may be dependent on p62 accumulation. Conclusion: Hypertension was a significant risk factor for fatty pancreas in patients with NAFLD and IPMN. In fatty pancreas, fatty infiltration into the pancreatic parenchyme might induce autophagy dysfunction, resulting in activation of antioxidant proteins NQO1. Thus, patients with fatty pancreas require careful follow-up.
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Affiliation(s)
- Nao Otsuka
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Kyoko Shimizu
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
- Shinjuku Mitsui Building Clinic, Tokyo, Japan
| | - Makiko Taniai
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Katsutoshi Tokushige
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
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11
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Mukherjee S, Maheshwari D, Pal R, Sachdeva N. Pancreatic fat in type 2 diabetes: Causal or coincidental? World J Meta-Anal 2023; 11:68-78. [DOI: 10.13105/wjma.v11.i3.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/27/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023] Open
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12
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Rugivarodom M, Geeratragool T, Pausawasdi N, Charatcharoenwitthaya P. Fatty Pancreas: Linking Pancreas Pathophysiology to Nonalcoholic Fatty Liver Disease. J Clin Transl Hepatol 2022; 10:1229-1239. [PMID: 36381092 PMCID: PMC9634764 DOI: 10.14218/jcth.2022.00085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/05/2022] [Accepted: 06/27/2022] [Indexed: 12/04/2022] Open
Abstract
Currently, scientific interest has focused on fat accumulation outside of subcutaneous adipose tissue. As various imaging modalities are available to quantify fat accumulation in particular organs, fatty pancreas has become an important area of research over the last decade. The pancreas has an essential role in regulating glucose metabolism and insulin secretion by responding to changes in nutrients under various metabolic circumstances. Mounting evidence has revealed that fatty pancreas is linked to impaired β-cell function and affects insulin secretion with metabolic consequences of impaired glucose metabolism, type 2 diabetes, and metabolic syndrome. It has been shown that there is a connection between fatty pancreas and the presence and severity of nonalcoholic fatty liver disease (NAFLD), which has become the predominant cause of chronic liver disease worldwide. Therefore, it is necessary to better understand the pathogenic mechanisms of fat accumulation in the pancreas and its relationship with NAFLD. This review summarizes the epidemiology, diagnosis, risk factors, and metabolic consequences of fatty pancreas and discusses its pathophysiology links to NAFLD.
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Affiliation(s)
| | | | | | - Phunchai Charatcharoenwitthaya
- Correspondence to: Phunchai Charatcharoenwitthaya, Division of Gastroenterology, Medicine Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Wang-Lang Road, Bangkok 10700, Thailand. ORCID: https://orcid.org/0000-0002-8334-0267. Tel: +66-2-4197282, Fax: +66-2-4115013, E-mail:
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13
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Mari A, Sbeit W, Khoury T. Bloating, Diarrhoea and Maldigestion in Patients with Metabolic Syndrome: Are Fatty Pancreas and Pancreatic Exocrine Insufficiency the Missing Pieces of the Puzzle? J Clin Med 2022; 11:5720. [PMID: 36233587 PMCID: PMC9573420 DOI: 10.3390/jcm11195720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Pancreatic exocrine insufficiency (PEI) is a disorder causing symptoms such as maldigestion, malnutrition, diarrhoea, bloating, vitamin deficiency and weight loss [...].
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Affiliation(s)
- Amir Mari
- Gastroenterology Department, Nazareth Hospital, Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan 5290002, Israel
| | - Wisam Sbeit
- Gastroenterology Department, Galilee Medical Center, Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan 5290002, Israel
| | - Tawfik Khoury
- Gastroenterology Department, Galilee Medical Center, Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan 5290002, Israel
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14
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Chan TT, Tse YK, Lui RNS, Wong GLH, Chim AML, Kong APS, Woo J, Yeung DKW, Abrigo JM, Chu WCW, Wong VWS, Tang RSY. Fatty Pancreas Is Independently Associated With Subsequent Diabetes Mellitus Development: A 10-Year Prospective Cohort Study. Clin Gastroenterol Hepatol 2022; 20:2014-2022.e4. [PMID: 34571257 DOI: 10.1016/j.cgh.2021.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although the association between fatty pancreas and metabolic syndrome has been suggested in retrospective studies, long-term prospective data on the effect of fatty pancreas on various metabolic outcomes are lacking. We aimed to prospectively investigate the association between fatty pancreas and the development of major metabolic outcomes. METHODS A total of 631 subjects from a population study using fat-water magnetic resonance imaging to quantify pancreatic and liver fat content during 2008 to 2010 were followed up prospectively until December 2020 (mean follow-up time, 11.1 ± 1.1 y). Subjects with significant alcohol intake and diabetes mellitus (DM) at baseline were excluded. Incidence of newly diagnosed DM, hypertension, dyslipidemia, ischemic heart disease, cardiovascular accidents, pancreatic cancer, and mortality were evaluated. RESULTS Among the 631 subjects (mean age, 48 ± 11 y), 93 (14.7%) had fatty pancreas. The fatty pancreas group had a higher incidence of DM (33.3% vs 10.4%; P < .001), hypertension (37.7% vs 22.7%; P = .003), and dyslipidemia (37.7% vs 14.6%; P < .001) during long-term follow-up evaluation. Individuals with both fatty liver and pancreas had the highest DM incidence, followed by fatty liver only and fatty pancreas only groups (P < .001). Fatty pancreas was associated independently with DM (adjusted hazard ratio, 1.81; 95% CI, 1.10-3.00; P = .020), but not hypertension or dyslipidemia on multivariate analysis. Each percentage increase of pancreatic fat increased the risk of incident DM by 7% (adjusted hazard ratio, 1.07; 95% CI, 1.01-1.13; P = .016). No participants developed pancreatic cancer during the follow-up period. CONCLUSIONS Fatty pancreas is associated independently with subsequent DM development, but not hypertension or dyslipidemia.
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Affiliation(s)
- Ting Ting Chan
- Department of Medicine and Therapeutics, Hong Kong Special Administrative Region, China; Institute of Digestive Disease, Hong Kong Special Administrative Region, China
| | - Yee Kit Tse
- Department of Medicine and Therapeutics, Hong Kong Special Administrative Region, China; Medical Data Analytic Centre, Hong Kong Special Administrative Region, China
| | - Rashid Nok-Shun Lui
- Department of Medicine and Therapeutics, Hong Kong Special Administrative Region, China; Institute of Digestive Disease, Hong Kong Special Administrative Region, China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, Hong Kong Special Administrative Region, China; Institute of Digestive Disease, Hong Kong Special Administrative Region, China; Medical Data Analytic Centre, Hong Kong Special Administrative Region, China
| | - Angel Mei-Ling Chim
- Department of Medicine and Therapeutics, Hong Kong Special Administrative Region, China; Institute of Digestive Disease, Hong Kong Special Administrative Region, China
| | - Alice Pik-Shan Kong
- Department of Medicine and Therapeutics, Hong Kong Special Administrative Region, China
| | - Jean Woo
- Department of Medicine and Therapeutics, Hong Kong Special Administrative Region, China
| | - David Ka-Wai Yeung
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jill M Abrigo
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Hong Kong Special Administrative Region, China; Institute of Digestive Disease, Hong Kong Special Administrative Region, China; Medical Data Analytic Centre, Hong Kong Special Administrative Region, China.
| | - Raymond Shing-Yan Tang
- Department of Medicine and Therapeutics, Hong Kong Special Administrative Region, China; Institute of Digestive Disease, Hong Kong Special Administrative Region, China.
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15
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Salman AA, Salman MA, Said M, El Sherbiny M, Elkassar H, Hassan MB, Marwan A, Morad MA, Ashoush O, Labib S, Aon MH, Awad A, Sayed M, Taha AE, Moustafa A, Shaaban HED, Khater A, Elewa A, Khalaf AM, Mostafa AA, Matter M, Youssef A. Improvement of Pancreatic Steatosis and Indices of Insulin Resistance After Metabolic Surgery. Front Med (Lausanne) 2022; 9:894465. [PMID: 35733870 PMCID: PMC9207952 DOI: 10.3389/fmed.2022.894465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Obesity is associated with fat accumulation in ectopic sites such as the pancreas, the so-called pancreatic steatosis (PS). Bariatric surgery has been shown to be associated with reducing pancreatic fat. This study investigated the effect of laparoscopic sleeve gastrectomy (LSG) on pancreatic volume and its fat content and glucose homeostasis. METHODS The study enrolled 54 patients subjected to LSG. Metabolic variables and pancreatic exocrine function were assessed immediately before surgery and 12 months after. MRI of the abdomen was performed to measure pancreatic fat content and its total volume and visceral adipose tissue (VAT). RESULTS Surgery resulted in a significant reduction in body weight and BMI. HbA1c, fasting insulin, C-peptide levels, HOMA-IR, and Hs-CRP levels decreased significantly. Surgery resulted in significant improvement in lipid profile except for HDL-cholesterol and liver function tests. Total VAT volume decreased significantly. Total pancreas volume decreased by a mean of 9.0 cm3 (95% CI: 6.6-11.3). The median change of pancreatic fat was -26.1% (range: -55.6 to 58.3%). Pancreatic lipase decreased significantly (P < 0.001). There was a positive correlation between the percentage of total weight loss and decrease in pancreatic fat volume (r = 0.295, P = 0.030). CONCLUSION Weight loss after LSG is associated with a reduction of total VAT volume, total pancreatic volume, and pancreatic fat content. These changes are associated with improved glucose homeostasis, reduced systemic inflammation, and decreased pancreatic lipase secretion.
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Affiliation(s)
| | | | - Mostafa Said
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammad El Sherbiny
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hesham Elkassar
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Badr Hassan
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Marwan
- Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Omar Ashoush
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Safa Labib
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed H. Aon
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Abeer Awad
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Sayed
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed E. Taha
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Moustafa
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam El-Din Shaaban
- Tropical and Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Amir Khater
- Tropical and Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Ahmed Elewa
- General Surgery Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Adel M. Khalaf
- Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed A. Mostafa
- Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Matter
- Radiodiagnosis Department, Faculty of Medicine, Alazhar University, Cairo, Egypt
| | - Ahmed Youssef
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Oh H, Park HJ, Oh J, Lee ES, Park SB, Cha MJ, Ahn S. Hyperechoic pancreas on ultrasonography: an analysis of its severity and clinical implications. Ultrasonography 2022; 41:335-343. [PMID: 34743485 PMCID: PMC8942727 DOI: 10.14366/usg.21099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE This study investigated risk factors for hyperechoic pancreas (HP) on ultrasonography (US) according to HP severity. METHODS Between December 2008 and February 2014, 1,459 subjects who underwent abdominal US as part of health examinations were retrospectively included. Two radiologists assessed and categorized the severity of HP as normal, mild, moderate, and severe. Subjects were allocated to two groups as follows: fatty pancreas 1 (FP1; mild to severe HP) and fatty pancreas 2 (FP2; moderate to severe HP). Clinico-metabolic parameters such as the body mass index and blood test profile of subjects with normoglycemia and prediabetes/diabetes were compared (normal vs. FP1; normal or mild HP vs. FP2). Logistic regression analysis was used to evaluate the associations between HP, nonalcoholic fatty liver disease (NAFLD), and diabetes/prediabetes with adjustment for clinico-metabolic parameters. RESULTS Of the 1,459 subjects, 71.2% and 40.4% showed HP and NAFLD on US, respectively. Normoglycemia and prediabetes/diabetes were present in 74.3% and 25.7% of subjects, respectively. Univariable analysis revealed that all the clinico-metabolic parameters were significantly associated with HP (all P<0.05). In the adjusted multivariable analysis, prediabetes/diabetes, NAFLD, age, and body mass index were significantly associated with HP with the FP1 and FP2 criteria. The independent factor with the strongest association with HP was NAFLD using the FP1 criterion (odds ratio [OR], 7.93; P<0.001) and prediabetes/diabetes using the FP2 criterion (OR, 6.96; P<0.001). CONCLUSION NAFLD and prediabetes/diabetes were associated with US-diagnosed HP. Moderate to severe HP was a better predictor of prediabetes/diabetes, suggesting that evaluating HP severity may be useful in clinical practice.
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Affiliation(s)
- Hyunji Oh
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jiyun Oh
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Min Jae Cha
- Department of Mathematics, Ajou University, Suwon, Korea
| | - Soohyun Ahn
- Department of Mathematics, Ajou University, Suwon, Korea
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Fatty Pancreas-Centered Metabolic Basis of Pancreatic Adenocarcinoma: From Obesity, Diabetes and Pancreatitis to Oncogenesis. Biomedicines 2022; 10:biomedicines10030692. [PMID: 35327494 PMCID: PMC8945032 DOI: 10.3390/biomedicines10030692] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 12/13/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest types of cancer, and it is currently the third most common cause of cancer death in the U.S.A. Progress in the fight against PDAC has been hampered by an inability to detect it early in the overwhelming majority of patients, and also by the reduced oxygen levels and nutrient perfusion caused by new matrix formation through the activation of stromal cells in the context of desmoplasia. One harbinger of PDAC is excess intrapancreatic fat deposition, namely, fatty pancreas, which specifically affects the tumor macro- and microenvironment in the organ. Over half of PDAC patients have diabetes mellitus (DM) at the time of diagnosis, and fatty pancreas is associated with subsequent DM development. Moreover, there is a strong association between fatty pancreas and fatty liver through obesity, and a higher intrapancreatic fat percentage has been noted in acute pancreatitis patients with DM than in those without DM. All these findings suggest that the link between fatty pancreas and PDAC might occur through metabolic alterations, either DM-related or non-DM-related. Based on clinical, in vivo and in vitro evidence, the current review highlights the etiologies of fatty pancreas (including fatty infiltration and replacement) and the fatty pancreas-associated metabolic alterations involved in oncogenesis to provide crucial targets to prevent, detect, and/or effectively treat PDAC.
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The Coexistence of Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus. J Clin Med 2022; 11:jcm11051375. [PMID: 35268466 PMCID: PMC8910939 DOI: 10.3390/jcm11051375] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/12/2022] Open
Abstract
The incidence of nonalcoholic fatty liver disease (NAFLD) is growing worldwide. Epidemiological data suggest a strong relationship between NAFLD and T2DM. This is associated with common risk factors and pathogenesis, where obesity, insulin resistance and dyslipidemia play pivotal roles. Expanding knowledge on the coexistence of NAFLD and T2DM could not only protect against liver damage and glucotoxicity, but may also theoretically prevent the subsequent occurrence of other diseases, such as cancer and cardiovascular disorders, as well as influence morbidity and mortality rates. In everyday clinical practice, underestimation of this problem is still observed. NAFLD is not looked for in T2DM patients; on the contrary, diagnosis for glucose metabolism disturbances is usually not performed in patients with NAFLD. However, simple and cost-effective methods of detection of fatty liver in T2DM patients are still needed, especially in outpatient settings. The treatment of NAFLD, especially where it coexists with T2DM, consists mainly of lifestyle modification. It is also suggested that some drugs, including hypoglycemic agents, may be used to treat NAFLD. Therefore, the aim of this review is to detail current knowledge of NAFLD and T2DM comorbidity, its prevalence, common pathogenesis, diagnostic procedures, complications and treatment, with special attention to outpatient clinics.
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Pancreatic Steatosis Is Associated with Both Metabolic Syndrome and Pancreatic Stiffness Detected by Ultrasound Elastography. Dig Dis Sci 2022; 67:293-304. [PMID: 33651254 DOI: 10.1007/s10620-021-06844-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/10/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION There is increasing evidence that pancreatic steatosis (PS) is associated with metabolic syndrome (MS). However, it is not known whether it is associated with PS grade and pancreatic stiffness, or not. We aimed to evaluate the relationship between PS and its grade detected by transabdominal ultrasound, and pancreatic stiffness determined by two-dimensional shearwave elastography (2D-SWE), whether it has clinical significance and its relationship with MS. METHODS Patients with and without PS were evaluated prospectively. RESULTS Patients with PS had higher odds ratio for MS (OR 5.49). Also, ultrasonographic grade of PS was associated with MS parameters and hepatosteatosis. Pancreatic SWE value was significantly higher in PS group and positively correlated with PS grade, liver fat, MS, number of MS criteria. DISCUSSION/CONCLUSION PS and its grade were associated with MS. In this first comprehensive PS-SWE study, we found that pancreas stiffness increased in the presence of PS, in correlation with PS grade and MS.
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Filippatos TD, Alexakis K, Mavrikaki V, Mikhailidis DP. Nonalcoholic Fatty Pancreas Disease: Role in Metabolic Syndrome, "Prediabetes," Diabetes and Atherosclerosis. Dig Dis Sci 2022; 67:26-41. [PMID: 33469809 DOI: 10.1007/s10620-021-06824-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023]
Abstract
Fat accumulation in the pancreas associated with obesity and the metabolic syndrome (MetS) has been defined as "non-alcoholic fatty pancreas disease" (NAFPD). The aim of this review is to describe the association of NAFPD with obesity, MetS, type 2 diabetes mellitus (T2DM) and atherosclerosis and also increase awareness regarding NAFPD. Various methods are used for the detection and quantification of pancreatic fat accumulation that may play a significant role in the differences that have been observed in the prevalence of NAFPD. Endoscopic ultrasound provides detailed images of the pancreas and its use is expected to increase in the future. Obesity and MetS have been recognized as NAFPD risk factors. NAFPD is strongly associated with non-alcoholic fatty liver disease (NAFLD) and it seems that the presence of both may be related with aggravation of NAFLD. A role of NAFPD in the development of "prediabetes" and T2DM has also been suggested by most human studies. Accumulation of fat in pancreatic tissue possibly initiates a vicious cycle of beta-cell deterioration and further pancreatic fat accumulation. Additionally, some evidence indicates a correlation between NAFPD and atherosclerotic markers (e.g., carotid intima-media thickness). Weight loss and bariatric surgery decreases pancreatic triglyceride content but pharmacologic treatments for NAFPD have not been evaluated in specifically designed studies. Hence, NAFPD is a marker of local fat accumulation possibly associated with beta-cell function impairment, carbohydrate metabolism disorders and atherosclerosis.
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Affiliation(s)
- T D Filippatos
- Metabolic Diseases Research Unit, Internal Medicine Laboratory, School of Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion, Crete, Greece.
| | - K Alexakis
- Metabolic Diseases Research Unit, Internal Medicine Laboratory, School of Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion, Crete, Greece
| | - V Mavrikaki
- Metabolic Diseases Research Unit, Internal Medicine Laboratory, School of Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion, Crete, Greece
| | - D P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, NW3 2QG, UK.,Mohammed Bin Rashid University (MBRU) of Medicine and Health Sciences, Dubai, United Arab Emirates
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Khoury T, Mari A, Sbeit W. A Novel Clinical Score Predicting the Presence of Fatty Pancreas. J Clin Med 2021; 10:5843. [PMID: 34945139 PMCID: PMC8704931 DOI: 10.3390/jcm10245843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Fatty pancreas (FP) has become an increasingly encountered entity in recent years. Several studies have shown an association with several disease states. AIMS we aimed to generate a simple non-invasive scoring model to predict the presence of FP. METHOD We performed a retrospective cross-sectional analysis at Galilee Medical Center. Inclusion criteria included patients who underwent endoscopic ultrasound (EUS) for hepatobiliary indications and who had either hyperechogenic pancreas consistent with FP or no sonographic evidence of fatty pancreas. RESULTS We included 569 patients. Among them, 78 patients had FP by EUS and 491 patients did not have FP. On univariate analysis, obesity (odds ratio (OR) 5.11, p < 0.0001), hyperlipidemia (OR 2.86, p = 0.0005), smoking (OR 2.02, p = 0.04), hypertension (OR 2.58, p = 0.0001) and fatty liver (OR 5.94, p < 0.0001) were predictive of FP. On multivariate analysis, obesity (OR 4.02, p < 0.0001), hyperlipidemia (OR 2.22, p = 0.01) and fatty liver (OR 4.80, p < 0.0001) remained significantly associated with FP. We developed a diagnostic score which included three parameters that were significant on multivariate regression analysis, with assignment of weights for each variable according to the OR estimate. A low cut-off score of ≤1 was associated with a negative predictive value (NPV) of 98.1% for FP, whereas a high cut-off score of ≥2 was associated with a positive predictive value (PPV) of 35-56%. CONCLUSION We recommend incorporating this simple score as an aid to identify individuals with FP.
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Affiliation(s)
- Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel;
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 5290002, Israel;
| | - Amir Mari
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 5290002, Israel;
- Gastroenterology and Endoscopy Units, The Nazareth Hospital, EMMS, Nazareth 16100, Israel
| | - Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel;
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 5290002, Israel;
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Sbeit W, Greener T, Kadah A, Mari A, Goldin E, Mahamid M, Khoury T. Pancreatic and hepatobiliary manifestations of nonalcoholic fatty pancreatic disease: a referral multi-center experience. Eur J Gastroenterol Hepatol 2021; 33:e297-e301. [PMID: 33600093 DOI: 10.1097/meg.0000000000002041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nonalcoholic fatty pancreatic disease (NAFPD) is an increasingly recognized disease with accumulating evidence of associated co-morbidities. However, data linked with other pancreatic and hepatobiliary disorders are still being studied. AIMS To investigate the association of pancreato-hepato-biliary disorders with NAFPD. METHODS At two Israeli medical centers, a total of 569 patients were analyzed who underwent endoscopic ultrasound for hepatobiliary indications. They were divided into groups depending on the presence or absence of NAFPD. RESULTS Seventy-eight patients (13.7%) had NAFPD (NAFPD group) vs. 491 patients (86.3%) without (non-NAFPD group). NAFPD was significantly associated with obesity [odds ratio (OR) 4.98, 95% confidence interval (CI) 3.02-8.24, P < 0.0001], hypertension (OR 2.55, 95% CI 1.57-4.15, P = 0.0002), active smoking (OR 2.02, 95% CI 1.04-3.93, P = 0.03), and hyperlipidemia (OR 2.86, 95% CI 1.58-5.18, P = 0.0005). On multivariate regression analysis: fatty liver (OR 5.49, 95% CI 2.88-10.49, P < 0.0001), main duct intraductal papillary mucinous neoplasm (M-IPMN) (OR 2.69, 95% CI 1.05-6.9, P = 0.04), and gallstones (OR 1.93, 95% CI 1.1-3.38, P = 0.02) were the most endoscopically and ultrasonographically detected diseases that significantly correlated with NAFPD. CONCLUSION NAFPD was associated with several diseases, most importantly the premalignant M-IPMN. Further investigation for these coexisting diseases should be considered.
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Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed
| | - Tomer Greener
- Faculty of Medicine, Hebrew University of Jerusalem
- Department of Gastroenterology and Liver Diseases, Shaare Zedek Medical Center, Jerusalem
| | - Anas Kadah
- Department of Gastroenterology, Galilee Medical Center, Nahariya
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed
| | - Amir Mari
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed
- Gastroenterology and Endoscopy Units, The Nazareth Hospital, EMMS, Nazareth, Israel
| | - Eran Goldin
- Faculty of Medicine, Hebrew University of Jerusalem
- Department of Gastroenterology and Liver Diseases, Shaare Zedek Medical Center, Jerusalem
| | - Mahmud Mahamid
- Faculty of Medicine, Hebrew University of Jerusalem
- Department of Gastroenterology and Liver Diseases, Shaare Zedek Medical Center, Jerusalem
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed
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Filippatos TD. Non-Alcoholic Fatty Pancreas Disease: A Diagnosis of Increasing Importance. Angiology 2021; 73:495-496. [PMID: 34747669 DOI: 10.1177/00033197211053902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Theodosios D Filippatos
- Metabolic Diseases Research Unit, Internal Medicine, Laboratory, School of Medicine, 37777University of Crete, Heraklion, Greece
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Sahin S, Karadeniz A. Pancretic Fat Accummulation is Associated with Subclinical Atherosclerosis. Angiology 2021; 73:508-513. [PMID: 34607492 DOI: 10.1177/00033197211038334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We investigated the relationship between pancreatic fat accumulation and markers of atherosclerosis among patients with nonalcoholic fatty liver disease (NAFLD). Patients with NAFLD have been reported to be at an increased risk of vascular events. We grouped 183 patients in whom we detected and graded hepatosteatosis (HS) on transabdominal ultrasonography into 2 groups based on the presence/absence of pancreatic fat. There were 85 participants (50 female; mean age: 53.6 ± 9.7 years) who were nonalcoholic fatty pancreas disease (NAFPD) positive and 98 participants (56 female; mean age: 51.4 ± 9.3 years) who were NAFPD negative. Carotid intima media thickness (cIMT) was significantly greater in the group where HS was accompanied by NAFPD (0.51 [0.40-0.62] vs 0.45 [0.35-0.55] mm; P < .001). Multivariable analyses showed that the independent predictors of increased cIMT were age (odds ratio [OR]: 1.108; 95% CI: 1.059-1.158, P = .001), hypertension (OR: 2.244; 95% CI: 1.099-4.579, P = .026), and the presence of NAFPD (OR: 3.078; CI 95% CI: 1.531-6.190, P = .0002). In the present study we demonstrated that, in patients with NAFLD, pancreatic fat accumulation was significantly associated with cIMT, a marker of early atherosclerosis. NAFPD may increase the risk of vascular events associated with NAFLD.
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Affiliation(s)
- Sinan Sahin
- Department of Cardiology, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Aysegul Karadeniz
- Department of Radiology, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
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Oh J, Park HJ, Lee ES, Park SB, Choi BI, Ahn S. Severity of hyperechoic pancreas on ultrasonography as a risk factor for glycemic progression. Ultrasonography 2021; 40:499-511. [PMID: 33730774 PMCID: PMC8446494 DOI: 10.14366/usg.20122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/06/2021] [Accepted: 01/16/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the association between the severity of hyperechoic pancreas (HP) on ultrasonography (US) and glycemic progression. METHODS In total, 1,386 participants who underwent abdominal US as part of health examinations between December 2008 and May 2014 were included in this retrospective study. We classified pancreatic echogenicity on a 4-point scale, and compared it using two distinct criteria: fatty pancreas (FP) 1 criterion (normal vs. ≥mild HP) and FP2 criterion (normal/mild HP vs. ≥moderate HP). According to the presence of nonalcoholic fatty liver disease (NAFLD), participants were subdivided into four groups: non-NAFLD and non-HP, isolated NAFLD, isolated HP, and HP with NAFLD. Glycemic progression was defined as progression from normoglycemia to prediabetes or diabetes or progression from prediabetes to diabetes. RESULTS During the follow-up (median, 5.9 years), 262 of the 1,386 participants developed glycemic progression. Using FP2, the probability of glycemic progression across the four subgroups showed cumulative aggravation for NAFLD and HP (all P<0.05). Isolated HP showed a higher probability of glycemic progression than isolated NAFLD according to FP2 (P<0.001). The highest probability of glycemic progression was observed in patients with both NAFLD and HP (P<0.001). The hazard ratio for glycemic progression increased with the severity of HP. CONCLUSION Increasing severity of HP on US was found to be significantly correlated with glycemic progression. Moreover, isolated HP of moderate or greater severity predicted glycemic progression independent of NAFLD.
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Affiliation(s)
- Jiyun Oh
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soohyun Ahn
- Department of Mathematics, Ajou University, Suwon, Korea
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Altinmakas E, Guler B, Copur S, Siriopol D, Sag AA, Guneyli S, Dogan H, Afsar B, Balik E, Covic A, Johnson RJ, Kanbay M. Determinants of Pancreatic Steatosis: A Retrospective Observational Study. Middle East J Dig Dis 2021; 13:343-349. [PMID: 36606009 PMCID: PMC9489440 DOI: 10.34172/mejdd.2021.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/04/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Metabolic syndrome affects 35% of the adult population in developed countries associated with non-alcoholic steatohepatitis, insulin resistance, and cardiovascular events. Fatty infiltration of the pancreas, or pancreatic steatosis, is a risk factor for acute pancreatitis, pancreatic malignancies, and diabetes mellitus, yet its relationship with metabolic syndrome is not well defined. METHODS We performed a single-centered retrospective observational study of 322 healthy subjects (subjects volunteering to be kidney transplant donors, mean age=46.3±13.5, 163 men and 159 women) in the last 2 years (July 2018-February 2020) from our institution. Pancreatic steatosis and hepatosteatosis were confirmed by computed tomography. RESULTS Pancreatic steatosis was present in 26.3% (85/322) of the subjects, and this finding correlated with age, body mass index (BMI), male sex, a family history of diabetes, creatinine, cystatin C, uric acid, low-density lipoprotein (LDL) cholesterol, triglycerides, glycemia, hemoglobin, transverse body diameter, and subcutaneous fat thickness levels by univariable logistic regression. On multiple linear regression only age (95% CI 1.01, 1.06), BMI (95% CI 1.01, 1.19), male sex (95% CI 1.49-5.99), uric acid (95% CI 1.01, 1.76), and subcutaneous fat thickness levels (95% CI 1.21-2.36) remained independently associated with pancreatic steatosis. CONCLUSION Pancreatic steatosis is common and associated with obesity, elevated serum uric acid, subcutaneous fat thickness, and male sex. Future studies are needed to evaluate if there are specific clinical consequences to the presence of pancreatic steatosis.
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Affiliation(s)
- Emre Altinmakas
- Department of Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Begum Guler
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Dimitrie Siriopol
- Nephrology Clinic, Dialysis and Renal Transplant Center, ‘C.I. PARHON’ University Hospital, and ‘Grigore T. Popa’ University of Medicine, Iasi, Romania
| | - Alan A. Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, USA
| | - Serkan Guneyli
- Department of Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Hakan Dogan
- Department of Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Baris Afsar
- Department of Medicine, Division of Nephrology, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Emre Balik
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, ‘C.I. PARHON’ University Hospital, and ‘Grigore T. Popa’ University of Medicine, Iasi, Romania
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
,Corresponding Author: Mehmet Kanbay, MD Department of Medicine, Division of Nephrology Koc University School of Medicine 34010, Istanbul, Turkey Tel: + 90 212 2508250 Fax: + 90 850 2508250 E-mail:
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Zhang CL, Wang JJ, Li JN, Yang Y. Nonalcoholic fatty pancreas disease: An emerging clinical challenge. World J Clin Cases 2021; 9:6624-6638. [PMID: 34447810 PMCID: PMC8362510 DOI: 10.12998/wjcc.v9.i23.6624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/20/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty pancreas disease (NAFPD) is an emerging disease that has gained an increasing amount of attention in recent years. It describes fat accumulation in the pancreas with insignificant alcohol consumption, but the pathogenesis is largely unknown. A wide range of terms have been used to describe the phenomenon of pancreatic fat accumulation, but NAFPD remains an under-recognized and non-independent disorder. Obesity, age, sex, race, and unhealthy lifestyle are established independent risk factors for NAFPD, which is strongly associated with metabolic syndrome, type 2 diabetes, pancreatitis, pancreatic fistula, pancreatic cancer, and nonalcoholic fatty liver disease. At present, imaging techniques are common diagnostic aids, but uniform criteria and consensus are lacking. Therapeutically, healthy diet, weight loss, and exercise are the mainstays to reduce pancreatic fat accumulation. It can be seen that there is a limited understanding of NAFPD at this stage and further exploration is needed. Previous studies have revealed that NAFPD may directly affect diagnosis and clinical decision-making. Therefore, exploring the pathophysiological mechanism and clinical associations of NAFPD is a major challenge for researchers and clinicians.
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Affiliation(s)
- Cheng-Lei Zhang
- Department of Clinical Laboratory, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
- The Institute of Endocrinology, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
| | - Jing-Jiao Wang
- Department of Stomatology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
| | - Jian-Ning Li
- The Institute of Endocrinology, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
- School of Basic Medical Sciences, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
| | - Yi Yang
- The Institute of Endocrinology, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
- School of Basic Medical Sciences, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
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Abstract
OBJECTIVES Fatty pancreas (FP), previously believed to be without clinical significance, recently has been shown to be associated with comorbid diseases. We aimed to explore whether FP predispose to acute pancreatitis. METHODS Patients who underwent endoscopic ultrasound for hepatobiliary indications were included. Patients with pathological pancreato-biliary findings other than FP were excluded. The cohort was divided into patients with a history of pancreatitis (within 6 months of endoscopic ultrasound, group A) and patients without (group B). RESULTS Overall, 189 patients were included. Sixty-one (32.3%) patients were in group A, and 128 (67.7%) patients were in group B. The average age in group A was 55.5 (standard deviation, 17.7) versus 58.5 (standard deviation, 13.5) in group B. The prevalence of FP in group A (37.7%) was higher compared with group B (4.7%) (P = 0.001). On univariate analysis, FP showed significant correlation with a history of acute pancreatitis [odds ratio (OR), 5.14, P = 0.006] and hyperlipidemia (OR, 4.19; P = 0.002). On multivariate analysis, FP remained significantly associated with a history of acute pancreatitis after stratification for obesity and hyperlipidemia (OR, 10.78; 95% confidence interval, 3.75-30.89; P < 0.0001). CONCLUSIONS Fatty pancreas was associated with acute pancreatitis. Clinicians should be aware of this association.
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Sbeit W, Greener T, Kadah A, Mari A, Goldin E, Khoury T, Mahamid M. Pancreatobiliary manifestations of nonalcoholic fatty liver disease: a retrospective case-control multicenter study. Eur J Gastroenterol Hepatol 2021; 33:722-726. [PMID: 32483086 DOI: 10.1097/meg.0000000000001780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) has become a major cause of chronic liver disease. Several extrahepatic manifestations have been reported in relation to NAFLD. However, data regarding pancreatobiliary manifestation are scarce. AIM We aimed to explore the association of pancreatobiliary manifestation with NAFLD. METHODS A retrospective multicenter study that included all patients who underwent an endoscopic ultrasound performed for hepatobiliary indications and for whom the endosonographer reported on the presence or absence of fatty liver. The endoscopic ultrasound reports were reviewed and all pathological findings were reported. RESULTS Overall, 545 patients were included in the study, among them, 278 patients had fatty liver (group A) as compared to 267 who did not have (group B). The average age in group A was 64.5 ± 13.5 years vs. 61.2 ± 14.7 years in group B. Male sex constituted 49.6 and 58% in groups A and B, respectively. On multivariate analysis, fatty pancreas [odds ratio (OR) 4.02; P = 0.001], serous cystadenoma (SCA) (OR 5.1; P = 0.0009), mucinous cystadenoma (MCA) (OR 9.7; P = 0.005), side-branch intraductal papillary mucinous neoplasm (IPMN) (OR 2.76; P < 0.0001), mixed-type IPMN (OR 16.4; P = 0.0004), pancreatic neuroendocrine tumor (NET) (OR 8.76; P < 0.0001), gallbladder stones (OR 1.9; P = 0.02) and hilar lymphadenopathy (OR 6.8; P < 0.0001) were significantly higher among patients with NAFLD. After adjustment for fatty pancreas, the association remained significant for SCA (OR 3; P = 0.01), MCA (OR 4.6; P = 0.03), side-branch IPMN (OR 1.7; P = 0.02), mixed-type IPMN (OR 5.5; P = 0.01) and pancreatic NET (OR 4.5; P = 0.001). CONCLUSION Pancreatobiliary manifestations are common among patients with NAFLD. Assessment of these coexistent manifestations should be considered in the setting of patients with NAFLD.
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Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed
| | - Tomer Greener
- Gastroenterology Department, Shaare Zedek Medical Center, Jerusalem
| | - Anas Kadah
- Department of Gastroenterology, Galilee Medical Center, Nahariya
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed
| | - Amir Mari
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed
- Gastroenterology and Endoscopy Units, The Nazareth Hospital, EMMS, Nazareth, Israel
| | - Eran Goldin
- Gastroenterology Department, Shaare Zedek Medical Center, Jerusalem
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed
| | - Mahmud Mahamid
- Gastroenterology Department, Shaare Zedek Medical Center, Jerusalem
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e Silva LDLS, Fernandes MSDS, de Lima EA, Stefano JT, Oliveira CP, Jukemura J. Fatty Pancreas: Disease or Finding? Clinics (Sao Paulo) 2021; 76:e2439. [PMID: 33624707 PMCID: PMC7885852 DOI: 10.6061/clinics/2021/e2439] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/27/2020] [Indexed: 12/22/2022] Open
Abstract
Despite a growing number of investigative studies on pancreatic fat deposition, there remains no clear indication regarding the clinical relevance of fat infiltration in the pancreas, also called fatty pancreas (FP). An individual's body weight is correlated with their pancreatic weight. Moreover, lipid infiltration causes disorders that compromise not only morphology but also metabolic functions. Fat infiltration leads to insulin resistance, type II diabetes mellitus, and pancreatic cancer; however, knowledge about pancreatic fat content and aspects related to the clinical profile remains unclear in the literature. The present review describes the current knowledge of FP, including its pathophysiology and clinical implications, as well as lifestyle changes in FP.
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Affiliation(s)
- Lucas de Lucena Simões e Silva
- Departamento de Gastroenterologia (LIM 07), Divisao de Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Matheus Santos de Sousa Fernandes
- Programa de Pos Graduacao em Neuropsiquiatria e Ciencias do Comportamento, Departamento Educacao Fisica, Universidade Federal de Pernambuco, PE, BR
| | | | - José Tadeu Stefano
- Departamento de Gastroenterologia (LIM 07), Divisao de Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Claudia P. Oliveira
- Departamento de Gastroenterologia (LIM 07), Divisao de Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - José Jukemura
- Departamento de Gastroenterologia Divisao de Cirurgia Digestiva, Instituto do Cancer (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Faculdade de Medicina, Sao Paulo, SP, BR
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Gubergrits NB, Byelyayeva NV, Mozhyna TL. Parallels between non-alcoholic fatty liver disease and non-alcoholic fatty pancreatic disease: looking for points of contact or regard through the lens of metabolic syndrome. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2020; 183:80-101. [DOI: 10.31146/1682-8658-ecg-183-11-80-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
The aim. The aim of our study was to analyze the available data from literature sources concerning the issues of etiology, pathogenesis, clinic, diagnosis and features of treatment of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic fatty pancreatic disease (NAFPD).Materials and methods. We conducted a retrospective analysis of foreign literature sources that contain up-to-date information about the state of the problem of NAFLD and NAFPD.Results. NAFLD and NAFPD develop against the background of metabolic syndrome (MS), systemic insulin resistance, oxidative stress, changes in lipid metabolism. The natural course of NAFPD is associated with high risk of MS progression, occurrence of NAFLD, arterial hypertension, type 2 diabetes mellitus, exocrine pancreatic insufficiency, acute and chronic pancreatitis, pancreas cancer. Correction of the components of MS can reduce the severity of NAFLD and NAFPD; enzyme replacement therapy can improve the function of β-cells in pancreas steatosis.Conclusion. The alternatives of the pharmacological treatment of NAFLD and NAFPD continue to be actively explored. We emphasize the need of including medications containing pancreatic enzymes in the treatment of NAFLD.
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Shao M, Ye Z, Qin Y, Wu T. Abnormal metabolic processes involved in the pathogenesis of non-alcoholic fatty liver disease (Review). Exp Ther Med 2020; 20:26. [PMID: 32934691 PMCID: PMC7471863 DOI: 10.3892/etm.2020.9154] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/28/2020] [Indexed: 12/13/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases and can lead to liver cirrhosis or liver cancer in severe cases. In recent years, the incidence of NAFLD has increased substantially. The trend has continued to increase and has become a key point of concern for health systems. NAFLD is often associated with metabolic abnormalities caused by increased visceral obesity, including insulin resistance, diabetes mellitus, hypertension, dyslipidemia, atherosclerosis and systemic microinflammation. Therefore, the pathophysiological mechanisms of NAFLD must be clarified to develop new drug treatment strategies. Recently, researchers have conducted numerous studies on the pathogenesis of NAFLD and have identified various important regulatory factors and potential molecular mechanisms, providing new targets and a theoretical basis for the treatment of NAFLD. However, the pathogenesis of NAFLD is extremely complex and involves the interrelationship and influence of multiple organs and systems. Therefore, the condition must be explored further. In the present review, the abnormal metabolic process, including glucose, lipid, amino acid, bile acid and iron metabolism are reviewed. It was concluded that NAFLD is associated with an imbalanced metabolic network that involves glucose, lipids, amino acids, bile acids and iron, and lipid metabolism is the core metabolic process. The current study aimed to provide evidence and hypotheses for research and clinical treatment of NAFLD.
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Affiliation(s)
- Mingmei Shao
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China
| | - Zixiang Ye
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China
| | - Yanhong Qin
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China
| | - Tao Wu
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China
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Ballester-Vallés C, Flores-Méndez J, Delgado-Moraleda J, Ballesteros Martín-Portugués A, Merino-Torres J, Fornés-Ferrer V, Martí-Bonmatí L. Hepatic and pancreatic fat as imaging biomarkers of metabolic syndrome. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chait A, den Hartigh LJ. Adipose Tissue Distribution, Inflammation and Its Metabolic Consequences, Including Diabetes and Cardiovascular Disease. Front Cardiovasc Med 2020; 7:22. [PMID: 32158768 PMCID: PMC7052117 DOI: 10.3389/fcvm.2020.00022] [Citation(s) in RCA: 738] [Impact Index Per Article: 147.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/10/2020] [Indexed: 12/13/2022] Open
Abstract
Adipose tissue plays essential roles in maintaining lipid and glucose homeostasis. To date several types of adipose tissue have been identified, namely white, brown, and beige, that reside in various specific anatomical locations throughout the body. The cellular composition, secretome, and location of these adipose depots define their function in health and metabolic disease. In obesity, adipose tissue becomes dysfunctional, promoting a pro-inflammatory, hyperlipidemic and insulin resistant environment that contributes to type 2 diabetes mellitus (T2DM). Concurrently, similar features that result from adipose tissue dysfunction also promote cardiovascular disease (CVD) by mechanisms that can be augmented by T2DM. The mechanisms by which dysfunctional adipose tissue simultaneously promote T2DM and CVD, focusing on adipose tissue depot-specific adipokines, inflammatory profiles, and metabolism, will be the focus of this review. The impact that various T2DM and CVD treatment strategies have on adipose tissue function and body weight also will be discussed.
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Affiliation(s)
- Alan Chait
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Laura J den Hartigh
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States
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Ferrara D, Montecucco F, Dallegri F, Carbone F. Impact of different ectopic fat depots on cardiovascular and metabolic diseases. J Cell Physiol 2019; 234:21630-21641. [PMID: 31106419 DOI: 10.1002/jcp.28821] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/17/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022]
Abstract
A growing body of evidence is pointing out the pathophysiological role of fat accumulation in different organs. Ectopic fat depots within heart, liver, skeletal muscle, kidney, and pancreas as well as around blood vessels might be more associated to cardiometabolic risk than classical variables, such as body mass index. Among different mechanisms, lipid metabolism appears to be particularly influenced by ectopic fat depots. Indeed, intracellular accumulation of nonesterified fatty acids, and triglycerides promotes endoplasmic reticulum stress, mitochondrial uncoupling, oxidative stress, and altered membrane composition/function, finally promoting inflammatory response and cell death. The dysfunctional adipose tissue was shown to induce both local and systemic effects, with relevant clinical consequences. Epicardial fat and myocardial steatosis have been associated with the development of atrial fibrillation and ventricular dysfunction. Similarly perivascular adipose tissue appears to trigger atherosclerosis and hypertension. Nonalcoholic fatty liver disease has been recognized both as the hepatic manifestation of metabolic syndrome and as a cardiovascular (CV) risk factor. Importantly, the renal sinus fat emerged as a potential player in kidney dysfunction. Finally, both skeletal muscle and pancreatic fat depots have been indicated as potential endocrine modulators of insulin resistance. Considering the global rise in the prevalence of obesity, the understanding of mechanisms underlying ectopic fat accumulation represents an urgent need, with potential clinical implications for CV risk stratification. Here, we attempt to update the current knowledge of the different ectopic fat depots, focusing on underlying mechanisms and potential clinical implications.
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Affiliation(s)
- Daniele Ferrara
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fabrizio Montecucco
- Centre of Excellence for Biomedical Research (CEBR), Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa, Italy
| | - Franco Dallegri
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa, Italy
| | - Federico Carbone
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa, Italy
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Abstract
Pancreatic steatosis is an emerging clinical entity whose pathophysiology, natural history, and long-term complications are poorly characterized in the current literature. Epidemiological and prospective studies have described prevalence rates between 16% and 35%. Although the natural history is not well known, there are strong associations with obesity, metabolic syndrome, type 2 diabetes mellitus, and nonalcoholic fatty liver disease. Ectopic fat accumulation of the pancreas can cause chronic, low-grade inflammation from adipocytokine imbalances that involve beta cells and acinar cells. This mechanism can lead to pancreatic endocrine and exocrine dysfunction and initiate carcinogenesis. Although it is associated with morbid conditions, pancreatic steatosis may be amendable to treatment with a healthy diet, less meat consumption, exercise, and smoking cessation. Pancreatic steatosis should factor into clinical decision-making and prognostication of patients with pancreatic and systemic disease. This review seeks to describe the pathophysiology, natural history, diagnosis, and complications of this emerging clinically relevant entity.
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Milovanovic T, Dragasevic S, Stojkovic Lalosevic M, Zgradic S, Milicic B, Dumic I, Kmezic S, Saponjski D, Antic A, Markovic V, Popovic D. Ultrasonographic Evaluation of Fatty Pancreas in Serbian Patients with Non Alcoholic Fatty Liver Disease-A Cross Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:697. [PMID: 31627351 PMCID: PMC6843527 DOI: 10.3390/medicina55100697] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022]
Abstract
Background and Objectives: The aim of the study was to determine the association between presences of fatty pancreas (FP) with the features of metabolic syndrome (MeS) in patients with non-alcoholic fatty liver disease (NAFLD) and to establish a new noninvasive scoring system for the prediction of FP in patients with NAFLD. Material and Methods: 143 patients with NAFLD were classified according to FP severity grade into the two groups and evaluated for diagnostic criteria of MeS. All patients underwent sonographic examination with adiposity measurements and the liver biopsy. Liver fibrosis was evaluated semi-quantitatively according to the METAVIR scoring system and using non-invasive markers of hepatic fibrosis. Results: Waist circumference (WC) was predictive for increased risk of FP in NAFLD patients. Elevated fasting plasma glucose, total cholesterol, serum amylase and lipase levels were associated with presence of severe FP (p value = 0.052, p value = 0.007, p value = 0.014; p value = 0.024, respectively). Presence of increased amounts of mesenteric fat was associated with severe FP (p value = 0.013). The results of this study demonstrated highly significant association between NAFLD and presence of FP. The model for predicting the presence of FP was designed with probability value above 6.5. Conclusion: Pancreatic fat accumulation leads to worsening of pancreatic function which in turns exacerbates severity of metabolic syndrome associated with both, NAFLD and NAFPD.
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Affiliation(s)
- Tamara Milovanovic
- School of Medicine, University of Belgrade, 11 000 Belgrade, Serbia.
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, 11 000 Belgrade, Serbia.
| | - Sanja Dragasevic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, 11 000 Belgrade, Serbia.
| | - Milica Stojkovic Lalosevic
- School of Medicine, University of Belgrade, 11 000 Belgrade, Serbia.
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, 11 000 Belgrade, Serbia.
| | - Sanja Zgradic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, 11 000 Belgrade, Serbia.
| | - Biljana Milicic
- Institute for Medical Informatics and Biostatistics, School of Dentistry, University of Belgrade, 11 000 Belgrade, Serbia.
| | - Igor Dumic
- Division of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA.
- Mayo Clinic College of Medicine and Sciences, Rochester, MN 55905, USA.
| | - Stefan Kmezic
- Clinic for Abdominal Surgery-First Surgical Clinic, Clinical Center of Serbia, 11 000 Belgrade, Serbia.
| | - Dusan Saponjski
- Center for Radiology and MRI, Clinical Center of Serbia, 11 000 Belgrade, Serbia.
| | - Andrija Antic
- School of Medicine, University of Belgrade, 11 000 Belgrade, Serbia.
- Clinic for Abdominal Surgery-First Surgical Clinic, Clinical Center of Serbia, 11 000 Belgrade, Serbia.
| | - Velimir Markovic
- School of Medicine, University of Belgrade, 11 000 Belgrade, Serbia.
- Clinic for Abdominal Surgery-First Surgical Clinic, Clinical Center of Serbia, 11 000 Belgrade, Serbia.
| | - Dragan Popovic
- School of Medicine, University of Belgrade, 11 000 Belgrade, Serbia.
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, 11 000 Belgrade, Serbia.
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Pinte L, Balaban DV, Băicuş C, Jinga M. Non-alcoholic fatty pancreas disease - practices for clinicians. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2019; 57:209-219. [PMID: 30901317 DOI: 10.2478/rjim-2019-0005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Indexed: 02/07/2023]
Abstract
Obesity is a growing health burden worldwide, increasing the risk for several diseases featuring the metabolic syndrome - type 2 diabetes mellitus, dyslipidemia, non-alcoholic fatty liver disease and cardiovascular diseases. With the increasing epidemic of obesity, a new pathologic condition has emerged as a component of the metabolic syndrome - that of non-alcoholic fatty pancreas disease (NAFPD). Similar to non-alcoholic fatty liver disease (NAFLD), NAFPD comprises a wide spectrum of disease - from deposition of fat in the pancreas - fatty pancreas, to pancreatic inflammation and possibly pancreatic fibrosis. In contrast with NAFLD, diagnostic evaluation of NAFPD is less standardized, consisting mostly in imaging methods. Also the natural evolution of NAFPD and its association with pancreatic cancer is much less studied. Not least, the clinical consequences of NAFPD remain largely presumptions and knowledge about its metabolic impact is limited. This review will cover epidemiology, pathogenesis, diagnostic evaluation tools and treatment options for NAFPD, with focus on practices for clinicians.
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Affiliation(s)
- Larisa Pinte
- "Colentina" Clinical Hospital, Bucharest, Romania
| | - Daniel Vasile Balaban
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | - Cristian Băicuş
- "Colentina" Clinical Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mariana Jinga
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
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Abstract
PURPOSE OF REVIEW Pancreatic steatosis is a clinical entity with emerging significance and impacts patient health in a multitude of ways. It has a high prevalence in the global population with predilections for different demographics by age, sex and ethnicity. Understanding the pathophysiology, clinical features and complications of this entity may be important to understanding the consequences of the ongoing obesity global epidemic. RECENT FINDINGS Obesity and metabolic syndrome contribute to metabolic derangements that result in lipid mishandling by adipocytes. Adipocytokine imbalances in circulation and in the pancreatic microenvironment cause chronic, low-grade inflammation. The resulting beta cell and acinar cell apoptosis leads to pancreatic endocrine and exocrine dysfunction. Furthermore, these adipocytokines regulate cell growth, differentiation, as well as angiogenesis and lymphatic spread. These consequences of adipocyte infiltration are thought to initiate carcinogenesis, leading to pancreatic intraepithelial neoplasia and pancreatic ductal adenocarcinoma. SUMMARY Obesity will lead to millions of deaths each year and pancreatic steatosis may be the key intermediate entity that leads to obesity-related complications. Enhancing our understanding may reveal strategies for preventing mortality and morbidity related to the global epidemic of obesity. Further research is needed to determine the pathophysiology, long-term complications and effective treatment strategies for this condition.
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40
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Hepatic and pancreatic fat as imaging biomarkers of metabolic syndrome. RADIOLOGIA 2019; 62:122-130. [PMID: 31447050 DOI: 10.1016/j.rx.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 04/05/2019] [Accepted: 05/30/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To objectively evaluate hepatic and pancreatic involvement in metabolic syndrome through magnetic resonance imaging (MRI) biomarkers. MATERIAL AND METHODS From an initial retrospective sample of 407 patients diagnosed with metabolic syndrome studied by MRI in a single center during a 2-year period, 154 were excluded because of a lack of clinical and/or laboratory data, pancreatic abnormalities, or inadequate quality of MRI studies. To measure hepatic and pancreatic fat, we used chemical shift imaging (in-phase and out-of-phase), measuring the fat fraction (%) in regions of interest in the pancreas and liver. Associations between the fat fraction and selected clinical and laboratory variables were assessed with beta regression models. RESULTS In the end, 253 patients were included. The hepatic fat fraction was 4.9% and the pancreatic fat fraction was 7.9%. We found no significant associations between the hepatic fat fraction and any of the clinical or laboratory variables. However, the pancreatic fat fraction was positively associated with age (OR=1.025, p<0.001) and baseline glucose (OR=1.005, p<0.001). Patients with diabetes had higher values of pancreatic fat fraction (OR=2.64, p=0.038). Pancreatic fat fraction and hepatic fat fraction were positively associated (OR=69.44, p<0.001). CONCLUSIONS Pancreatic steatosis can be considered a marker of metabolic syndrome and diabetes. Quantitative MRI enables the diagnosis and grading of fatty pancreas through simple chemical shift techniques.
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Bi Y, Wang JL, Li ML, Zhou J, Sun XL. The association between pancreas steatosis and metabolic syndrome: A systematic review and meta-analysis. Diabetes Metab Res Rev 2019; 35:e3142. [PMID: 30767421 DOI: 10.1002/dmrr.3142] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/23/2019] [Accepted: 02/09/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Pancreas steatosis is the description of fat accumulation in the pancreatic gland. The prevalence and development mechanisms of pancreatic steatosis in patients with metabolic disorders still remain unclear. The aim of this study is to systematically review the association between pancreatic steatosis and metabolic co-morbidities. METHODS We performed a systematic search strategy using three electronic databases (MEDLINE, Scopus, and Embase) for relevant studies concerning the associations of pancreatic steatosis with metabolic syndrome (MetS) and its clinical relevance from inception until 30 September 2018. RESULTS One thousand three hundred fifty one references were identified in the initial search, and a total of 13 studies involving 49 329 subjects were included. This analyses elucidated the presence of non-alcoholic fatty pancreas disease (NAFPD) and was associated with a significant increased risk of metabolic syndrome (RR = 2.25; 95% CI, 2.00-2.53; P < 0.0001; I2 = 42.8%; eight studies included), hypertension (RR = 1.43; 95% CI, 1.08-1.90; P = 0.013; I2 = 94.7%; nine studies included), non-alcoholic fatty liver disease (NAFLD) (RR = 2.49; 95% CI, 2.06-3.02; P < 0.0001; I2 = 96.9%; nine studies included), diabetes mellitus (RR = 1.99; 95% CI, 1.18-3.35; P = 0.01; I2 = 97.6%; 10 studies included), and central obesity (RR = 1.91; 95% CI, 1.67-2.19; P < 0.0001; I2 = 95.9%; six studies included). The association between NAFPD and hyperlipidaemia was not statistically significant (RR = 1.33; 95% CI, 0.82-2.17; P = 0.249; I2 = 97%; five studies included). CONCLUSIONS The existing evidence indicates that NAFPD is significantly associated with an increased risk of metabolic syndrome and its components. Well-designed prospective cohort studies between pancreatic steatosis and MetS are needed to elaborate the causality in the future.
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Affiliation(s)
- Ye Bi
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Ji-Lan Wang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Ming-Long Li
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jie Zhou
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiang-Lan Sun
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Investigation of the Relationship between Fatty Pancreas and Cholecystectomy Using Noncontrast Computed Tomography. J Med Imaging Radiat Sci 2019; 50:220-226. [DOI: 10.1016/j.jmir.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/04/2018] [Accepted: 10/12/2018] [Indexed: 12/15/2022]
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Chen Y, Long L, Jiang Z, Zhang L, Zhong D, Huang X. Quantification of pancreatic proton density fat fraction in diabetic pigs using MR imaging and IDEAL-IQ sequence. BMC Med Imaging 2019; 19:38. [PMID: 31088378 PMCID: PMC6515681 DOI: 10.1186/s12880-019-0336-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 04/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background Recent studies have highlighted the correlation between diabetes and pancreatic fat infiltration. Notably, pancreatic fat content (PFC) is a potential biomarker in diabetic patients, and magnetic resonance imaging (MRI) provides an effective method for noninvasive assessment of pancreatic fat infiltration. However, most reports of quantitative measurement of pancreatic fat have lacked comparisons of pathology results. The primary objective of this study was to determine the feasibility and accuracy of pancreatic MRI by using pancreatic fat fraction (PFF) measurements with the IDEAL-IQ sequence; the secondary objective was to explore changes in PFC between pigs with and without diabetes. Methods In this prospective study, 13 Bama Mini-pigs (7 females, 6 males; median age, 2 weeks) were randomly assigned to diabetes (n = 7) or control (n = 6) groups. Pigs in the diabetes group received high fat/high sugar feed, combined with streptozotocin injections. At the end of 15 months, biochemical changes were evaluated. All pigs underwent axial MRI with the IDEAL-IQ sequence to measure PFF; PFC of fresh pancreatic parenchyma was measured by the Soxhlet extraction method; and pancreatic fat distribution was observed by histopathology. Results of all analyses were compared between the diabetes and control groups by using the Mann-Whitney U-test. Correlations of PFF and PFC, fasting blood glucose (GLU), and serum insulin (INS) were calculated by using the Spearman correlation coefficient. Single-measure intraclass correlation coefficient (ICC) was used to assess interreader agreement. Results There were significant differences between diabetes and control groups: GLU (mmol/L) was 18.06 ± 6.03 and 5.06 ± 1.41 (P < 0.001); INS (mU/L) was 21.59 ± 2.93 and 29.32 ± 3.27 (P = 0.003); PFC (%) was 34.60 ± 3.52 and 28.63 ± 3.25 (P = 0.027); and PFF (%) was 36.51 ± 4.07 and 27.75 ± 3.73 (P = 0.003). There was a strongly positive correlation between PFF and PFC (r = 0.934, P < 0.001); there were moderate correlations between PFF and GLU (r = 0.736, P = 0.004; positive correlation), and between PFF and INS (r = − 0.747, P = 0.003; negative correlation). Excellent interreader agreement was observed for PFF measurements (ICC, 0.954). Conclusions Pancreatic fat infiltration shows a clear association with diabetes. MRI with the IDEAL-IQ sequence can be used to accurately and reproducibly quantify PFC.
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Affiliation(s)
- Yidi Chen
- Radiology Department, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Liling Long
- Radiology Department, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, China.
| | - Zijian Jiang
- Radiology Department, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Ling Zhang
- Radiology Department, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Delin Zhong
- Radiology Department, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Xialing Huang
- Radiology Department, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, China
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Yang W, Xie Y, Song B, Xia C, Tang C, Li J. Effects of aging and menopause on pancreatic fat fraction in healthy women population: A strobe-compliant article. Medicine (Baltimore) 2019; 98:e14451. [PMID: 30762758 PMCID: PMC6408125 DOI: 10.1097/md.0000000000014451] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/06/2018] [Accepted: 01/17/2019] [Indexed: 02/05/2023] Open
Abstract
Pancreatic fat fraction has been shown to increase in many pathological situations. However, pancreatic fat fraction and its physiological changes in healthy women are still unclear. The aim of this study is to investigate the effect of aging and menopause on pancreatic fat fraction in healthy female population.This was a cross-sectional study. A phantom of fat-water mixtures was established. One hundred sixty-seven healthy women (20-70 years) were recruited. Fat fraction was quantified with double-echo chemical shift magnetic resonance imaging with T1 and T2* correction. The association between measured and actual fat fractions was determined with Pearson correlation. Linear regression analysis was used to establish the calibration curve. Fat fractions were analyzed via analysis of variance.A significant positive linear correlation was revealed between the measured and actual fat fractions on the phantom (r = 0.991, P < .001). There was no significant difference in fat fractions among caput, corpus, and cauda of the pancreas. Pancreatic fat fraction remained constant during the age of 20 to 40 years (4.41 ± 0.79%) but significantly increased during the ages of 41 to 50 and 51 to 70 years (7.49 ± 1.10% and 9.43 ± 1.51%, respectively, P < .001). Moreover, pancreatic fat fractions of the healthy women aged 41 to 70 years were still significantly higher than these in the groups aged 20 to 40 years when postmenopausal healthy women were removed (P < .001). For volunteers aged 46 to 49 years, pancreatic fat fraction of the postmenopausal women was significantly increased compared with that of their premenopausal counterparts (P < .001).We found that an even distribution of pancreatic fat in healthy women, aging and menopause as 2 independent risk factors for pancreatic steatosis, a fatty infiltration in the pancreas beginning in the fifth decade in women.
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Affiliation(s)
| | - Yi Xie
- Department of Gastroenterology
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | | | - Jing Li
- Department of Gastroenterology
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Rosenblatt R, Mehta A, Snell D, Hissong E, Kierans AS, Kumar S. Ultrasonographic Nonalcoholic Fatty Pancreas Is Associated with Advanced Fibrosis in NAFLD: A Retrospective Analysis. Dig Dis Sci 2019; 64:262-268. [PMID: 30269271 DOI: 10.1007/s10620-018-5295-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/17/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Nonalcoholic fatty pancreas disease (NAF-P) is strongly linked with nonalcoholic fatty liver disease (NAFLD), but its relationship with advanced liver disease is unknown. AIMS This study investigated the association between NAF-P and both advanced fibrosis and nonalcoholic steatohepatitis (NASH). METHODS This retrospective study evaluated adults with biopsy-proven NAFLD with a sonogram within 1 year of liver biopsy. NAF-P was diagnosed by comparing the echogenicity of the pancreas to the kidney and was graded by severity. The primary outcome was the effect of NAF-P on the presence of advanced fibrosis and NASH, while secondary outcomes included the association of extensive NAF-P (grade II/III). Propensity score matching for independent risk factors of advanced fibrosis (age, gender, body mass index, and diabetes) was performed. RESULTS One hundred and four patients were included in the study and 91 (87.5%) had NAF-P. After propensity score matching, NAF-P was significantly associated with advanced fibrosis (OR 10.52, p < 0.001) but not NASH (p = 0.27). Extensive NAF-P was predictive of advanced fibrosis (OR 3.35, p = 0.006) and NASH (OR 5.37, p < 0.001). NAF-P had a negative predictive value (NPV) of 93% for advanced fibrosis. When matching for the NAFLD fibrosis score in addition to the variables above, both NAF-P (OR 5.36, p = 0.001) and extensive NAF-P (OR 5.38, p = 0.002) still significantly predicted advanced fibrosis. CONCLUSION NAF-P is predictive of advanced fibrosis, even when controlling for independent predictors of advanced fibrosis and the NAFLD fibrosis score. NAF-P has an excellent NPV and is a safe, inexpensive finding that can rule out advanced fibrosis.
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Affiliation(s)
- Russell Rosenblatt
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Amit Mehta
- Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10021, USA
| | - David Snell
- Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10021, USA
| | - Erika Hissong
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Andrea Siobhan Kierans
- Division of Radiology, Weill Cornell Medicine, 1305 York Avenue, 3rd Floor, New York, NY, 10021, USA
| | - Sonal Kumar
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA.
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Ahbab S, Ünsal A, Ataoğlu HE, Can TS, Kayaş D, Savaş Y. Prediabetes and Type 2 Diabetes are Independent Risk Factors for Computed Tomography-Estimated Nonalcoholic Fatty Pancreas Disease. Clinics (Sao Paulo) 2019; 74:e1337. [PMID: 31664423 PMCID: PMC6807690 DOI: 10.6061/clinics/2019/e1337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/26/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Nonalcoholic fatty pancreas disease (NAFPD) is characterized by excessive fat deposition in the pancreas in the absence of alcohol consumption. In this study, we aimed to detect a possible relationship between adipose tissue accumulation, prediabetes and diabetes. METHODS This cross-sectional and retrospective study included 110 patients. Three groups were classified as controls, patients with prediabetes and patients with type 2 diabetes. The abdominal computed tomography (CT) attenuation measurement results of the pancreas were evaluated independently by two experienced radiologists. CT measurements and biochemical parameters were compared between study groups. The relationship between continuous variables was assessed by using one-way ANOVA. To determine the changes in the dependent variable for the effects on study groups, the independent variable was adjusted using ANCOVA. A p-value less than 0.05 was considered statistically significant. RESULTS The presence of prediabetes and type 2 diabetes was correlated with a decrease in the mean Hounsfield Unit (HU) value of the pancreas (p=0.002). Age was determined to be an independent risk factor and was correlated with NAFPD (p=0.0001). When compared to the controls (p=0.041), 71% of patients with prediabetes and 67% of patients with type 2 diabetes were observed to have an increased incidence of NAFPD. Decreased serum amylase was found to be correlated with the mean HU value of the pancreas (p=0.043). CONCLUSION NAFPD was independently correlated with both prediabetes and type 2 diabetes adjusted for age (p=0.0001) in this study. Additionally, age was determined to be an independent risk factor and was correlated with NAFPD.
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Affiliation(s)
- Süleyman Ahbab
- Internal Medicine Clinic, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
- *Corresponding author. E-mail:
| | - Ahmet Ünsal
- Internal Medicine Clinic, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hayriye Esra Ataoğlu
- Internal Medicine Clinic, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Tuba Selçuk Can
- Department of Radiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Derya Kayaş
- Internal Medicine Clinic, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yıldıray Savaş
- Department of Radiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Niu CY, Wu FX. Research status of fatty pancreas. Shijie Huaren Xiaohua Zazhi 2018; 26:1280-1288. [DOI: 10.11569/wcjd.v26.i21.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Fatty pancreas is a newly proposed condition which is characterized by fat deposition and steatosis in the pancreas followed by outcome of pancreatic and metabolic complications. It has been found to be correlated with many metabolic disorders and a variety of diseases. Fatty pancreas has been associated with obesity, non-alcoholic fatty liver disease, metabolic syndrome, type 2 diabetes mellitus, acute and chronic pancreatitis, and even pancreatic carcinoma. Therefore, fatty pancreas might not only be an early marker of glucose or lipid metabolism disorders or metabolic syndrome, but also be a predictor of poor outcome of pancreatic related diseases. At present, imaging examination is the main diagnostic method. However, there is currently still a lack of a unified terminology, diagnostic criteria, treatment consensus, and guidelines due to very limited knowledge on this condition. Here we discuss the pathophysiology, pathogenesis, clinical implications, diagnosis, and treatment of fatty pancreas, with an aim to improve the early intervention, treatment, and prognosis prediction of fatty pancreas related metabolic disorders.
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Affiliation(s)
- Chun-Yan Niu
- Department of Gastroenterology, Xiang'an Hospital of Xiamen University, Xiamen 361101, Fujian Province, China,Department of Gastroenterology, the First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, Shaanxi Province, China
| | - Fang-Xiong Wu
- Department of Gastroenterology, the First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, Shaanxi Province, China
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Kim SR, Lerman LO. Diagnostic imaging in the management of patients with metabolic syndrome. Transl Res 2018; 194:1-18. [PMID: 29175480 PMCID: PMC5839955 DOI: 10.1016/j.trsl.2017.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/18/2017] [Accepted: 10/26/2017] [Indexed: 02/07/2023]
Abstract
Metabolic syndrome (MetS) is the constellation of metabolic risk factors that might foster development of type 2 diabetes and cardiovascular disease. Abdominal obesity and insulin resistance play a prominent role among all metabolic traits of MetS. Because intervention including weight loss can reduce these morbidity and mortality in MetS, early detection of the severity and complications of MetS could be useful. Recent advances in imaging modalities have provided significant insight into the development and progression of abdominal obesity and insulin resistance, as well as target organ injuries. The purpose of this review is to summarize advances in diagnostic imaging modalities in MetS that can be applied for evaluating each components and target organs. This may help in early detection, monitoring target organ injury, and in turn developing novel therapeutic target to alleviate and avert them.
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Affiliation(s)
- Seo Rin Kim
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn.
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Prevalence and clinical characteristics of fatty pancreas in Yangzhou, China: A cross-sectional study. Pancreatology 2018; 18:263-268. [PMID: 29477252 DOI: 10.1016/j.pan.2018.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence and risk factors of fatty pancreas in Yangzhou, China. METHODS This was a cross-sectional study. Initially, 2093 subjects were included in the study. After the exclusion of 865 subjects based on incomplete information, a total of 1228 subjects were selected for further analysis. The subjects were stratified into two groups (the fatty pancreas group and the non-fatty pancreas group) based on the results. Anthropometric and biochemical findings were compared between the groups. RESULTS Among the 2093 study subjects, 56 (2.7%) had fatty pancreas. Overall, 53 out of 1228 subjects were diagnosed with fatty pancreas and included into the fatty pancreas group. Univariate analysis showed significant differences in age and the prevalence of general obesity, central obesity, alcohol consumption, metabolic syndrome and fatty liver between the two groups (all p < 0.01). The fatty pancreas group had higher levels of aspartate aminotransferase, alanine aminotransferase, serum uric acid, fasting blood glucose, total cholesterol, triglycerides and low-density lipoprotein, and lower levels of high-density lipoprotein than did the non-fatty pancreas group (all p < 0.05). Multivariate logistic regression analysis showed that age (p = 0.007), central obesity (p = 0.002) and fatty liver (p = 0.006) were independent risk factors for fatty pancreas, with odds ratios (ORs) of 1.034 (95% confidence interval (CI): 1.009-1.059), 5.364 (95% CI: 1.890-15.227), and 2.666 (95% CI: 1.332-5.338), respectively. CONCLUSION The prevalence of fatty pancreas in the examined population is approximately 2.7%. Increased age, central obesity and fatty liver disease are independent risk factors for fatty pancreas.
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The association of fatty pancreas with subclinical atherosclerosis in nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol 2018; 30:411-417. [PMID: 29309395 DOI: 10.1097/meg.0000000000001059] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Ectopic fat accumulation in many tissues has been shown to be a risk factor for developing cardiovascular disease. No study to date has investigated whether fatty pancreas plays a role in the development of subclinical atherosclerosis. We aimed to assess the relationship between fatty pancreas and subclinical atherosclerosis in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) and healthy controls. PATIENTS AND METHODS One hundred patients with biopsy-proven NAFLD and 38 healthy controls were included. Transabdominal ultrasonography examination was performed on all the cases with high-resolution ultrasonography (Acuson S3000) using 6 mHz convex probes. The measurements of carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (cf-PWV) were performed to investigate the relationship between fatty pancreas and atherosclerosis. RESULTS The rate of newly diagnosed DM and prediabetes in the NAFLD patients was 6 and 21%, respectively. Most of the patients with NAFLD (97%) were found to have an increased echogenicity of the pancreas at ultrasound examination. Grade of fatty pancreas was correlated positively with cf-PWV levels (P<0.05), whereas no correlation was found with CIMT (P>0.05). The presence of fatty pancreas was associated significantly with higher CIMT and cf-PWV levels (P<0.05). The results for cf-PWV and CIMT did not remain significant after adjustment for confounding factors. Although the levels of cf-PWV and CIMT increased with increasing grade of fatty pancreas, there was no significant association. CONCLUSION We have shown for the first time that fatty pancreas is a contributing factor for the development of atherosclerosis in patients with NAFLD. This study also confirms the strong association between NAFLD and fatty pancreas.
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