Nonalcoholic fatty pancreas disease and Nonalcoholic fatty liver disease: more than ectopic fat

Abstract

SummaryObjective The aim of this study was to evaluate the metabolic effects of fatty pancreas (nonalcoholic fatty pancreas disease -NAFPD) in a group of obese paediatric patients with nonalcoholic fatty liver disease (NAFLD). Methods We included 121 consecutive children with echographic evidence of hepatic steatosis. All patients underwent to abdominal ultrasound to evaluate pancreatic echogenic pattern. We divided the patients into two groups on the basis of the presence of fatty pancreas. In all patients liver function tests, lipid and gluco-insulinemic profile were evaluated. A selected subset of patients (67) underwent to liver biopsy. Results Of these 121 patients, 58 showed NAFPD and 63 patients exhibited a normal pancreatic echogenic pattern. No differences were found in age, transaminases serum levels, lipid profile and pancreatic enzymes between the two groups. The patients with NAFPD had a significantly higher z-BMI, fasting insulin, insulin resistance (HOMA-IR) and lower ISI respect to the group without fatty pancreas. The patients with fatty pancreas showed a more advanced form of liver disease, with higher values of fibrosis, ballooning and NAS score with respect to the group without NAFPD. Conclusions Our study demonstrated that NAFPD is a frequent condition in obese paediatric patients affected by NAFLD. Our data suggest that pancreatic fat should not be considered an inert accumulation of fat, but as an additional factor able to affect glucose metabolism and severity of liver disease, increasing the risk of develop metabolic syndrome.

Non-alcoholic fatty pancreas disease

“…Recent epidemiological studies reported a 16% prevalence of NAFPD in the general adult population, with an increase of this percentage in obese patients with NAFLD, while the prevalence in the paediatric population is still not available 4. Uygun et al 24 noted that under US examination, the prevalence of fatty pancreas was approximately 50% in adults with biopsy proven NAFLD, illustrating the close association these two conditions have to one another.…”

“…Contrary to those of NAFLD, the potential consequences of pancreatic fat accumulation are as of yet, not well established 4. Ongoing fatty infiltration and endocrine/exocrine dysfunction of the pancreas is mediated by the direct toxic effect of fat on pancreatic acinar cells and islets 5.…”

“…According to the WHO, in 2014, more than 1.9 billion adults were estimated to be overweight, with a further 600 million considered obese 2. There are a number of life-threating disorders associated with excess body fat, principally metabolic syndrome including type 2 diabetes mellitus (T2DM), cardiovascular diseases and several forms of malignant neoplasms 3 4…”

“…In recent years, fatty infiltration of the liver in the absence of excess alcohol intake, termed as non-alcoholic fatty liver disease (NAFLD), has become the most common cause of chronic liver disease in children and adolescents, and a major cause of liver disease in adults 4. NAFLD includes a wide spectrum of disorders from simple fat accumulation in the hepatocytes to advanced forms of liver disease with inflammation, progressive fibrosis and cirrhosis 4…”

“…Excessive lipid deposition in the pancreas is known as steatosis or non-alcoholic fatty pancreas disease (NAFPD) 4. Contrary to those of NAFLD, the potential consequences of pancreatic fat accumulation are as of yet, not well established 4.…”