Pancreatic steatosis: Is it related to either obesity or diabetes mellitus?

Abstract

The accumulation of fat in the pancreatic gland has been referred to using various synonyms, such as pancreatic lipomatosis, fatty replacement, fatty infiltration, fatty pancreas, lipomatous pseudohypertrophy, non-alcoholic fatty pancreatic disease and pancreatic steatosis We believe that pancreatic steatosis is the best description of fat accumulation in the pancreatic gland without fat replacement, and this term also describes the possibility that the fat accumulation is a reversible process. A review of the existing literature was carried out, and it was found that there was notable evidence from both the pathological and the imaging point of view that pancreatic steatosis is an increasing problem due to the increasing incidence of obesity. The conclusion was that pancreatic steatosis was easily detectable using modern imaging techniques, such as ultrasonography, endoscopic ultrasonography, computed tomography and magnetic resonance imaging. Pancreatic steatosis was not due to the presence of diabetes mellitus but was highly associated with the metabolic syndrome. The possible presence of steatopancreatitis should be better evaluated, especially regarding the inflammatory cascade, and additional studies are needed which are capable of assessing whether non-alcoholic steatopancreatitis really exists as does non-alcoholic steatohepatitis. Finally, the presence of exocrine pancreatic function should be extensively evaluated in patients with pancreatic steatosis. Key words: Computed tomography; Endoscopic ultrasonography; Magnetic resonance imaging; Metabolic syndrome; Pancreatic steatosis; Pathology; Type 2 diabetes mellitus; Ultrasonography Core tip: Pancreatic steatosis is easily detectable using modern imaging techniques, such as ultrasonography, endoscopic ultrasonography, computed tomography and magnetic resonance imaging. It is not due to the presence of diabetes mellitus but is highly associated with the metabolic syndrome. The possible presence of steatopancreatitis should be better evaluated, especially regarding the inflammatory cascade, and additional studies are needed which are capable of assessing whether non-alcoholic steatopancreatitis really exists as does non-alcoholic steatohepatitis. Additional studies regarding the exocrine pancreatic function in patients with pancreatic steatosis are needed.

Pancreas Volume and Fat Deposition in Diabetes and Normal Physiology: Consideration of the Interplay Between Endocrine and Exocrine Pancreas

“…However, since pancreatic fat content may also be affected by age and obesity, a causal association between pancreatic fat content and glucose intolerance or beta-cell dysfunction is difficult to establish [106,[131][132][133][134][135][136]. In our analysis, using CT scan, there was a significant correlation between pancreatic fat content and BMI, but no significant difference in pancreatic fat volume between subjects with and without T2D who were matched for age, sex, and BMI [13] ( Table 1 and Figure 4).…”

Pancreas volume reduction and metabolic effects in Japanese patients with severe obesity following laparoscopic sleeve gastrectomy

“…It is clear that obesity is a major risk factor for T2DM, and it appears to drive tissue insulin resistance via ectopic fat gain, with the best-studied organ being the liver [1][2][3]. Excess liver fat, and its related condition of NAFLD, have been recognized as playing an important role in the T2DM-onset mechanism [3,17].…”

“…In addition, a greater proportion of PS is associated with increased insulin levels in morbidly obese patients without T2DM, due to their strong insulin resistance. Therefore, it may take the toxic effect of PS a long time to manifest as impaired β-cell function, and it has been assessed that pancreatic β-cell damage is present for more than a decade before T2DM is diagnosed [1,2]. Therefore, early detection of PS in morbidly obese patients without T2DM can be an important indication for performing bariatric surgery to avoid the onset of T2DM.…”

Pancreatic Steatosis: Is it Related to Obesity, Diabetes Mellitus and Metabolic Syndrome?

“…This may be due to accumulation of pancreatic fat. The pancreatic steatosis is easily detectable using ultrasound, computed tomography and magnetic resonance [7][8][9][10][11][12][13].…”