Q&A: Fatty pancreas may predict subsequent diabetes development
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Fatty pancreas independently correlated with diabetes mellitus but not hypertension or dyslipidemia, according to research published in Clinical Gastroenterology and Hepatology.
In a prospective investigation, researchers followed 631 study subjects (mean age, 48 years ± 11 years; 14.7% fatty pancreas) from 2008 to 2010 to quantify the incidence of diabetes, hypertension, dyslipidemia, ischemic heart disease, cardiovascular accidents, pancreatic cancer and mortality.
During long-term follow-up (mean follow-up time, 11.1 years ± 1.1 years), subjects with fatty pancreas had increased incidence of diabetes (33.3% vs. 10.4%), hypertension (37.7% vs. 22.7%) and dyslipidemia (37.7% vs. 14.6%). The highest rates of incidence occurred among subjects with concurrent fatty liver and fatty pancreas followed by subjects with fatty liver only and, lastly, subjects with fatty pancreas only.
Researchers noted fatty pancreas independently associated with diabetes diagnoses (adjusted HR = 1.81; 95% CI, 1.1-3) with risk increased by 7% (aHR = 1.07; 95% CI, 1.01-1.13) for each percentage rise of pancreatic fat.
Healio Gastroenterology spoke with lead study author, Ting Ting Chan, of the department of medicine and therapeutics at The Chinese University of Hong Kong, about the key study takeaways and how these results inform future patient management.
Healio: Why did your team undertake this investigation?
Chan: First, the pancreas is another common site of ectopic fat deposition apart from the liver. This is not an uncommon finding during radiological or endosonographic examinations with a prevalence of 10% to 30% as reported in literature. There has been excessive evidence and in-depth studies on nonalcoholic fatty liver diseases and its association with metabolic outcomes. Yet its counterpart, fatty pancreas, is still under investigated for its clinical significance despite increasing recognition of the condition. Moreover, pre-existing studies on fatty pancreas are mostly retrospective or cross-sectional. Long term prospective data in the real world are lacking.
Lastly, we are fortunate to have a well-built database established by our team's previous population screening study using fat-water MRI as pancreatic fat quantification. We are inspired to know how our recruited subjects have been doing over the 10-year follow-up period with a hope to answer the above knowledge gaps.
Healio: What is the most important take-home message?
Chan: The fatty pancreas group had a significantly higher incidence of diabetes mellitus, hypertension and dyslipidemia during long-term follow-up. People with fatty pancreas had 1.81 times higher risk to develop diabetes over 10 years.
After multivariate analysis, fatty pancreas was only found to be independently associated with diabetes but not hypertension or dyslipidemia.
Healio: How do these results inform fatty pancreas management going forward?
Chan: We hope to raise awareness on this increasingly common but under-addressed condition. Fatty pancreas may not be only a surrogate marker of obesity or fatty liver but also an early alarm for future metabolic disease development.
Healio: What additional research, if any, is needed?
Chan: Since the event rates of cardiovascular diseases were too infrequent in our study to make a meaningful comparison, future studies regarding the association of fatty pancreas with ischemic heart or cerebrovascular diseases would be needed. Evidence advocating the relationship between fatty pancreas and pancreatic cancer development is emerging. This research question also warrants a longer follow-up of a larger population.
Healio: What advice would you give to clinicians treating this subgroup of patients?
Chan: Clinicians should be aware of the clinical implications of fatty pancreas and monitor patients for future diabetes development. We should also look forward to further research regarding other clinical outcomes of fatty pancreas patients in the future.
References:
Chan TT, et al. Clin Gastroenterol Hepatol. 2021;doi:10.1016/j.cgh.2021.09.027.
Wong VW, et al. Am J Gastroenterol. 2014;doi:10.1038/ajg.2014.1.
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