Exploring the metabolic syndrome: Nonalcoholic fatty pancreas disease

Abstract

After the first description of fatty pancreas in 1933, the effects of pancreatic steatosis have been poorly investigated, compared with that of the liver. However, the interest of research is increasing. Fat accumulation, associated with obesity and the metabolic syndrome (MetS), has been defined as "fatty infiltration" or "nonalcoholic fatty pancreas disease" (NAFPD). The term "fatty replacement" describes a distinct phenomenon characterized by death of acinar cells and replacement by adipose tissue. Risk factors for developing NAFPD include obesity, increasing age, male sex, hypertension, dyslipidemia, alcohol and hyperferritinemia. Increasing evidence support the role of pancreatic fat in the development of type 2 diabetes mellitus, MetS, atherosclerosis, severe acute pancreatitis and even pancreatic cancer. Evidence exists that fatty pancreas could be used as the initial indicator of "ectopic fat deposition", which is a key element of nonalcoholic fatty liver disease and/or MetS. Moreover, in patients with fatty pancreas, pancreaticoduodenectomy is associated with an increased risk of intraoperative blood loss and post-operative pancreatic fistula.

Keywords: Fatty pancreas; Metabolic syndrome; Nonalcoholic fatty liver disease; Nonalcoholic fatty pancreas disease; Pancreatic cancer; Pancreatic fat; Pancreatic fatty infiltration; Pancreatic fatty replacement; Pancreatic lipomatosis; Pancreatic steatosis.

Figure 1

MEDLINE/PubMed findings about pancreatic fat.

Figure 2

Pancreatic steatosis. Courtesy of Prof. Vasquez E and Dr. Angelico G, Anatomical Pathology Department, University of Catania -Catania, Italy.

Figure 3

Normal pancreas. Courtesy of Prof. Vasquez E and Dr. Angelico G, Anatomical Pathology Department, University of Catania -Catania, Italy.

Figure 4

Pathogenesis of “fatty replacement”.