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. 2024 Jun 1;119(6):1158-1166.
doi: 10.14309/ajg.0000000000002792. Epub 2024 Apr 8.

Associations of Intrapancreatic Fat Deposition With Incident Diseases of the Exocrine and Endocrine Pancreas: A UK Biobank Prospective Cohort Study

Xiaowu Dong  1 , Qingtian Zhu  1 , Chenchen Yuan  1 , Yaodong Wang  2 , Xiaojie Ma  3 , Xiaolei Shi  1 , Weiwei Chen  4 , Zhao Dong  5 , Lin Chen  1 , Qinhao Shen  1 , Hongwei Xu  2 , Yanbing Ding  1 , Weijuan Gong  1 , Weiming Xiao  1 , Shengfeng Wang  6   7 , Weiqin Li  3 , Guotao Lu  1
Affiliations

Associations of Intrapancreatic Fat Deposition With Incident Diseases of the Exocrine and Endocrine Pancreas: A UK Biobank Prospective Cohort Study

Xiaowu Dong et al. Am J Gastroenterol. .

Abstract

Introduction: To investigate whether increased intrapancreatic fat deposition (IPFD) heightens the risk of diseases of the exocrine and endocrine pancreas.

Methods: A prospective cohort study was conducted using data from the UK Biobank. IPFD was quantified using MRI and a deep learning-based framework called nnUNet. The prevalence of fatty change of the pancreas (FP) was determined using sex- and age-specific thresholds. Associations between IPFD and pancreatic diseases were assessed with multivariate Cox-proportional hazard model adjusted for age, sex, ethnicity, body mass index, smoking and drinking status, central obesity, hypertension, dyslipidemia, liver fat content, and spleen fat content.

Results: Of the 42,599 participants included in the analysis, the prevalence of FP was 17.86%. Elevated IPFD levels were associated with an increased risk of acute pancreatitis (hazard ratio [HR] per 1 quintile change 1.513, 95% confidence interval [CI] 1.179-1.941), pancreatic cancer (HR per 1 quintile change 1.365, 95% CI 1.058-1.762) and diabetes mellitus (HR per 1 quintile change 1.221, 95% CI 1.132-1.318). FP was also associated with a higher risk of acute pancreatitis (HR 3.982, 95% CI 2.192-7.234), pancreatic cancer (HR 1.976, 95% CI 1.054-3.704), and diabetes mellitus (HR 1.337, 95% CI 1.122-1.593, P = 0.001).

Discussion: FP is a common pancreatic disorder. Fat in the pancreas is an independent risk factor for diseases of both the exocrine pancreas and endocrine pancreas.

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Conflict of interest statement

Guarantor of the article: Guotao Lu, PhD.

Specific author contributions: G.L., W.L., and S.W.: conceptualization. X.M., X.S., and W.C.: methodology. X.D. and Y.W.: formal analysis. X.D., Q.Z., and C.Y.: investigation. X.S. and Z.D.: data curation. X.D., L.C., and Q.S.: writing—original draft. G.L., W.L., and S.W.: writing—review and editing. Y.D., W.G., and W.X.: supervision. X.D., C.Y., X.S., Y.D., and G.L.: funding acquisition. G.L.: resources. All authors read and approved the final draft and took full responsibility for its content, including the accuracy of the data and its statistical analysis.

Financial support: This work was supported by the National Natural Science Foundation of China (No. 82200680, 82200720, 82200721, 82200996, 82241043, and 82173616); Cultivation Foundation of Yangzhou Municipal Key Laboratory (No. YZ2021147); The Medical Research Project of Jiangsu Provincial Health Commission (No. ZD2022011); Yangzhou key research and development plan (No. YZ2022080); and Suzhou Innovation Platform Construction Projects-Municipal Key Laboratory Construction (No. SZS2023001).

Potential competing interests: None to report.

Figures

Figure 1.
Figure 1.
Flowchart of the study. IPFD, intrapancreatic fat deposition; MRI, magnetic resonance imaging.
Figure 2.
Figure 2.
Distribution of IPFD (a) and the prevalence of FP (b) by sex and age. The boxes represented medians with interquartile ranges (a) or proportions (b). The whiskers represented 1.5 × interquartile ranges (a) or confidence interval (b). FP, fatty change of the pancreas; IPFD, intrapancreatic fat deposition.
Figure 3.
Figure 3.
Kaplan-Meier estimates of acute pancreatitis (a, b), pancreatic cancer (c, d), diabetes mellitus (e, f), and all pancreatic diseases (g, h). FP, fatty change of the pancreas.
Figure 4.
Figure 4.
Cox regression model of the association between IPFD and all pancreatic diseases, DM, AP, and PC. (a) Participants were grouped by IPFD quintiles. Q1–Q5 represented the quintiles of IPFD, and individuals in the lowest quintile of IPFD (Q1) were used as the reference group. (b) Participants were grouped by FP diagnosis. Data presented as hazard ratio (95% CI), adjusted with model 2 for age, sex, ethnicity, BMI, central obesity, smoking and drinking status, hypertension, dyslipidemia, liver fat content, and spleen fat content. AP, acute pancreatitis; BMI, body mass index; CI, confidence interval; DM, diabetes mellitus; FP, fatty change of the pancreas; IPFD, intrapancreatic fat deposition; PC, pancreatic cancer.
Figure 5.
Figure 5.
Subgroup analysis for the association between IPFD and AP, PC, DM, and all pancreatic diseases. Data presented as hazard ratio (95% CI), adjusted with model 2 for age, sex, ethnicity, BMI, central obesity, smoking and drinking status, hypertension, dyslipidemia, liver fat content, and spleen fat content. AP, acute pancreatitis; BMI, body mass index; CI, confidence interval; DM, diabetes mellitus; FP, fatty change of the pancreas; PC, pancreatic cancer.
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