ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: J Pediatr 2018;193:134-138.e1

Obesity promotes visceral fat deposition, which may result in profound metabolic consequences that contribute directly to insulin resistance, and risk of cardiovascular disease and malignancy. Obese individuals are at increased risk of fatty liver disease, which can lead to steatohepatitis and subsequently advanced liver fibrosis. Less is known about fat deposition in the pancreas and its health consequences.

Pancreatic steatosis can be classified into the subtypes: fatty replacement, fatty infiltration, lipomatous pseudo-hypertrophy, non-alcoholic fatty pancreas disease (NAFPD) and non-alcoholic fatty steato-pancreatitis (NASP). The fat composition of the pancreas of obese mice shows a higher content of triglycerides and free fatty acids than in lean mice. Increased intracellular triglyceride accumulation in β-cells ultimately results in reduced insulin secretion, insulin resistance, cell apoptosis and a vicious cycle of fatty replacement. The cause and effect relationship between the MetS and NAFPD has not yet been established.¹¹

Here, Kim et al. assessed fatty pancreas by the pancreato-perihepatic fat index (PPHFI) on transabdominal ultrasonography and related the values to MetS and insulin resistance. PPHFI is calculated as the ratio of mean brightness of the pancreatic body to that of perihepatic fat. PPHFI was positively correlated with MetS and insulin resistance, and had a slightly higher accuracy than the HOMA-IR value for diagnosing MetS in obese children and adolescents. The odds of MetS increased by four-fold with an increase in PPHFI, and by two-fold with a higher HOMA-IR value. It is suggested that fatty pancreas causes ß-cell dysfunction, and then, might induce T2DM. PPHFI also showed positive correlations with levels of TG, LDL cholesterol, ALT, insulin and fasting plasma glucose; systolic blood pressure; diastolic blood pressure; HOMA-IR value and BMI. Transabdominal ultrasonography is relatively easy, cost-effective, and free of radiation, making it a potentially useful screening tool.

11. Romana B, Chela H, Dailey F, Nassir F, Tahan V. Non-alcoholic fatty pancreas disease (NAFPD): A silent spectator or the fifth component of metabolic syndrome? A literature review. Endocrine, metabolic & immune disorders drug targets 2018.