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Longitudinal association of fatty pancreas with the incidence of type-2 diabetes in lean individuals: a 6-year computed tomography-based cohort study

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Only a few studies have longitudinally evaluated whether fatty pancreas increases the risk of type-2 diabetes (T2D), and their results were inconsistent. Fatty pancreas is closely linked to overweight and obesity, but previous studies did not exclude overweight or obese individuals. Therefore, in this cohort study, we investigated the association between fatty pancreas and T2D incidence in lean individuals.

Methods

Between 2008 and 2013, 1478 nondiabetic lean individuals (i.e. body-mass index < 25 kg/m2) underwent health examinations including computed tomography (CT) and were followed for a median of 6.19 years. Fatty pancreas was evaluated by a histologically-validated method using pancreas attenuation (Hounsfield units [HU]) on CT at baseline; lower pancreas attenuation indicates more pancreatic fat. To detect incident T2D, we used fasting plasma glucose, HbA1c, and self-reports of prescribed anti-diabetes medications. Odds ratios (OR) for the association between pancreas attenuation and incident T2D were estimated using logistic regression models adjusted for likely confounders.

Results

T2D occurred in 61 participants (4.13%) during the follow-up period. Lower pancreas attenuation (i.e. more pancreatic fat) at baseline was associated with incident T2D (unadjusted OR per 10 HU lower attenuation: 1.56 [95% CI 1.28–1.91], p < 0.001). The multivariable-adjusted analysis revealed a similar association (adjusted OR per 10 HU lower attenuation: 1.32 [95% CI 1.06–1.63], p = 0.012).

Conclusions

T2D was likely to develop in lean individuals with the fatty pancreas. Among people who are neither obese nor overweight, the fatty pancreas can be used to define a group at high risk for T2D.

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Abbreviations

BMI:

Body-mass index

CT:

Computed tomography

CIs:

Confidence intervals

P–S:

Difference between the pancreatic attenuation and the splenic attenuation

HU:

Hounsfield units

JDS:

Japan diabetes society

MRI:

Magnetic resonance imaging

NGSP:

National glycohemoglobin standardization program

OR:

Odds ratios

P/S ratio:

Ratio of the pancreatic attenuation to the splenic attenuation

ROIs:

Regions of interest

SOL:

Space-occupying lesions

T2D:

Type-2 diabetes

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Acknowledgements

The authors thank Keita Numata from the System Development Section, Keijinkai Maruyama Clinic; Kunihiko Hayashi, Hiromitsu Yonezawa, Eiji Kazuta, Kimihiro Saito, Keiko Takasaki, and Miyuki Yoshioka from the Department of Radiology, Keijinkai Maruyama Clinic; and Yuki Yoshino from the Department of Radiology, Teine Keijinkai Hospital. We thank Joseph Green for suggestions and comments on earlier versions of this manuscript.

Funding

This study was supported by JSPS KAKENHI Grant Number 19K16978. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan

    Hajime Yamazaki, Jui Wang, Tsukasa Kamitani, Shunichi Fukuhara & Yosuke Yamamoto

  2. Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    Hajime Yamazaki

  3. Department of Radiology, Keijinkai Maruyama Clinic, 3-16, Odori Nishi 26-chome, Chuo-ku, Sapporo, 064-0820, Japan

    Shinichi Tauchi

  4. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 517, No. 17, Xu-Zhou Road, Taipei, 100, Taiwan

    Jui Wang

  5. Department of Health Checkup and Promotion, Keijinkai Maruyama Clinic, 3-16, Odori Nishi 26-chome, Chuo-ku, Sapporo, 064-0820, Japan

    Mitsuru Dohke & Nagisa Hanawa

  6. Department of Radiology, Teine Keijinkai Hospital, 1-40, 1-jo 12-chome, Maeda, Teine-ku, Sapporo, 006-8555, Japan

    Yoshihisa Kodama

  7. Center for Gastroenterology, Teine Keijinkai Hospital, 1-40, 1-jo 12-chome, Maeda, Teine-ku, Sapporo, 006-8555, Japan

    Akio Katanuma

  8. Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Yoshifumi Saisho

Authors
  1. Hajime Yamazaki
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  2. Shinichi Tauchi
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  3. Jui Wang
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  11. Yosuke Yamamoto
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Contributions

H.Y., J.W., and Y.Y. designed the study. S.T., M.D., N.H. and Y.K. collected the data. H.Y. wrote the draft and analyzed the data. H.Y., S.T., J.W., M.D., N.H., Y.K., A.K., Y.S., T.K., S.F., and Y.Y. reviewed, made critical revisions, and approved the article before submission. H.Y. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Hajime Yamazaki.

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Yamazaki, H., Tauchi, S., Wang, J. et al. Longitudinal association of fatty pancreas with the incidence of type-2 diabetes in lean individuals: a 6-year computed tomography-based cohort study. J Gastroenterol 55, 712–721 (2020). https://doi.org/10.1007/s00535-020-01683-x

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  • DOI: https://doi.org/10.1007/s00535-020-01683-x

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