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  • Review Article
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The clinical significance of pancreatic steatosis

Nature Reviews Gastroenterology & Hepatology volume 8, pages 169–177 (2011)Cite this article

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Abstract

More research is now focused on pancreatic steatosis. Multiple definitions, clinical associations and synonyms for pancreatic steatosis are described in the literature and can be confusing. The integration and comparison of several studies concerning this topic is therefore challenging. In the past, pancreatic steatosis was considered an innocuous condition, a bystander of many underlying diseases (such as congenital syndromes, hemochromatosis and viral infection). However, evidence that pancreatic steatosis (strongly associated with obesity and the metabolic syndrome) has a role in type 2 diabetes mellitus, pancreatic exocrine dysfunction, acute pancreatitis, pancreatic cancer and the formation of pancreatic fistula after pancreatic surgery is emerging. This Review focuses on the different etiological factors and the clinical consequences of pancreatic steatosis.

Key Points

  • Pancreatic fat accumulation has many different synonyms

  • In pancreatic fatty replacement, death of acinar cells (e.g. because of hemochromatosis, viral infection or duct obstruction) leads to adipocyte replacement

  • In pancreatic fat infiltration, or nonalcoholic fatty pancreas disease (NAFPD), obesity leads to adipocyte infiltration of the pancreas

  • NAFPD is possibly associated with type 2 diabetes mellitus, a more severe course of acute pancreatitis, pancreatic cancer and pancreatic fistula formation after pancreatic surgery

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Figure 1: Histological findings of pancreatic steatosis.
Figure 2: CT scan of pancreatic steatosis.
Figure 3: Etiological factors and consequences of pancreatic steatosis.

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References

  1. Berghöfer, A. et al. Obesity prevalence from a European perspective: a systematic review. BMC Public Health 8, 200 (2008).

    PubMed  PubMed Central  Google Scholar 

  2. Flegal, K. M., Carroll, M. D., Ogden, C. L. & Curtin, L. R. Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303, 235–241 (2010).

    CAS  PubMed  Google Scholar 

  3. Wilson, P. W., D'Agostino, R. B., Sullivan, L., Parise, H. & Kannel, W. B. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch. Intern. Med. 162, 1867–1872 (2002).

    PubMed  Google Scholar 

  4. Ogden, C. L., Yanovski, S. Z., Carroll, M. D. & Flegal, K. M. The epidemiology of obesity. Gastroenterology 132, 2087–2102 (2007).

    PubMed  Google Scholar 

  5. Calle, E. E., Rodriguez, C., Walker-Thurmond, K. & Thun, M. J. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of, U. S. adults. N. Engl. J. Med. 348, 1625–1638 (2003).

    PubMed  Google Scholar 

  6. van Herpen, N. A. & Schrauwen-Hinderling, V. B. Lipid accumulation in non-adipose tissue and lipotoxicity. Physiol. Behav. 94, 231–241 (2008).

    CAS  PubMed  Google Scholar 

  7. van Geenen, E. J. et al. Nonalcoholic fatty liver disease is related to nonalcoholic fatty pancreas disease. Pancreas 39, 1185–1190 (2010).

    PubMed  Google Scholar 

  8. Ogilvie, R. The island of langerhans in 19 cases of obesity. J. Pathol. 37, 473–481 (1933).

    Google Scholar 

  9. Olsen, T. S. Lipomatosis of the pancreas in autopsy material and its relation to age and overweight. Acta Pathol. Microbiol. Scand. A 86A, 367–373 (1978).

    CAS  PubMed  Google Scholar 

  10. Stamm, B. H. Incidence and diagnostic significance of minor pathologic changes in the adult pancreas at autopsy: a systematic study of 112 autopsies in patients without known pancreatic disease. Hum. Pathol. 15, 677–683 (1984).

    CAS  PubMed  Google Scholar 

  11. Al-Haddad, M. et al. Risk factors for hyperechogenic pancreas on endoscopic ultrasound: a case-control study. Pancreas 38, 672–675 (2009).

    PubMed  Google Scholar 

  12. Lee, Y. et al. Pancreatic steatosis: harbinger of type 2 diabetes in obese rodents. Int. J. Obes. (Lond.) 34, 396–400 (2010).

    CAS  Google Scholar 

  13. Lingvay, I. et al. Noninvasive quantification of pancreatic fat in humans. J. Clin. Endocrinol. Metab. 94, 4070–4076 (2009).

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Lozano, M. et al. Lipomatosis of the pancreas: an unusual cause of massive steatorrhea. Pancreas 3, 580–582 (1988).

    CAS  PubMed  Google Scholar 

  15. Schwenzer, N. F. et al. Quantification of pancreatic lipomatosis and liver steatosis by MRI: comparison of in/opposed-phase and spectral-spatial excitation techniques. Invest. Radiol. 43, 330–337 (2008).

    PubMed  Google Scholar 

  16. Walters, M. N., Leak, P. J., Joske, R. A., Stanley, N. F. & Perret, D. H. Murine infection with reovirus 3. Pathology of infection with types 1 and 2. Br. J. Exp. Pathol. 46, 200–212 (1965).

    CAS  Google Scholar 

  17. Lin, W. C., Chen, J. H., Lin, C. H. & Shen, W. C. Rapidly progressive pancreatic lipomatosis in a young adult patient with transfusion-dependent myelodysplastic syndrome. J. Formos. Med. Assoc. 106, 676–679 (2007).

    PubMed  Google Scholar 

  18. Feigelson, J. et al. Imaging changes in the pancreas in cystic fibrosis: a retrospective evaluation of 55 cases seen over a period of 9 years. J. Pediatr. Gastroenterol. Nutr. 30, 145–151 (2000).

    CAS  PubMed  Google Scholar 

  19. Makay, O. et al. Fat replacement of the malignant pancreatic tissue after neoadjuvant therapy. Int. J. Clin. Oncol. 15, 88–92 (2010).

    PubMed  Google Scholar 

  20. López, J. M. et al. Effects of prolonged ethanol intake and malnutrition on rat pancreas. Gut 38, 285–292 (1996).

    PubMed  PubMed Central  Google Scholar 

  21. Wilson, J. S., Somer, J. B. & Pirola, R. C. Chronic ethanol feeding causes accumulation of serum cholesterol in rat pancreas. Exp. Mol. Pathol. 41, 289–297 (1984).

    CAS  PubMed  Google Scholar 

  22. Wilson, J. S. et al. Alcohol causes a fatty pancreas. A rat model of ethanol-induced pancreatic steatosis. Alcohol Clin. Exp. Res. 6, 117–121 (1982).

    CAS  PubMed  Google Scholar 

  23. Altinel, D. et al. Lipomatous pseudohypertrophy of the pancreas: a clinicopathologically distinct entity. Pancreas 39, 392–397 (2010).

    PubMed  PubMed Central  Google Scholar 

  24. Larsen, M. O. et al. Beta-cell function and islet morphology in normal, obese, and obese beta-cell mass-reduced Gottingen minipigs. Am. J. Physiol. Endocrinol. Metab. 288, E412–E421 (2005).

    CAS  PubMed  Google Scholar 

  25. Mathur, A. et al. Nonalcoholic fatty pancreas disease. HPB (Oxford) 9, 312–318 (2007).

    Google Scholar 

  26. Patel, S., Bellon, E. M., Haaga, J. & Park, C. H. Fat replacement of the exocrine pancreas. AJR Am. J. Roentgenol. 135, 843–845 (1980).

    CAS  PubMed  Google Scholar 

  27. Winston, C. B., Mitchell, D. G., Outwater, E. K. & Ehrlich, S. M. Pancreatic signal intensity on T1-weighted fat saturation MR images: clinical correlation. J. Magn. Reson. Imaging 5, 267–271 (1995).

    CAS  PubMed  Google Scholar 

  28. Kumar, V., Fausto, N. & Abbas, A. (Eds) Robbins and Cotran Pathologic Basis of Disease 7th edn (Saunders Elsevier, Philadelphia, 2009).

    Google Scholar 

  29. Tushuizen, M. E. et al. Pancreatic fat content and beta-cell function in men with and without type 2 diabetes. Diabetes Care 30, 2916–2921 (2007).

    CAS  PubMed  Google Scholar 

  30. Mathur, A. et al. Pancreatic steatosis promotes dissemination and lethality of pancreatic cancer. J. Am. Coll. Surg. 208, 989–994 (2009).

    PubMed  Google Scholar 

  31. Walters, M. N. Adipose atrophy of the exocrine pancreas. J. Pathol. Bacteriol. 92, 547–557 (1966).

    CAS  PubMed  Google Scholar 

  32. Pinnick, K. E. et al. Pancreatic ectopic fat is characterized by adipocyte infiltration and altered lipid composition. Obesity (Silver Spring) 16, 522–530 (2008).

    CAS  Google Scholar 

  33. Dreiling, D. A., Elsbach, P., Schaffner, F. & Schwartz, I. L. The effect of restriction of protein and total calories on pancreatic function in obese patients. Gastroenterology 42, 686–690 (1962).

    CAS  PubMed  Google Scholar 

  34. Jia, D. M., Fukumitsu, K. I., Tabaru, A., Akiyama, T. & Otsuki, M. Troglitazone stimulates pancreatic growth in congenitally CCK-A receptor-deficient OLETF rats. Am. J. Physiol. Regul. Integr. Comp. Physiol. 280, R1332–R1340 (2001).

    CAS  PubMed  Google Scholar 

  35. Raeder, H. et al. Pancreatic lipomatosis is a structural marker in nondiabetic children with mutations in carboxyl-ester lipase. Diabetes 56, 444–449 (2007).

    CAS  PubMed  Google Scholar 

  36. Kuroda, N., Okada, M., Toi, M., Hiroi, M. & Enzan, H. Lipomatous pseudohypertrophy of the pancreas: further evidence of advanced hepatic lesion as the pathogenesis. Pathol. Int. 53, 98–101 (2003).

    PubMed  Google Scholar 

  37. Yang, D. M., Kim, H. C., Ryu, J. K., Joo, K. R. & Ahn, K. J. Sonographic appearance of focal fatty infiltration of the pancreas. J. Clin. Ultrasound 38, 45–47 (2010).

    PubMed  Google Scholar 

  38. Mathur, A. et al. Fatty pancreas: a factor in postoperative pancreatic fistula. Ann. Surg. 246, 1058–1064 (2007).

    PubMed  Google Scholar 

  39. Saisho, Y. et al. Pancreas volumes in humans from birth to age one hundred taking into account sex, obesity, and presence of type-2 diabetes. Clin. Anat. 20, 933–942 (2007).

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Matsumoto, S. et al. Uneven fatty replacement of the pancreas: evaluation with CT. Radiology 194, 453–458 (1995).

    CAS  PubMed  Google Scholar 

  41. Cnop, M., Hannaert, J. C., Hoorens, A., Eizirik, D. L. & Pipeleers, D. G. Inverse relationship between cytotoxicity of free fatty acids in pancreatic islet cells and cellular triglyceride accumulation. Diabetes 50, 1771–1777 (2001).

    CAS  PubMed  Google Scholar 

  42. Schneider, K., Harms, K. & Fendel, H. The increased echogenicity of the pancreas in infants and children: the white pancreas. Eur. J. Pediatr. 146, 508–511 (1987).

    CAS  PubMed  Google Scholar 

  43. Shawker, T. H., Linzer, M. & Hubbard, V. S. Chronic pancreatitis: the diagnostic significance of pancreatic size and echo amplitude. J. Ultrasound Med. 3, 267–272 (1984).

    CAS  PubMed  Google Scholar 

  44. Lee, J. S. et al. Clinical implications of fatty pancreas: correlations between fatty pancreas and metabolic syndrome. World J. Gastroenterol. 15, 1869–1875 (2009).

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Worthen, N. J. & Beabeau, D. Normal pancreatic echogenicity: relation to age and body fat. AJR Am. J. Roentgenol. 139, 1095–1098 (1982).

    CAS  PubMed  Google Scholar 

  46. Katz, D. S. et al. Using CT to reveal fat-containing abnormalities of the pancreas. AJR Am. J. Roentgenol. 172, 393–396 (1999).

    CAS  PubMed  Google Scholar 

  47. Kim, H. J. et al. Focal fatty replacement of the pancreas: usefulness of chemical shift MRI. AJR Am. J. Roentgenol. 188, 429–432 (2007).

    PubMed  Google Scholar 

  48. Kovanlikaya, A. et al. Obesity and fat quantification in lean tissues using three-point Dixon MR imaging. Pediatr. Radiol. 35, 601–607 (2005).

    PubMed  Google Scholar 

  49. Lacaille, F., Mani, T. M., Brunelle, F., Lallemand, D. & Schmitz, J. Magnetic resonance imaging for diagnosis of Shwachman's syndrome. J. Pediatr. Gastroenterol. Nutr. 23, 599–603 (1996).

    CAS  Google Scholar 

  50. Isserow, J. A., Siegelman, E. S. & Mammone, J. Focal fatty infiltration of the pancreas: MR characterization with chemical shift imaging. AJR Am. J. Roentgenol. 173, 1263–1265 (1999).

    CAS  PubMed  Google Scholar 

  51. Hu, H. H., Kim, H. W., Nayak, K. S. & Goran, M. I. Comparison of fat-water MRI and single-voxel MRS in the assessment of hepatic and pancreatic fat fractions in humans. Obesity (Silver Spring) 18, 841–847 (2010).

    Google Scholar 

  52. Kim, K. H. et al. Endoscopic retrograde pancreatographic findings of pancreatic lipomatosis. J. Korean Med. Sci. 14, 578–581 (1999).

    CAS  PubMed  PubMed Central  Google Scholar 

  53. Fraulob, J. C., Ogg-Diamantino, R., Fernandes-Santos, C., Aguila, M. B. & Mandarim-de-Lacerda, C. A. A mouse model of metabolic syndrome: insulin resistance, fatty liver and non-alcoholic fatty pancreas disease (NAFPD) in C57BL/6 mice fed a high fat diet. J. Clin. Biochem. Nutr. 46, 212–223 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  54. Gaujoux, S. et al. Fatty pancreas and increased body mass index are risk factors of pancreatic fistula after pancreaticoduodenectomy. Surgery 148, 15–23 (2010).

    PubMed  Google Scholar 

  55. Heni, M. et al. Pancreatic fat is negatively associated with insulin secretion in individuals with impaired fasting glucose and/or impaired glucose tolerance: a nuclear magnetic resonance study. Diabetes Metab. Res. Rev. 26, 200–205 (2010).

    CAS  PubMed  Google Scholar 

  56. Rosso, E. et al. The role of “fatty pancreas” and of BMI in the occurrence of pancreatic fistula after pancreaticoduodenectomy. J. Gastrointest. Surg. 13, 1845–1851 (2009).

    PubMed  Google Scholar 

  57. Zyromski, N. J. et al. Nuclear magnetic resonance spectroscopy-based metabolomics of the fatty pancreas: implicating fat in pancreatic pathology. Pancreatology 9, 410–419 (2009).

    CAS  PubMed  PubMed Central  Google Scholar 

  58. Sodhi, K. S., Thapa, B. R., Khandelwal, S. & Suri, S. Pancreatic lipomatosis in an infant with cystic fibrosis. Pediatr. Radiol. 35, 1157–1158 (2005).

    PubMed  Google Scholar 

  59. Soyer, P. et al. Cystic fibrosis in adolescents and adults: fatty replacement of the pancreas—CT evaluation and functional correlation. Radiology 210, 611–615 (1999).

    CAS  PubMed  Google Scholar 

  60. Robertson, M. B., Choe, K. A. & Joseph, P. M. Review of the abdominal manifestations of cystic fibrosis in the adult patient. Radiographics 26, 679–690 (2006).

    PubMed  Google Scholar 

  61. Carucci, L. R. & Jacobs, J. E. Focal fatty sparing of the pancreatic head in cystic fibrosis: CT findings. Abdom. Imaging 28, 853–855 (2003).

    CAS  PubMed  Google Scholar 

  62. King, L. J. et al. Hepatobiliary and pancreatic manifestations of cystic fibrosis: MR imaging appearances. Radiographics 20, 767–777 (2000).

    CAS  PubMed  Google Scholar 

  63. Lugo-Olivieri, C. H., Soyer, P. A. & Fishman, E. K. Cystic fibrosis: spectrum of thoracic and abdominal CT findings in the adult patient. Clin. Imaging 22, 346–354 (1998).

    CAS  PubMed  Google Scholar 

  64. Tsushima, Y., Matsumoto, M., Inaba, S., Watanabe, M. & Ohno, Y. A Japanese adult case of cystic fibrosis causing bone demineralization. Radiat. Med. 10, 157–162 (1992).

    CAS  PubMed  Google Scholar 

  65. Tham, R. T. et al. Cystic fibrosis: MR imaging of the pancreas. Radiology 179, 183–186 (1991).

    CAS  PubMed  Google Scholar 

  66. Murayama, S. et al. MR imaging of pancreas in cystic fibrosis. Pediatr. Radiol. 20, 536–539 (1990).

    CAS  PubMed  Google Scholar 

  67. Fiel, S. B. et al. Magnetic resonance imaging in young adults with cystic fibrosis. Chest 91, 181–184 (1987).

    CAS  PubMed  Google Scholar 

  68. Daneman, A., Gaskin, K., Martin, D. J. & Cutz, E. Pancreatic changes in cystic fibrosis: CT and sonographic appearances. AJR Am. J. Roentgenol. 141, 653–655 (1983).

    CAS  PubMed  Google Scholar 

  69. Jones, J. S. Adult cystic fibrosis (mucoviscidosis). Fatty replacement of the pancreas in a woman aged 47 years. Br. J. Dis. Chest 64, 25–36 (1970).

    CAS  PubMed  Google Scholar 

  70. Ruggiero, A. et al. MRI findings in Shwachman diamond syndrome. Pediatr. Blood Cancer 50, 352–354 (2008).

    PubMed  Google Scholar 

  71. Belkind-Gerson, J., Ontiveros-Nevares, P., Ocampo-Roosens, V. & Sandoval-Juaréz, D. Shwachman-Diamond syndrome in a Mexican family. Arch. Med. Res. 32, 318–323 (2001).

    CAS  PubMed  Google Scholar 

  72. Lee, J. H. et al. A case of Shwachman-Diamond syndrome confirmed with genetic analysis in a Korean child. J. Korean Med. Sci. 23, 142–145 (2008).

    CAS  PubMed  PubMed Central  Google Scholar 

  73. Cubuk, M., Arslan, G., Ceken, K., Ozkaynak, C. & Lüyleci, E. Schwachman-Diamond syndrome. A case report. Acta Radiol. 41, 627–628 (2000).

    CAS  PubMed  Google Scholar 

  74. Kurdziel, J. C. & Dondelinger, R. Fatty infiltration of the pancreas in Shwachman's syndrome: computed tomography demonstration. Eur. J. Radiol. 4, 202–204 (1984).

    CAS  PubMed  Google Scholar 

  75. Daentl, D. L., Frias, J. L., Gilbert, E. F. & Opitz, J. M. The Johanson-Blizzard syndrome: case report and autopsy findings. Am. J. Med. Genet. 3, 129–135 (1979).

    CAS  PubMed  Google Scholar 

  76. Volk, B. W. & Wellman, K. F. The Diabetic Pancreas 317–324 (Plenum Press, New York, 1977).

    Google Scholar 

  77. Papakonstantinou, O. et al. The pancreas in beta-thalassemia major: MR imaging features and correlation with iron stores and glucose disturbances. Eur. Radiol. 17, 1535–1543 (2007).

    PubMed  Google Scholar 

  78. Midiri, M. et al. MR imaging of pancreatic changes in patients with transfusion-dependent beta-thalassemia major. AJR Am. J. Roentgenol. 173, 187–192 (1999).

    CAS  PubMed  Google Scholar 

  79. Park, C. M., Han, J. K., Kim, T. K. & Choi, B. I. Fat replacement with absence of acinar and ductal structure in the pancreatic body and tail. J. Comput. Assist. Tomogr. 24, 893–895 (2000).

    CAS  PubMed  Google Scholar 

  80. Fernandes-Santos, C., Evangelista, C. R., de Souza, M. L., Barbosa, A. M. & Mandarim-de-Lacerda, C. A. Rosiglitazone aggravates nonalcoholic Fatty pancreatic disease in C57BL/6 mice fed high-fat and high-sucrose diet. Pancreas 38, e80–e86 (2009).

    CAS  PubMed  Google Scholar 

  81. Watanabe, S., Abe, K., Anbo, Y. & Katoh, H. Changes in the mouse exocrine pancreas after pancreatic duct ligation: a qualitative and quantitative histological study. Arch. Histol. Cytol. 58, 365–374 (1995).

    CAS  PubMed  Google Scholar 

  82. Kimura, W. Histological study on pathogenesis of sites of isolated islets of Langerhans and their course to the terminal state. Am. J. Gastroenterol. 84, 517–522 (1989).

    CAS  PubMed  Google Scholar 

  83. Sasaki, M., Nakanuma, Y. & Ando, H. Lipomatous pseudohypertrophy of the pancreas in a patient with cirrhosis due to chronic hepatitis B. Pathol. Int. 48, 566–568 (1998).

    CAS  PubMed  Google Scholar 

  84. Diamond, I. & Vallbona, C. Kwashiorkor in a North American white male. Pediatrics 25, 248–257 (1960).

    CAS  PubMed  Google Scholar 

  85. Chehter, E. Z., Longo, M. A., Laudanna, A. A. & Duarte, M. I. Involvement of the pancreas in AIDS: a prospective study of 109 post-mortems. AIDS 14, 1879–1886 (2000).

    CAS  PubMed  Google Scholar 

  86. Olufadi, R. & Byrne, C. D. Clinical and laboratory diagnosis of the metabolic syndrome. J. Clin. Pathol. 61, 697–706 (2008).

    CAS  PubMed  Google Scholar 

  87. Musso, G. et al. Should nonalcoholic fatty liver disease be included in the definition of metabolic syndrome? A cross-sectional comparison with Adult Treatment Panel III criteria in nonobese nondiabetic subjects. Diabetes Care 31, 562–568 (2008).

    CAS  PubMed  Google Scholar 

  88. Kahn, S. E., Hull, R. L. & Utzschneider, K. M. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature 444, 840–846 (2006).

    CAS  PubMed  Google Scholar 

  89. van Raalte, D. H., van der Zijl, N. J. & Diamant, M. Pancreatic steatosis in humans: cause or marker of lipotoxicity? Curr. Opin. Clin. Nutr. Metab. Care 13, 478–485 (2010).

    CAS  PubMed  Google Scholar 

  90. Lee, Y. et al. β-cell lipotoxicity in the pathogenesis of non-insulin-dependent diabetes mellitus of obese rats: impairment in adipocyte-β-cell relationships. Proc. Natl Acad. Sci. USA 91, 10878–10882 (1994).

    CAS  PubMed  PubMed Central  Google Scholar 

  91. van der Zijl, N. J. et al. Ectopic fat storage in the pancreas, liver, and abdominal fat depots: impact on β-cell function in individuals with impaired glucose metabolism. J. Clin. Endocrinol. Metab. doi:10.1210/jc.2010–1722.

  92. Szendroedi, J. & Roden, M. Ectopic lipids and organ function. Curr. Opin. Lipidol. 20, 50–56 (2009).

    CAS  PubMed  Google Scholar 

  93. DiMagno, E. P., Go, V. L. & Summerskill, W. H. Relations between pancreatic enzyme ouputs and malabsorption in severe pancreatic insufficiency. N. Engl. J. Med. 288, 813–815 (1973).

    CAS  PubMed  Google Scholar 

  94. Savvina, T. V. A histotopographic study of the pancreas in lipomatosis [Russian]. Arkh. Patol. 38, 68–73 (1976).

    CAS  PubMed  Google Scholar 

  95. Dupont, C. et al. Pancreatic lipomatosis and duodenal stenosis or atresia in children. J. Pediatr. 115, 603–605 (1989).

    CAS  PubMed  Google Scholar 

  96. So, C. B., Cooperberg, P. L., Gibney, R. G. & Bogoch, A. Sonographic findings in pancreatic lipomatosis. AJR Am. J. Roentgenol. 149, 67–68 (1987).

    CAS  PubMed  Google Scholar 

  97. Aubert, A. et al. Diffuse primary fat replacement of the pancreas: an unusual cause of steatorrhea [French]. Gastroenterol. Clin. Biol. 31, 303–306 (2007).

    PubMed  Google Scholar 

  98. Martínez, J. et al. Is obesity a risk factor in acute pancreatitis? A meta-analysis. Pancreatology 4, 42–48 (2004).

    PubMed  Google Scholar 

  99. Martínez, J. et al. Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis. Pancreatology. 6, 206–209 (2006).

    PubMed  Google Scholar 

  100. Zyromski, N. J. et al. A murine model of obesity implicates the adipokine milieu in the pathogenesis of severe acute pancreatitis. Am. J. Physiol. Gastrointest. Liver Physiol. 295, G552–G558 (2008).

    CAS  PubMed  Google Scholar 

  101. Lankisch, P. G. & Schirren, C. A. Increased body weight as a prognostic parameter for complications in the course of acute pancreatitis. Pancreas 5, 626–629 (1990).

    CAS  PubMed  Google Scholar 

  102. Suazo-Baráhona, J. et al. Obesity: a risk factor for severe acute biliary and alcoholic pancreatitis. Am. J. Gastroenterol. 93, 1324–1328 (1998).

    PubMed  Google Scholar 

  103. Blomgren, K. B., Sundström, A., Steineck, G. & Wiholm, B. E. Obesity and treatment of diabetes with glyburide may both be risk factors for acute pancreatitis. Diabetes Care 25, 298–302 (2002).

    CAS  PubMed  Google Scholar 

  104. Funnell, I. C., Bornman, P. C., Weakley, S. P., Terblanche, J. & Marks, I. N. Obesity: an important prognostic factor in acute pancreatitis. Br. J. Surg. 80, 484–486 (1993).

    CAS  PubMed  Google Scholar 

  105. Frossard, J. L., Lescuyer, P. & Pastor, C. M. Experimental evidence of obesity as a risk factor for severe acute pancreatitis. World J. Gastroenterol. 15, 5260–5265 (2009).

    CAS  PubMed  PubMed Central  Google Scholar 

  106. Ronti, T., Lupattelli, G. & Mannarino, E. The endocrine function of adipose tissue: an update. Clin. Endocrinol. (Oxf.) 64, 355–365 (2006).

    CAS  Google Scholar 

  107. Shoelson, S. E., Herrero, L. & Naaz, A. Obesity, inflammation, and insulin resistance. Gastroenterology 132, 2169–2180 (2007).

    CAS  PubMed  Google Scholar 

  108. McCullough, A. J. Pathophysiology of nonalcoholic steatohepatitis. J. Clin. Gastroenterol. 40 (Suppl. 1), S17–S29 (2006).

    CAS  PubMed  Google Scholar 

  109. Norman, J. G. New approaches to acute pancreatitis: role of inflammatory mediators. Digestion 60 (Suppl. 1), 57–60 (1999).

    CAS  PubMed  Google Scholar 

  110. Pitt, H. A. Hepato-pancreato-biliary fat: the good, the bad and the ugly. HPB (Oxford) 9, 92–97 (2007).

    Google Scholar 

  111. Vaino, H. & Bianchini, F. IARC Handbook of Cancer Prevention: Weight Control and Physical Activity Vol. 6 (IARC Press, Lyon, 2002).

    Google Scholar 

  112. Joint WHO/FAO expert consultation. Diet, nutrition and the prevention of chronic diseases. [online], (2003).

  113. Larsson, S. C., Orsini, N. & Wolk, A. Body mass index and pancreatic cancer risk: a meta-analysis of prospective studies. Int. J. Cancer 120, 1993–1998 (2007).

    CAS  PubMed  Google Scholar 

  114. Gumbs, A. A., Bessler, M., Milone, L., Schrope, B. & Chabot, J. Contribution of obesity to pancreatic carcinogenesis. Surg. Obes. Relat. Dis. 4, 186–193 (2008).

    PubMed  Google Scholar 

  115. Zyromski, N. J. et al. Obesity potentiates the growth and dissemination of pancreatic cancer. Surgery 146, 258–263 (2009).

    PubMed  Google Scholar 

  116. Toyama, N. et al. Pancreas head carcinoma with total fat replacement of the dorsal exocrine pancreas. J. Gastroenterol. 39, 76–80 (2004).

    PubMed  Google Scholar 

  117. Eriguchi, N. et al. Insulinoma occurring in association with fatty replacement of unknown etiology in the pancreas: report of a case. Surg. Today 30, 937–941 (2000).

    CAS  PubMed  Google Scholar 

  118. Shimizu, M., Hirokawa, M., Matsumoto, T., Iwamoto, S. & Manabe, T. Fatty replacement of the pancreatic body and tail associated with leiomyosarcoma of the pancreatic head. Pathol. Int. 47, 633–636 (1997).

    CAS  PubMed  Google Scholar 

  119. Cohen, D. J. & Fagelman, D. Pancreas islet cell carcinoma with complete fatty replacement: CT characteristics. J. Comput. Assist. Tomogr. 10, 1050–1051 (1986).

    CAS  PubMed  Google Scholar 

  120. Lee, S. E. et al. Measurement of pancreatic fat by magnetic resonance imaging: predicting the occurrence of pancreatic fistula after pancreatoduodenectomy. Ann. Surg. 251, 932–936 (2010).

    PubMed  Google Scholar 

  121. Hanish, S. I. et al. Obesity predicts increased overall complications following pancreas transplantation. Transplant. Proc. 37, 3564–3566 (2005).

    CAS  PubMed  Google Scholar 

  122. Humar, A. et al. The impact of donor obesity on outcomes after cadaver pancreas transplants. Am. J. Transplant. 4, 605–610 (2004).

    PubMed  Google Scholar 

  123. Nghiem, D. D., Olson, P. R. & Ormond, D. The “fatty pancreas allograft”: anatomopathologic findings and clinical experience. Transplant. Proc. 36, 1045–1047 (2004).

    CAS  PubMed  Google Scholar 

  124. Kaddis, J. S., Danobeitia, J. S., Niland, J. C., Stiller, T. & Fernandez, L. A. Multicenter analysis of novel and established variables associated with successful human islet isolation outcomes. Am. J. Transplant. 10, 646–656 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  125. Hanley, S. C., Paraskevas, S. & Rosenberg, L. Donor and isolation variables predicting human islet isolation success. Transplantation 85, 950–955 (2008).

    PubMed  Google Scholar 

  126. Cavallini, G., Frulloni, L., Vaona, B., Di, Francesco, V. & Bovo, P. Is hyperamylasemia related to dyslipidemia? Gastroenterology 112, 1058–1059 (1997).

    CAS  PubMed  Google Scholar 

  127. Gullo, L. et al. Can. pancreatic steatosis explain the finding of pancreatic hyperenzymemia in subjects with dyslipidemia? Pancreas 33, 351–353 (2006).

    PubMed  Google Scholar 

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Acknowledgements

We would like to thank T. L. Bollen for supplying the CT images of pancreatic steatosis.

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Authors and Affiliations

  1. Department of Gastroenterology & Hepatology, Vrije Universiteit University Medical Center, De Boelelaan 1117, Amsterdam, 1081, HV, The Netherlands

    Mark M. Smits & Erwin J. M. van Geenen

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  1. Mark M. Smits
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  2. Erwin J. M. van Geenen
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M. M Smits researched data for the article and both M. M. Smits and E. J. M. van Geenen contributed equally to the discussions, writing, editing and reviewing of the article.

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Correspondence to Mark M. Smits.

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Smits, M., van Geenen, E. The clinical significance of pancreatic steatosis. Nat Rev Gastroenterol Hepatol 8, 169–177 (2011). https://doi.org/10.1038/nrgastro.2011.4

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