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Presence of fat in the pancreas increases the risk of metabolic co-morbidities. Detection and quantification of pancreatic fat is not a routine clinical practice, at least in part because of need to use expensive imaging techniques. We aimed to systematically review common markers of pancreatic fat in blood and to investigate differences in these markers associated with fatty pancreas. The search was conducted in 3 databases (EMBASE, Scopus, and MEDLINE). Studies in humans were eligible for inclusion if they reported on biological markers and percentage of pancreatic fat or fatty pancreas prevalence. Data were pooled for correlation and effect size meta-analysis. A total of 17 studies including 11 967 individuals were eligible for meta-analysis. Markers of lipid metabolism, including circulating triglycerides (r = 0.38 [95% confidence interval (CI) 0.31, 0.46]) and high-density lipoprotein cholesterol (r = -0.33 [95% CI -0.35, -0.31]), and markers of glucose metabolism, including glycated haemoglobin (r = 0.39 [95% CI 0.30, 0.48], insulin (r = 0.38 [95% CI 0.33, 0.43]), and homeostasis model assessment-insulin resistance (r = 0.37 [95% CI 0.30, 0.44], yielded the best correlations with percentage of pancreatic fat. Further, effect size analysis showed large and medium effects for the above markers of lipid and glucose metabolism. Circulating levels of triglycerides and glycated haemoglobin appear to be the best currently available markers of pancreatic fat. The approach of non-invasive and accurate detection of pancreatic fat by blood analysis should be further explored in the future, by investigating other potential biological markers of pancreatic fat.

MS.Relationship between pancreatic hormones and glucose metabolism: A cross-sectional study in patients after acute pancreatitis. Am J Physiol Gastrointest Liver Physiol 311: G50 -G58, 2016. First published May 12, 2016 doi:10.1152/ajpgi.00074.2016.-Abnormal glucose metabolism is present in almost 40% of patients after acute pancreatitis, but its pathophysiology has been poorly investigated. Pancreatic hormone derangements have been sparingly studied to date, and their relationship with abnormal glucose metabolism is largely unknown. The aim was to investigate the associations between pancreatic hormones and glucose metabolism after acute pancreatitis, including the effect of potential confounders. This was a cross-sectional study of 83 adult patients after acute pancreatitis. Fasting venous blood was collected from all patients and used for analysis of insulin, glucagon, pancreatic polypeptide, amylin, somatostatin, C-peptide, glucose, and hemoglobin A1c. Statistical analyses were conducted using the modified Poisson regression, multivariable linear regression, and Spearman's correlation. Age, sex, body mass index, recurrence of acute pancreatitis, duration from first attack, severity, and etiology were adjusted for. Increased insulin was significantly associated with abnormal glucose metabolism after acute pancreatitis, in both unadjusted (P ϭ 0.038) and adjusted (P ϭ 0.001) analyses. Patients with abnormal glucose metabolism also had significantly decreased pancreatic polypeptide (P ϭ 0.001) and increased amylin (P ϭ 0.047) in adjusted analyses. Somatostatin, C-peptide, and glucagon were not changed significantly in both unadjusted and adjusted analyses. Increased insulin resistance and reduced insulin clearance may be important components of hyperinsulinemic compensation in patients after acute pancreatitis. Increased amylin and reduced pancreatic polypeptide fasting levels characterize impaired glucose homeostasis. Clinical studies investigating islet-cell hormonal responses to mixed-nutrient meal testing and euglycemichyperinsulinemic clamps are now warranted for further insights into the role of pancreatic hormones in glucose metabolism derangements secondary to pancreatic diseases. acute pancreatitis; glucose metabolism; insulin; amylin; pancreatic polypeptide THE PANCREAS, A DUAL GLAND with both endocrine and exocrine functions, plays a key role in the development of both diabetes and pancreatitis. Diabetes mellitus (DM) is one of the most prevalent chronic diseases and contributes significantly to allcause worldwide mortality, with one in 12 adult deaths attributed to it (15a, 16). Acute pancreatitis (AP) is the most common cause of gastrointestinal-related hospitalizations in the Western countries, with over 270,000 patients requiring hospitalization each year in the United States alone (19). A recent comprehensive systematic review and meta-analysis of prospective clinical studies (11) showed that abnormal glucose metabolism (AGM) after an episode of AP is present in nearly 40% of patients without h...

The pancreas plays a central role in metabolism and is involved in the pathogenesis of several diseases. Pancreas volume is a holistic quantitative measure of pancreas size but the clinical relevance of pancreas volumetry is poorly understood. Areas covered: The aim was to systematically review studies in adults that used computed tomography or magnetic resonance imaging to measure pancreas volume in health and disease, to determine normal pancreas volume range, and to quantify changes in pancreas volume that are associated with disease. Expert commentary: The normal pancreas volume range in adults is 71-83 cm, with no statistically significant difference between men and women. Type 2 diabetes and type 1 diabetes are associated with a progressively reduced pancreas volume. Overweight and obesity are associated with a progressively increased pancreas volume. There is a paucity of studies on pancreas volume in the setting of diseases of the exocrine pancreas, which should become a research priority in the future.

There have been many reports of altered pancreas size in diseases of the endocrine and exocrine pancreas, but few attempts to quantify such changes. The aim of this study was to conduct a systematic literature review, documenting the methodology, and quantitative data in studies reporting on pancreas size. Three electronic databases (Embase, Scopus, and MEDLINE) were searched by two reviewers independently. Studies of humans were included if they compared pancreas size (reported as pancreas diameters, areas, and/or lengths) between diseased populations and controls. A total of 28 studies with 3,810 individuals were included. Among these, 22 measured pancreas diameters, seven measured pancreas areas, and one measured pancreas lengths. The most common landmark for the head of the pancreas was the confluence of the superior mesenteric and splenic veins (three out of nine studies, 33.3%); for the body it was the superior mesenteric artery (seven out of nine, 77.8%); for the tail it was the internal border of the left kidney (two out of six, 33.3%). Pancreas diameters and areas tended to be smaller in diabetes mellitus, the extent of reduction being greater in individuals with type 1 than type 2 diabetes. Pancreas diameters tended to be greater in acute pancreatitis and pancreatic cancer but not in chronic pancreatitis. Pancreas diameters are a clinically relevant measure for diseases of the endocrine and exocrine pancreas. Consensus guidelines need to be developed to standardize their measurements. Clin. Anat. 31:913-926, 2018. © 2018 Wiley Periodicals, Inc.