Background Ectopic visceral fat is a major risk factor for obesity complications including insulin resistance and metabolic syndrome. Ultrasonography is a simple bedside screening tool used for the assessment of ectopic visceral fat including fatty pancreas. This study investigates the association between insulin resistance, metabolic syndrome and fatty pancreas detected by ultrasound in children with obesity. Methods This case-control study included 50 prepubertal obese (body mass index [BMI] ≥95th age- and sex-specific percentiles) and 30 lean children (BMI 5th–85th age- and sex-specific percentiles) as the control group. Clinical and laboratory parameters of metabolic syndrome including anthropometric indices of central obesity, blood pressure, fasting glucose and lipid profile were measured. Homeostasis model assessment-insulin resistance (HOMA-IR) was used to assess insulin resistance. Ultrasonographic assessment for pancreatic fat was done for all children. Results Fifty-eight percent of obese children had fatty pancreas. Obese children with fatty pancreas had a higher rate of metabolic syndrome (p=0.013) and insulin resistance than those with non-fatty pancreas (p=0.012). Regression analysis revealed that fatty pancreas is an independent predictor of metabolic syndrome and insulin resistance. Fatty pancreas increases the risk for metabolic syndrome (odds ratio [OR] 11.40; 95% confidence interval [CI]: 2.69–48.22) and insulin resistance (OR 7.85; 95% CI: 2.20–28.05) in children with obesity. Conclusions Obese children have higher pancreatic fat accumulation than lean children. Obese children with fatty pancreas are more susceptible to insulin resistance and metabolic syndrome.

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