Obesity and intrapancreatic fatty infiltration are associated with increased risk of pancreatic cancer and its precursor lesions. The interplay among obesity, inflammation, and oncogenic Kras signaling promotes pancreatic tumorigenesis. Targeting the interaction between obesity-associated inflammation and Kras signaling may provide new strategies for prevention and therapy of pancreatic cancer. Clin Cancer Res; 21(15); 3369-71. Ó2015 AACR.See related article by Rebours et al., p. 3522 In this issue of Clinical Cancer Research, Rebours and colleagues (1) report that fatty infiltration in normal pancreas is associated with the body mass index (BMI), and the percentages of total fat area, visceral fat area, and subcutaneous fat area (SFA) in 110 patients who underwent pancreatic resection for well-differentiated pancreatic neuroendocrine tumors. They demonstrate that intralobular fibrosis and intralobular fatty infiltration of the pancreas are independently associated the presence of pancreatic intraepithelial neoplasia (PanIN), the precursor lesions of pancreatic ductal adenocarcinoma. The number of PanIN lesions increases with the severity of hepatic steatosis and the percentage of intrapancreatic fatty infiltration, but not with the percentage of SFA or BMI (1). This study provides a direct link between obesity, intrapancreatic fatty infiltration, and the risk of pancreatic cancer precursor lesions. Consistent with the findings from this study, prior reports have similarly underscored the deleterious association between intrapancreatic fatty infiltration with the increased risk of pancreatic ductal carcinoma (2). The association between obesity and the increased risk of pancreatic cancer has been well documented by both epidemiologic and experimental studies. In a large case-control study by Silverman and colleagues (3), obesity was associated with 50% to 60% increased risk of pancreatic cancer in both men and women. Compared with the group with the lowest quartile of BMI and caloric intake, the group with the highest quartile of BMI and caloric intake had a 180% higher risk of pancreatic cancer (3). In a pooled analysis of 2,170 cases and 2,209 control subjects from the Pancreatic Cancer Cohort Consortium (PanScan), the adjusted odds ratio (OR) for pancreatic cancer for the highest versus lowest quartile of BMI was 1.33[95% confidence interval (CI), 1.04-1.69] and 1.34 (95% CI, 1.05-1.70) in men and women, respectively (4). Overweight or obesity during early adulthood was associated not only with an increased risk of pancreatic cancer but also with the early onset of disease. In patients with pancreatic cancer, obesity was associated with poor survival (5). High-fat diet (HFD) has been shown to promote the growth and tumor cell turnover of human pancreatic cancer cells in an orthotopic xenograft study (6). These studies provided strong evidence that the obesity, particularly android obesity, and intrapancreatic fatty infiltration are associated with increased risk of pancreatic cancer and play an important r...