Nonalcoholic fatty pancreas disease: An emerging clinical challenge

Abstract

Nonalcoholic fatty pancreas disease (NAFPD) is an emerging disease that has gained an increasing amount of attention in recent years. It describes fat accumulation in the pancreas with insignificant alcohol consumption, but the pathogenesis is largely unknown. A wide range of terms have been used to describe the phenomenon of pancreatic fat accumulation, but NAFPD remains an under-recognized and non-independent disorder. Obesity, age, sex, race, and unhealthy lifestyle are established independent risk factors for NAFPD, which is strongly associated with metabolic syndrome, type 2 diabetes, pancreatitis, pancreatic fistula, pancreatic cancer, and nonalcoholic fatty liver disease. At present, imaging techniques are common diagnostic aids, but uniform criteria and consensus are lacking. Therapeutically, healthy diet, weight loss, and exercise are the mainstays to reduce pancreatic fat accumulation. It can be seen that there is a limited understanding of NAFPD at this stage and further exploration is needed. Previous studies have revealed that NAFPD may directly affect diagnosis and clinical decision-making. Therefore, exploring the pathophysiological mechanism and clinical associations of NAFPD is a major challenge for researchers and clinicians.

Quantitative Assessment of Pancreatic Fat by Quantitative CT in Type 2 Diabetes Mellitus

“… 19 , 20 While most of the PFD do not lead to specific clinical symptoms in the early stage, as disease progresses, pancreatic atrophy, degeneration, and pancreatic steatosis can lead to chronic pancreatitis and pancreatic fibrosis, resulting in decreased release of pancreatic enzymes, as referred of pancreatic endocrine and exocrine dysfunction. 21 , 22 Chronic exposure to a high-fat diet has been reported to induce interlobular and intralobular fat accumulation, inflammatory cell infiltration, and pancreatic fibrosis, thereby impairing normal pancreatic architecture and islet function in rats. 23 , 24 Similarly, pancreas of high-fat diet-fed C57BL/6 mice developed intracellular lipid vesicles in acinar cells, fatty infiltration, and ectopic deposition of interlobular fat, making mice insulin resistant and β-cell dysfunction.…”

Liver-derived metabolites as signaling molecules in fatty liver disease

“…Although LPL expression in the pancreas is relatively low, evidence indicates that elevated VLDL levels contribute to the development of pancreatitis, as a common condition among obese and T2D patients [ 41 , 42 ], and are further known to be associated with fatty liver disease [ 43 ]. In mice, deletion of the VLDLR in pancreatic stellate cells ameliorates the development of pancreatitis [ 44 ].…”

Hepato-pancreatic fat-fetuin A based axis in context of diabetes and its reversal

“…NAFPD has been linked with several metabolic risk factors primarily obesity, age, and non-alcoholic fatty liver disease (NAFLD). 8 Since NAFLD has a strong association with T2DM, it stands to reason that NAFPD would show a similar association. 8 Besides obesity, age, and NAFLD, the etiopathogenesis of NAFPD includes alcohol consumption, malnutrition, low birth weight, drugs such as rosiglitazone, steroids, octreotide, and gemcitabine; and rare disorders such as cystic fibrosis, b-thalassemia, Diamond-Blackfan anemia, and hereditary hemochromatosis.…”

“…8 Since NAFLD has a strong association with T2DM, it stands to reason that NAFPD would show a similar association. 8 Besides obesity, age, and NAFLD, the etiopathogenesis of NAFPD includes alcohol consumption, malnutrition, low birth weight, drugs such as rosiglitazone, steroids, octreotide, and gemcitabine; and rare disorders such as cystic fibrosis, b-thalassemia, Diamond-Blackfan anemia, and hereditary hemochromatosis. The clinical consequences of pancreatic fat include impaired insulin secretion, chronic pancreatitis, possible link to pancreatic cancer, and exocrine dysfunction.…”