Metabolic implications of pancreatic fat accumulation

• Published in: Nature reviews. Endocrinology 2022-01, Vol.18 (1), p.43-54
• Main Authors: Wagner, Robert, Eckstein, Sabine S., Yamazaki, Hajime, Gerst, Felicia, Machann, Jürgen, Jaghutriz, Benjamin Assad, Schürmann, Annette, Solimena, Michele, Singer, Stephan, Königsrainer, Alfred, Birkenfeld, Andreas L., Häring, Hans-Ulrich, Fritsche, Andreas, Ullrich, Susanne, Heni, Martin
• Format: Article
• Language: English
• Subjects: 692/163/2743/137; 692/163/2743/2037; Adipose tissue; Adipose Tissue - metabolism; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - metabolism; Endocrinology; Fatty liver; Glucose metabolism; Humans; Insulin; Insulin Resistance; Insulin secretion; Liver diseases; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medicine; Medicine & Public Health; Metabolic syndrome; Metabolism; Non-alcoholic Fatty Liver Disease - metabolism; Pancreas; Pancreas - diagnostic imaging; Pancreas - metabolism; Prediabetic State - metabolism; Review Article
• ISSN: 1759-5029; 1759-5037
• DOI: 10.1038/s41574-021-00573-3

Fat accumulation outside subcutaneous adipose tissue often has unfavourable effects on systemic metabolism. In addition to non-alcoholic fatty liver disease, which has received considerable attention, pancreatic fat has become an important area of research throughout the past 10 years. While a number of diagnostic approaches are available to quantify pancreatic fat, multi-echo Dixon MRI is currently the most developed method. Initial studies have shown associations between pancreatic fat and the metabolic syndrome, impaired glucose metabolism and type 2 diabetes mellitus. Pancreatic fat is linked to reduced insulin secretion, at least under specific circumstances such as prediabetes, low BMI and increased genetic risk of type 2 diabetes mellitus. This Review summarizes the possible causes and metabolic consequences of pancreatic fat accumulation. In addition, potential therapeutic approaches for addressing pancreatic fat accumulation are discussed. There is growing evidence that fat accumulation in the pancreas can have consequences for metabolic health. This Review discusses the methods for detecting pancreatic fat and the potential causes and pathogenic consequences of pancreatic fat accumulation. Key points A number of studies have demonstrated a link between pancreatic fat and impaired glucose metabolism, as well as between pancreatic fat and type 2 diabetes mellitus. Possible causes of pancreatic steatosis include the metabolic syndrome, non-alcoholic fatty liver disease, alcohol consumption and specific genetic diseases. Chronic accumulation of fat in the pancreas can lead to chronic pancreatitis, pancreatic neoplasia, disturbed glucose metabolism and impaired insulin secretion. Different approaches, such as a hypocaloric diet, exercise, bariatric surgery and pharmacological interventions, can reduce pancreatic fat content. Preliminary evidence shows that a reduction in pancreatic fat improves insulin metabolism, but further experimental evidence is needed to untangle the underlying mechanisms.