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. 2020 Sep;15(9):e12653.
doi: 10.1111/ijpo.12653. Epub 2020 Apr 29.

The relationship between pancreas steatosis and the risk of metabolic syndrome and insulin resistance in Chinese adolescents with concurrent obesity and non-alcoholic fatty liver disease

Chileka Chiyanika  1 , Dorothy F Y Chan  2 , Steve C N Hui  1   3 , Hung-Kwan So  4 , Min Deng  1 , David K W Yeung  1   5 , E Anthony S Nelson  2 , Winnie C W Chu  1
Affiliations

The relationship between pancreas steatosis and the risk of metabolic syndrome and insulin resistance in Chinese adolescents with concurrent obesity and non-alcoholic fatty liver disease

Chileka Chiyanika et al. Pediatr Obes. 2020 Sep.

Abstract

Background: The incidence of childhood obesity and associated comorbidities are on an increasing trend worldwide. More than 340 million children and adolescents aged between 5 and 19 years old were overweight or had obesity in 2016, from which over 124 million children and adolescents (6% of girls and 8% of boys) had obesity.

Objective: To describe the relationship between pancreas steatosis, body fat and the risk of metabolic syndrome, insulin resistance in Hong Kong Chinese adolescents with both obesity and non-alcoholic fatty liver disease (NAFLD).

Methods: Fifty two adolescents with obesity and NAFLD were analysed (14-18 years), stratified into fatty and non-fatty pancreas groups using chemical shift encoded MRI-pancreas proton density fat fraction ≥5%. Pancreatic, abdominal subcutaneous adipose tissue (SAT)/visceral adipose tissue (VAT) volumes, biochemical and anthropometric parameters were measured. Mann-Whitney U test, multiple linear/binary logistic regression analyses and odds ratios were used.

Results: Fifty percent had fatty pancreas, 38% had metabolic syndrome and 81% had insulin resistance. Liver proton density fat fraction (PDFF) and VAT were independent predictors of insulin resistance (P = .006, .016). Pancreas and liver PDFF were both independent predictors of beta cells dysfunction (P = .015, .050) and metabolic syndrome (P = .021, .041). Presence of fatty pancreas in obesity was associated with insulin resistance (OR = 1.58, 95% CI = 0.39-6.4) and metabolic syndrome (OR = 1.70, 95% CI = 0.53-5.5).

Conclusion: A significant causal relationship exists between fatty pancreas, fatty liver, body fat and the risk of developing metabolic syndrome and insulin resistance.

Key points: Fatty pancreas is a common finding in adolescents with obesity, with a prevalence rate of 50% in this study cohort. Liver PDFF and VAT are independent predictors of insulin resistance while pancreas PDFF and liver PDFF are independent predictors of both beta cells dysfunction and metabolic syndrome. Presence of fatty pancreas at imaging should not be considered as a benign finding but rather as an imaging biomarker of emerging pancreatic metabolic and endocrine dysfunction.

Keywords: fatty liver; insulin resistance; magnetic resonance imaging; metabolic syndrome; pancreas.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the study subjects. NAFLD = Non‐alcoholic fatty liver disease, BMI = Body Mass Index, calculated as body weight in kilograms divided by height in metre squared, MRS = Magnetic resonance spectroscopy, PDFF = proton density fat fraction, CSE‐MRI = Chemical shift encoded magnetic resonance imaging
FIGURE 2
FIGURE 2
The regions of interest in the pancreas using chemical shift encoded MRI fat fraction image
FIGURE 3
FIGURE 3
The delineation of the pancreas in a single slice on an out of phase image at the level of the lower border of Lumbar 1 vertebrae
FIGURE 4
FIGURE 4
A, The original mDixon MRI fat fraction abdominal image of a single slice obtained at the level of lumbar 3 vertebrae. B, The extracted image from A, showing the subcutaneous adipose tissue (SAT) in colour pink and visceral adipose tissue (VAT) in colour blue using our validated in house method 31
See this image and copyright information in PMC

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