How to Cite
Vujasinovic, M., Demir, I. E., & all, et. (2026). Міжнародний міждисциплінарний консенсус щодо визначень, діагностичних критеріїв та лікування жирової дистрофії підшлункової залози: спільна заява, схвалена EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG та UEG. Herald of Pancreatic Club, 71(2), 4-383r. Retrieved from https://vkp.org.ua/index.php/journal/article/view/359
Abstract views: 40 PDF Downloads: 35
Abstract
У цьому міжнародному міждисциплінарному консенсусі вперше систематично визначається та характеризується жирова дистрофія підшлункової залози (ЖДПЗ). Ключовим його результатом є рекомендація прийняти термін «жирова дистрофія підшлункової залози» як стандартизоване та загальне поняття, що описує всі форми накопичення жиру в підшлунковій залозі (ПЗ). Цей термінологічний консенсус створює критичну основу для узгодженого звітування та клінічної комунікації. Ще одним важливим результатом доповіді є спільна позиція щодо діагностичних критеріїв на основі радіологічних та ендоскопічних моделей. Мета запропонованих критеріїв — посилити узгодженість клінічної оцінки та підтримати розробку стандартизованих протоколів досліджень. Крім встановлення термінології та діагностичних критеріїв, у консенсусі також узгоджуються загальноприйняті дані з відповідних галузей. Вони включають етіологію та епідеміологію ЖДПЗ, а також її зв’язок з вживанням алкоголю, курінням, гострим панкреатитом (ГП) та хронічним панкреатитом (ХП), екзокринною недостатністю підшлункової залози (ЕНПЗ), цукровим діабетом (ЦД) 2-го типу та наслідками хірургічного лікування. Крім того, розглядаються можливі зв’язки між ЖДПЗ та новоутвореннями, такими як внутрішньопротокова папілярна муцинозна неоплазія (ВПМН) та рак підшлункової залози (РПЗ), а також поточне розуміння метаболічних наслідків ЖДПЗ (функція бета-клітин і гомеостаз глюкози) та стратегій лікування. Під час обговорення консенсусу виникло питання обмеженої кількості високоякісних та перспективних клінічних даних. Тому багато рекомендацій у цій доповіді засновані на експертному консенсусі, а не на доказових даних. Це підкреслює нагальну потребу в подальших дослідженнях, зокрема, спрямованих на встановлення причинно-наслідкових зв’язків, валідацію засобів діагностики та визначення клінічної значущості ЖДПЗ для різних популяцій пацієнтів. Цей консенсус є узгодженням нашого розуміння та опорою для подальших досліджень, спрямованих на усунення поточних прогалин у знаннях та розвиток науково обґрунтованої клінічної практики в новій галузі.
References
1. Wagner R., Eckstein S. S., Yamazaki H. et al. Metabolic implications of pancreatic fat accumulation. Nat Rev Endocrinol. 2022; 18(1): 43–54.
2. Smits M. M., van Geenen E. J. The clinical significance of pancreatic steatosis. Nat Rev Gastroenterol Hepatol. 2011; 8(3): 169–77.
3. Ogilvie R. The island of Langerhans in 19 cases of obesity. J Pathol. 1933; 37: 473–81.
4. Váncsa S., Sipos Z., Váradi A. et al. Metabolic-associated fatty liver disease is associated with acute pancreatitis with more severe course: Post hoc analysis of a prospectively collected international registry. United European Gastroenterol J. 2023; 11(4): 371–82.
5. Vlăduț C., Steiner C., Löhr M. et al. High prevalence of pancreatic steatosis in pancreatic cancer patients: A meta-analysis and systematic review. Pancreatology. 2025; 25(1): 98–107.
6. Boltin D., Lambregts D. M., Jones F. et al. UEG framework for the development of high-quality clinical guidelines. United European Gastroenterol J. 2020; 8(8): 851–64.
7. Dominguez-Muñoz J. E., Vujasinovic M., de la Iglesia D. et al. European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations. United European Gastroenterol J. 2025; 13(1): 125–72.
8. Löhr J. M., Beuers U., Vujasinovic M. et al. European Guideline on IgG4-related digestive disease — UEG and SGF evidence-based recommendations. United European Gastroenterol J. 2020; 8(6): 637–66.
9. Löhr J. M., Dominguez-Munoz E., Rosendahl J. et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J. 2017; 5(2): 153–99.
10. Malagelada C., Keller J., Sifrim D. et al. European Guideline on Chronic Nausea and Vomiting-A UEG and ESNM Consensus for Clinical Management. United European Gastroenterol J. 2025; 13(3): 427–71.
11. Speckman R. A., Friedly J. L. Asking structured, answerable clinical questions using the Population, Intervention/Comparator, Outcome (PICO) Framework. Pm R. 2019; 11(5): 548–53.
12. Howick J., Chalmers I., Glasziou P. et al. Oxford centre for evidence-based medicine 2011 levels of evidence. Centre for Evidence-Based Medicine. Retrieved July from: https://www.cebm.net/wp‐content/uploads/2014/06/CEBM‐Levels‐of‐Evidence‐2.1.pdf.
13. Likert R. A technique for the measurement of attitudes. Archives of Psychology. 1932; 22: 1–55.
14. Boone H., Boone D. Analyzing Likert Data. The Journal of Extension. 2012; 50(2).
15. Olsen T. S. Lipomatosis of the pancreas in autopsy material and its relation to age and overweight. Acta Pathol Microbiol Scand A. 1978; 86a(5): 367–73.
16. Gullo L., Salizzoni E., Serra C. et al. Can pancreatic steatosis explain the finding of pancreatic hyperenzymemia in subjects with dyslipidemia? Pancreas. 2006; 33(4): 351–3.
17. Wang H., Maitra A., Wang H. Obesity, intrapancreatic fatty infiltration, and pancreatic cancer. Clin Cancer Res. 2015; 21(15): 3369–71.
18. Souza M., Silva G. P., Junior C. R. O. et al. Prevalence, clinical characteristics, and outcomes of fatty pancreas disease: an updated systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2025; 37(2): 137–46.
19. Robson H. N., Scott G. B. Lipomatous pseudohypertrophy of the pancreas. Gastroenterology. 1953; 23(1): 74–81.
20. Mathur A., Marine M., Lu D. et al. Nonalcoholic fatty pancreas disease. HPB (Oxford). 2007; 9(4): 312–8.
21. Singh R. G., Nguyen N. N., DeSouza S. V. et al. Comprehensive analysis of body composition and insulin traits associated with intra-pancreatic fat deposition in healthy individuals and people with new-onset prediabetes/diabetes after acute pancreatitis. Diabetes Obes Metab. 2019; 21(2): 417–23.
22. Kim M. K., Chun H. J., Park J. H. et al. The association between ectopic fat in the pancreas and subclinical atherosclerosis in type 2 diabetes. Diabetes Res Clin Pract. 2014; 106(3): 590–6.
23. Marks W. M., Filly R. A., Callen P. W. Ultrasonic evaluation of normal pancreatic echogenicity and its relationship to fat deposition. Radiology. 1980; 137(2): 475–9.
24. Redfield E. S., Jr. Isolated fat replacement of body and tail of pancreas; report of a case. U S Armed Forces Med J. 1950; 1(11): 1313–21.
25. Walters M. N. Adipose atrophy of the exocrine pancreas. J Pathol Bacteriol. 1966; 92(2): 547–57.
26. Targher G., Rossi A. P., Zamboni G. A. et al. Pancreatic fat accumulation and its relationship with liver fat content and other fat depots in obese individuals. J Endocrinol Invest. 2012; 35(8): 748–53.
27. Rinella M. E., Lazarus J. V., Ratziu V. et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023; 79(6): 1542–56.
28. Lilly A. C., Astsaturov I., Golemis E. A. Intrapancreatic fat, pancreatitis, and pancreatic cancer. Cell Mol Life Sci. 2023; 80(8): 206.
29. Stamm B. H. Incidence and diagnostic significance of minor pathologic changes in the adult pancreas at autopsy: a systematic study of 112 autopsies in patients without known pancreatic disease. Hum Pathol. 1984; 15(7): 677–83.
30. Coulier B. Pancreatic lipomatosis: An extensive pictorial review. J Belg Soc Radiol. 2016; 100(1): 39.
31. Al-Mrabeh A., Zhyzhneuskaya S. V., Peters C. et al. Hepatic lipoprotein export and remission of human type 2 diabetes after weight loss. Cell Metab. 2020; 31(2): 233–49.e4.
32. Raitano E., Cannella R., Messana D. et al. The role of fat in pancreatic diseases: from pathology to imaging. Journal of Medical Imaging and Interventional Radiology. 2024; 11(1): 26.
33. Soyer P., Spelle L., Pelage J. P. et al. Cystic fibrosis in adolescents and adults: fatty replacement of the pancreas — CT evaluation and functional correlation. Radiology. 1999; 210(3): 611–5.
34. Löhr M., Goertchen P., Nizze H. et al. Cystic fibrosis associated islet changes may provide a basis for diabetes. An immunocytochemical and morphometrical study. Virchows Arch A Pathol Anat Histopathol. 1989; 414(2): 179–85.
35. Raeder H., Haldorsen I. S., Ersland L. et al. Pancreatic lipomatosis is a structural marker in nondiabetic children with mutations in carboxyl-ester lipase. Diabetes. 2007; 56(2): 444–9.
36. Catanzaro R., Cuffari B., Italia A., Marotta F. Exploring the metabolic syndrome: Nonalcoholic fatty pancreas disease. World J Gastroenterol. 2016; 22(34): 7660–75.
37. Pinnick K. E., Collins S. C., Londos C. et al. Pancreatic ectopic fat is characterized by adipocyte infiltration and altered lipid composition. Obesity (Silver Spring). 2008; 16(3): 522–30.
38. Tong X., Dai C., Walker J. T. et al. Lipid droplet accumulation in human pancreatic islets is dependent on both donor age and health. Diabetes. 2020; 69(3): 342–54.
39. Horii T., Kozawa J., Fujita Y. et al. Lipid droplet accumulation in β cells in patients with type 2 diabetes is associated with insulin resistance, hyperglycemia and β cell dysfunction involving decreased insulin granules. Front Endocrinol (Lausanne). 2022; 13: 996716.
40. Olzmann J. A., Carvalho P. Dynamics and functions of lipid droplets. Nat Rev Mol Cell Biol. 2019; 20(3): 137–55.
41. Navina S., Acharya C., DeLany J. P. et al. Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci Transl Med. 2011; 3(107): 107ra10.
42. Schmitz-Moormann P., Pittner P. M., Heinze W. Lipomatosis of the pancreas. A morphometrical investigation. Pathol Res Pract. 1981; 173(1–2): 45–53.
43. Acharya C., Cline R. A., Jaligama D. et al. Fibrosis reduces severity of acute-on-chronic pancreatitis in humans. Gastroenterology. 2013; 145(2): 466–75.
44. Simsek H., Singh M. Effect of prolonged ethanol intake on pancreatic lipids in the rat pancreas. Pancreas. 1990; 5(4): 401–7.
45. Wilson J. S., Colley P. W., Sosula L. et al. Alcohol causes a fatty pancreas. A rat model of ethanol-induced pancreatic steatosis. Alcohol Clin Exp Res. 1982; 6(1): 117–21.
46. Stuart C. E., Ko J., Modesto A. E. et al. Implications of tobacco smoking and alcohol consumption on ectopic fat deposition in individuals after pancreatitis. Pancreas. 2020; 49(7): 924–34.
47. Wang C. Y., Ou H. Y., Chen M. F. et al. Enigmatic ectopic fat: prevalence of nonalcoholic fatty pancreas disease and its associated factors in a Chinese population. J Am Heart Assoc. 2014; 3(1): e000297.
48. Yamazaki H., Tauchi S., Kimachi M. et al. Association between pancreatic fat and incidence of metabolic syndrome: a 5-year Japanese cohort study. J Gastroenterol Hepatol. 2018; 33(12): 2048–54.
49. Wong V. W., Wong G. L., Yeung D. K. et al. Fatty pancreas, insulin resistance, and β-cell function: a population study using fat-water magnetic resonance imaging. Am J Gastroenterol. 2014; 109(4): 589–97.
50. Sepe P. S., Ohri A., Sanaka S. et al. A prospective evaluation of fatty pancreas by using EUS. Gastrointest Endosc. 2011; 73(5): 987–93.
51. Fujii M., Ohno Y., Yamada M. et al. Impact of fatty pancreas and lifestyle on the development of subclinical chronic pancreatitis in healthy people undergoing a medical checkup. Environ Health Prev Med. 2019; 24(1): 10.
52. Muftah A. A., Pecha R. L., Riojas Barrett M. et al. Pancreatic parenchymal changes seen on endoscopic ultrasound are dynamic in the setting of fatty pancreas: A short-term follow-up study. Pancreatology. 2022; 22(8): 1187–94.
53. Lee J. S., Kim S. H., Jun D. W. et al. Clinical implications of fatty pancreas: correlations between fatty pancreas and metabolic syndrome. World J Gastroenterol. 2009; 15(15): 1869–75.
54. Wu W. C., Wang C. Y. Association between non-alcoholic fatty pancreatic disease (NAFPD) and the metabolic syndrome: case-control retrospective study. Cardiovasc Diabetol. 2013; 12: 77.
55. Lesmana C. R., Pakasi L. S., Inggriani S. et al. Prevalence of Non-Alcoholic Fatty Pancreas Disease (NAFPD) and its risk factors among adult medical check-up patients in a private hospital: a large cross sectional study. BMC Gastroenterol. 2015; 15: 174.
56. Uygun A., Kadayifci A., Demirci H. et al. The effect of fatty pancreas on serum glucose parameters in patients with nonalcoholic steatohepatitis. Eur J Intern Med. 2015; 26(1): 37–41.
57. Zhou J., Li M. L., Zhang D. D. et al. The correlation between pancreatic steatosis and metabolic syndrome in a Chinese population. Pancreatology. 2016; 16(4): 578–83.
58. Li S., Su L., Lv G. et al. Transabdominal ultrasonography of the pancreas is superior to that of the liver for detection of ectopic fat deposits resulting from metabolic syndrome. Medicine (Baltimore). 2017; 96(37): e8060.
59. Wang D., Yu X. P., Xiao W. M. et al. Prevalence and clinical characteristics of fatty pancreas in Yangzhou, China: A cross-sectional study. Pancreatology. 2018; 18(3): 263–8.
60. Weng S., Zhou J., Chen X. et al. Prevalence and factors associated with nonalcoholic fatty pancreas disease and its severity in China. Medicine (Baltimore). 2018; 97(26): e11293.
61. Sotoudehmanesh R., Tahmasbi A., Sadeghi A. et al. The prevalence of nonalcoholic fatty pancreas by endoscopic ultrasonography. Pancreas. 2019; 48(9): 1220–4.
62. Koç U., Taydaş O. Evaluation of pancreatic steatosis prevalence and anthropometric measurements using non-contrast computed tomography. Turk J Gastroenterol. 2020; 31(9): 640–8.
63. Okada K., Watahiki T., Horie K. et al. The prevalence and clinical implications of pancreatic fat accumulation identified during a medical check-up. Medicine (Baltimore). 2021; 100(41): e27487.
64. Sezgin O., Yaraş S., Özdoğan O. Pancreatic steatosis is associated with both metabolic syndrome and pancreatic stiffness detected by ultrasound elastography. Dig Dis Sci. 2022; 67(1): 293–304.
65. Chen Y., Zhang P., Lv S. et al. Ectopic fat deposition and its related abnormalities of lipid metabolism followed by nonalcoholic fatty pancreas. Endosc Ultrasound. 2022; 11(5): 407–13.
66. Osman M. A. A., Alkhouly M., Elmohaseb G. F. et al. Relation between non-alcoholic fatty pancreas and clinical and biochemical parameters in women with polycystic ovary syndrome: A multi-centric study. Int J Gen Med. 2022; 15: 8225–33.
67. Berger Z., Orellana F., Cocio R. et al. Pancreatic steatosis: A frequent finding in a Chilean population. Rev Gastroenterol Mex (Engl Ed). 2023; 88(2): 118–24.
68. Abbasoğlu A., Karçaaltıncaba M., Karaosmanoğlu A. D. et al. Associations between hepatic and pancreatic steatosis with lumbar spinal bone marrow fat: A single-center magnetic resonance imaging study. Turk J Gastroenterol. 2023; 34(6): 618–25.
69. Maetzel H., Rutkowski W., Panic N. et al. Non-alcoholic fatty pancreas disease and pancreatic exocrine insufficiency: pilot study and systematic review. Scand J Gastroenterol. 2023; 58(9): 1030–7.
70. Sezgin O., Yaraş S., Cindoruk M. et al. Prevalence of pancreatic steatosis and its associated factors in Turkey: A nation-wide multicenter study. Turk J Gastroenterol. 2024; 35(3): 239–54.
71. Dong X., Zhu Q., Yuan C. et al. Associations of intrapancreatic fat deposition with incident diseases of the exocrine and endocrine pancreas: A UK Biobank Prospective Cohort Study. Am J Gastroenterol. 2024; 119(6): 1158–66.
72. Chung M. J., Park S. W., Lee K. J. et al. Clinical impact of pancreatic steatosis measured by CT on the risk of post-ERCP pancreatitis: a multicenter prospective trial. Gastrointest Endosc. 2024; 99(2): 214–23.e4.
73. Lee Y., Lingvay I., Szczepaniak L. S. et al. Pancreatic steatosis: harbinger of type 2 diabetes in obese rodents. Int J Obes (Lond). 2010; 34(2): 396–400.
74. Souza-Mello V., Gregório B. M., Relvas-Lucas B. et al. Pancreatic ultrastructural enhancement due to telmisartan plus sitagliptin treatment in diet-induced obese C57BL/6 mice. Pancreas. 2011; 40(5): 715–22.
75. Gotoh K., Inoue M., Shiraishi K. et al. Spleen-derived interleukin-10 downregulates the severity of high-fat diet-induced non-alcoholic fatty pancreas disease. PLoS One. 2012; 7(12): e53154.
76. Lipovšek S., Dolenšek J., Dariš B. et al. Western diet-induced ultrastructural changes in mouse pancreatic acinar cells. Front Cell Dev Biol. 2024; 12: 1380564.
77. Tremmel D. M., Feeney A. K., Mitchell S. A. et al. Hypertension, but not body mass index, is predictive of increased pancreatic lipid content and islet dysfunction. Am J Transplant. 2020; 20(4): 1105–15.
78. Dholakia S., Sharples E. J., Ploeg R. J., Friend P. J. Significance of steatosis in pancreatic transplantation. Transplant Rev (Orlando). 2017; 31(4): 225–31.
79. Kato S., Iwasaki A., Kurita Y. et al. Three-dimensional analysis of pancreatic fat by fat-water magnetic resonance imaging provides detailed characterization of pancreatic steatosis with improved reproducibility. PLoS One. 2019; 14(12): e0224921.
80. Nghiem D. D., Olson P. R., Ormond D. The "fatty pancreas allograft": anatomopathologic findings and clinical experience. Transplant Proc. 2004; 36(4): 1045–7.
81. Fullenkamp A. M., Bell L. N., Robbins R. D. et al. Effect of different obesogenic diets on pancreatic histology in Ossabaw miniature swine. Pancreas. 2011; 40(3): 438–43.
82. van Geenen E. J., Smits M. M., Schreuder T. C. et al. Smoking is related to pancreatic fibrosis in humans. Am J Gastroenterol. 2011; 106(6): 1161–6; quiz 7.
83. Gerst F., Wagner R., Kaiser G. et al. Metabolic crosstalk between fatty pancreas and fatty liver: effects on local inflammation and insulin secretion. Diabetologia. 2017; 60(11): 2240–51.
84. Klöppel G., Maillet B. Pseudocysts in chronic pancreatitis: a morphological analysis of 57 resection specimens and 9 autopsy pancreata. Pancreas. 1991; 6(3): 266–74.
85. van Geenen E. J., Smits M. M., Schreuder T. C. et al. Nonalcoholic fatty liver disease is related to nonalcoholic fatty pancreas disease. Pancreas. 2010; 39(8): 1185–90.
86. Wagner R., Jaghutriz B. A., Gerst F. et al. Pancreatic steatosis associates with impaired insulin secretion in genetically predisposed individuals. J Clin Endocrinol Metab. 2020; 105(11): 3518–25.
87. Angrisani M., Ceresoli M., Ippolito D. et al. Estimating fatty pancreas-A preoperative bedside assessment by bioelectric impedance analysis: Implications for pancreatic surgery. Pancreas. 2022; 51(4): 345–50.
88. Mathur A., Zyromski N. J., Pitt H. A. et al. Pancreatic steatosis promotes dissemination and lethality of pancreatic cancer. J Am Coll Surg. 2009; 208(5): 989–94; discussion 94–6.
89. Kim S. Y., Kim H., Cho J. Y. et al. Quantitative assessment of pancreatic fat by using unenhanced CT: pathologic correlation and clinical implications. Radiology. 2014; 271(1): 104–12.
90. Sugimoto M., Takahashi S., Kojima M. et al. In patients with a soft pancreas, a thick parenchyma, a small duct, and fatty infiltration are significant risks for pancreatic fistula after pancreaticoduodenectomy. J Gastrointest Surg. 2017; 21(5): 846–54.
91. Fukui H., Hori M., Fukuda Y. et al. Evaluation of fatty pancreas by proton density fat fraction using 3-T magnetic resonance imaging and its association with pancreatic cancer. Eur J Radiol. 2019; 118: 25–31.
92. Naik R. R., Rajan A., Kalita N. Automated image analysis method to detect and quantify fat cell infiltration in hematoxylin and eosin stained human pancreas histology images. BBA Adv. 2023; 3: 100084.
93. Fukuda Y., Yamada D., Eguchi H. et al. CT density in the pancreas is a promising imaging predictor for pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2017; 24(9): 2762–9.
94. Hori M., Takahashi M., Hiraoka N. et al. Association of pancreatic Fatty infiltration with pancreatic ductal adenocarcinoma. Clin Transl Gastroenterol. 2014; 5(3): e53.
95. Gaujoux S., Cortes A., Couvelard A. et al. Fatty pancreas and increased body mass index are risk factors of pancreatic fistula after pancreaticoduodenectomy. Surgery. 2010; 148(1): 15–23.
96. Tranchart H., Gaujoux S., Rebours V. et al. Preoperative CT scan helps to predict the occurrence of severe pancreatic fistula after pancreaticoduodenectomy. Ann Surg. 2012; 256(1): 139–45.
97. Rosso E., Casnedi S., Pessaux P. et al. The role of "fatty pancreas" and of BMI in the occurrence of pancreatic fistula after pancreaticoduodenectomy. J Gastrointest Surg. 2009; 13(10): 1845–51.
98. Rebours V., Gaujoux S., d’Assignies G. et al. Obesity and fatty pancreatic infiltration are risk factors for pancreatic precancerous lesions (PanIN). Clin Cancer Res. 2015; 21(15): 3522–8.
99. Yamashita Y., Ashida R., Kitano M. Imaging of fibrosis in chronic pancreatitis. Front Physiol. 2021; 12: 800516.
100. Majumder S., Philip N. A., Takahashi N. et al. Fatty pancreas: Should we be concerned? Pancreas. 2017; 46(10): 1251–8.
101. Worthen N. J., Beabeau D. Normal pancreatic echogenicity: relation to age and body fat. AJR Am J Roentgenol. 1982; 139(6): 1095–8.
102. Oh H., Park H. J., Oh J. et al. Hyperechoic pancreas on ultrasonography: an analysis of its severity and clinical implications. Ultrasonography. 2022; 41(2): 335–43.
103. Matsumoto S., Mori H., Miyake H. et al. Uneven fatty replacement of the pancreas: evaluation with CT. Radiology. 1995; 194(2): 453–8.
104. Ünal E., Karaosmanoğlu A. D., Akata D. et al. Invisible fat on CT: making it visible by MRI. Diagn Interv Radiol. 2016; 22(2): 133–40.
105. Previtali C., Sartoris R., Rebours V. et al. Quantitative imaging predicts pancreatic fatty infiltration on routine CT examination. Diagn Interv Imaging. 2023; 104(7–8): 359–67.
106. Reeder S. B., Sirlin C. B. Quantification of liver fat with magnetic resonance imaging. Magn Reson Imaging Clin N Am. 2010; 18(3): 337–57, ix.
107. Filippatos T. D., Alexakis K., Mavrikaki V., Mikhailidis D. P. Nonalcoholic fatty pancreas disease: Role in metabolic syndrome, "prediabetes," diabetes and atherosclerosis. Dig Dis Sci. 2022; 67(1): 26–41.
108. Djuric-Stefanovic A., Masulovic D., Kostic J. et al. CT volumetry of normal pancreas: correlation with the pancreatic diameters measurable by the cross-sectional imaging, and relationship with the gender, age, and body constitution. Surg Radiol Anat. 2012; 34(9): 811–7.
109. Sakai N. S., Taylor S. A., Chouhan M. D. Obesity, metabolic disease and the pancreas-Quantitative imaging of pancreatic fat. Br J Radiol. 2018; 91(1089): 20180267.
110. Kühn J. P., Berthold F., Mayerle J. et al. Pancreatic steatosis demonstrated at MR imaging in the general population: Clinical relevance. Radiology. 2015; 276(1): 129–36.
111. Idilman I. S., Tuzun A., Savas B. et al. Quantification of liver, pancreas, kidney, and vertebral body MRI-PDFF in non-alcoholic fatty liver disease. Abdom Imaging. 2015; 40(6): 1512–9.
112. Singh R. G., Yoon H. D., Wu L. M. et al. Ectopic fat accumulation in the pancreas and its clinical relevance: A systematic review, meta-analysis, and meta-regression. Metabolism. 2017; 69: 1–13.
113. Kim H. J., Byun J. H., Park S. H. et al. Focal fatty replacement of the pancreas: usefulness of chemical shift MRI. AJR Am J Roentgenol. 2007; 188(2): 429–32.
114. Yaman V., Arslan S. Lipomatous pseudohypertrophy of the pancreas: A rare disease with a novel imaging finding. Pancreas. 2025; 54(5): e494–5.
115. Karcaaltincaba M. CT differentiation of distal pancreas fat replacement and distal pancreas agenesis. Surg Radiol Anat. 2006; 28(6): 637–41.
116. Karaosmanoglu D., Karcaaltincaba M., Akata D. et al. Pancreatic lipoma computed tomography diagnosis of 17 patients and follow-up. Pancreas. 2008; 36(4): 434–6.
117. Smereczyński A., Kołaczyk K. Is a fatty pancreas a banal lesion? J Ultrason. 2016; 16(66): 273–80.
118. Pan Z., Chen Q., Lin H. et al. Enhanced accuracy and stability in automated intra-pancreatic fat deposition monitoring of type 2 diabetes mellitus using Dixon MRI and deep learning. Abdom Radiol (NY). 2025; 50: 3685–97.
119. Lin D., Wang Z., Li H. et al. Automated measurement of pancreatic fat deposition on Dixon MRI using nnU-Net. J Magn Reson Imaging. 2023; 57(1): 296–307.
120. Yang J. Z., Zhao J., Nemati R. et al. An adapted deep convolutional neural network for automatic measurement of pancreatic fat and pancreatic volume in clinical multi-protocol magnetic resonance images: a retrospective study with multi-ethnic external validation. Biomedicines. 2022; 10(11): 2991.
121. Ibrahim R. M., Solanki S., Qiao W. et al. Fatty pancreas on EUS: Risk factors, correlation with CT/MRI, and implications for pancreatic cancer screening. Endosc Ultrasound. 2025; 14(1): 13–9.
122. Kawamura A., Takakura K., Torisu Y. et al. Impact of qualitative endoscopic ultrasonography on fatty pancreas at a referral medical center. JGH Open. 2022; 6(1): 44–9.
123. Geeratragool T., Pausawasdi N., Angkathunyakul N. et al. Novel endoscopic ultrasound criteria for pancreatic steatosis: prospective study with histology as the gold standard. Gastrointestinal Endoscopy. 2024; 99: AB859.
124. Sbeit W., Greener T., Kadah A. et al. Pancreatic and hepatobiliary manifestations of nonalcoholic fatty pancreatic disease: a referral multi-center experience. Eur J Gastroenterol Hepatol. 2021; 33(1S Suppl 1): e297–e301.
125. Sbeit W., Khoury T. Fatty pancreas represents a risk factor for acute pancreatitis: A pilot study. Pancreas. 2021; 50(7): 990–3.
126. Abboud Y., Kim K., Samaan J. S. et al. Endoscopic ultrasound guided shear wave elastography is safe with high feasibility and reproducibility when used in the pancreas: findings from a prospective cohort. Pancreas. 2023; 52(2): e115–20.
127. Mohamed G., Zalomek C., El Helou M. et al. Endoscopic ultrasound guided shearwave elastography (EUS-SWE) predicts fat in the pancreas and correlates with fat-fraction on magnetic resonance imaging (MRI): results from a prospective study. Digestive Disease Week 2024: Gastrointestinal Endoscopy DDW ePoster Library; 2024.
128. Konikoff T., Loebl N., Benson A. A. et al. Enhancing detection of various pancreatic lesions on endoscopic ultrasound through artificial intelligence: a basis for computer-aided detection systems. J Gastroenterol Hepatol. 2025; 40(1): 235–40.
129. Matana Kaštelan Z., Brumini I., Poropat G. et al. Pancreatic iodine density and fat fraction on dual-energy computed tomography in acute pancreatitis. Diagnostics (Basel). 2024; 14(9): 955.
130. Al-Ani Z., Ko J., Petrov M. S. Intra-pancreatic fat deposition across the pancreatitis spectrum and the influence of gut hormones. Dig Liver Dis. 2023; 55(8): 1081–90.
131. Szentesi A., Párniczky A., Vincze Á. et al. Multiple hits in acute pancreatitis: Components of metabolic syndrome synergize each other's deteriorating effects. Front Physiol. 2019; 10: 1202.
132. Wongtrakul W., Untaaveesup S., Pausawadi N., Charatcharoenwitthaya P. Bidirectional association between non-alcoholic fatty liver disease and fatty pancreas: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2023; 35(10): 1107–16.
133. Yamazaki H., Heni M., Wagner R. et al. The causal effect of intrapancreatic fat deposition on acute and chronic pancreatitis: A Mendelian randomization study. Am J Gastroenterol. 2024; 119(12): 2540–4.
134. Park C. H., Chung M. J., Park D. H. et al. Impact of pancreatic fat on the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis. Surg Endosc. 2022; 36(8): 5734–42.
135. Prouvot C., Boumaiza M., Maoui K. et al. Pancreatic steatosis is a strong risk factor for post-ERCP pancreatitis: An emerging concept. Dig Liver Dis. 2025; 57(2): 542–8.
136. Bai X. H., Yin J., Yu S. Y. et al. Extracellular volume fraction derived from dual-energy CT: a potential predictor for acute pancreatitis after pancreatoduodenectomy. Eur Radiol. 2024; 34(11): 6957–66.
137. Partelli S., Andreasi V., Schiavo Lena M. et al. The role of acinar content at pancreatic resection margin in the development of postoperative pancreatic fistula and acute pancreatitis after pancreaticoduodenectomy. Surgery. 2021; 170(4): 1215–22.
138. Xie J., Xu L., Pan Y. et al. Nonalcoholic fatty pancreas disease is related independently to the severity of acute pancreatitis. Eur J Gastroenterol Hepatol. 2019; 31(8): 973–8.
139. Panc K., Gundogdu H., Sekmen S. et al. Liver and pancreatic fat fractions as predictors of disease severity in acute pancreatitis: an MRI IDEAL-IQ study. Abdom Radiol (NY). 2025; 50(8): 3734–43.
140. Mahmoudi S., Martin S., Koch V. et al. Value of dual-energy CT perfusion analysis in patients with acute pancreatitis: Correlation and discriminative diagnostic accuracy with varying disease severity. Diagnostics (Basel). 2022; 12(11): 2601.
141. Sbeit W., Abu Elheja F., Msheiil B. et al. Fatty pancreas was associated with a higher acute pancreatitis Systemic Inflammatory Response Syndrome score at hospital admission. Eur J Gastroenterol Hepatol. 2023; 35(9): 980–4.
142. Shintani S., Inatomi O., Bamba S. et al. Larger volume and higher fat content of the pancreatic head are predictive factors for postendoscopic retrograde cholangiopancreatography pancreatitis. Pancreas. 2022; 51(1): 28–34.
143. Pokhrel B., Choi E. K., Khalid O. et al. Increased fat in pancreas not associated with risk of pancreatitis post-endoscopic retrograde cholangiopancreatography. Clin Exp Gastroenterol. 2014; 7: 199–204.
144. Miyake H., Sakagami J., Yasuda H. et al. Association of fatty pancreas with pancreatic endocrine and exocrine function. PLoS One. 2018; 13(12): e0209448.
145. Vendrik K. E. W., Tonneijck L., Muskiet M. H. A. et al. Pancreatic steatosis is not associated with exocrine pancreatic function in overweight type 2 diabetes patients. Pancreas. 2017; 46(9): e75–6.
146. Kromrey M. L., Friedrich N., Hoffmann R. T. et al. Pancreatic steatosis is associated with impaired exocrine pancreatic function. Invest Radiol. 2019; 54(7): 403–8.
147. Rana S. S., Ancil S., Jayanna S. H. et al. Clinical features and outcomes of total pancreatic lipomatosis with chronic pancreatitis: a case series. Ann Gastroenterol. 2025; 38(1): 100–4.
148. Engjom T., Kavaliauskiene G., Tjora E. et al. Sonographic pancreas echogenicity in cystic fibrosis compared to exocrine pancreatic function and pancreas fat content at Dixon-MRI. PLoS One. 2018; 13(7): e0201019.
149. Otsuka N., Shimizu K., Taniai M., Tokushige K. Risk factors for fatty pancreas and effects of fatty infiltration on pancreatic cancer. Front Physiol. 2023; 14: 1243983.
150. Kashiwagi K., Seino T., Fukuhara S. et al. Pancreatic fat content detected by computed tomography and its significant relationship with intraductal papillary mucinous neoplasm. Pancreas. 2018; 47(9): 1087–92.
151. Sotozono H., Kanki A., Yasokawa K. et al. Value of 3-T MR imaging in intraductal papillary mucinous neoplasm with a concomitant invasive carcinoma. Eur Radiol. 2022; 32(12): 8276–84.
152. Evrimler S., Yip-Schneider M. T., Swensson J. et al. Magnetic resonance imaging-derived fat fraction predicts risk of malignancy in intraductal papillary mucinous neoplasm. Abdom Radiol (NY). 2021; 46(10): 4779–86.
153. Yamada D., Kobayashi S., Takahashi H. et al. Pancreatic CT density is an optimal imaging biomarker for earlier detection of malignancy in the pancreas with intraductal papillary mucinous neoplasm. Pancreatology. 2022; 22(4): 488–96.
154. Capurso G., Crippa S., Vanella G. et al. Factors associated with the risk of progression of low-risk branch-duct intraductal papillary mucinous neoplasms. JAMA Netw Open. 2020; 3(11): e2022933.
155. Sreedhar U. L., DeSouza S. V., Park B., Petrov M. S. A systematic review of intra-pancreatic fat deposition and pancreatic carcinogenesis. J Gastrointest Surg. 2020; 24(11): 2560–9.
156. Lipp M., Tarján D., Lee J. et al. Fatty pancreas is a risk factor for pancreatic cancer: A systematic review and meta-analysis of 2956 patients. Cancers (Basel). 2023; 15(19): 4876.
157. Chan C. H., Chang C. C., Peng Y. C. The clinical significance of pancreatic steatosis in pancreatic cancer: A hospital-based study. Diagnostics (Basel). 2024; 14(19).
158. Yamazaki H., Streicher S. A., Wu L. et al. Evidence for a causal link between intra-pancreatic fat deposition and pancreatic cancer: A prospective cohort and Mendelian randomization study. Cell Rep Med. 2024; 5(2): 101391.
159. Zhou L., Xiao W. M., Li C. P. et al. Impact of fatty pancreas on postoperative pancreatic fistulae: A meta-analysis. Front Oncol. 2021; 11: 622282.
160. Tanaka K., Yamada S., Hayashi M., Kodera Y. ASO authors reflections: Preoperative pancreatic fat and body composition measurements influence the incidence of grade B/C postoperative pancreatic fistula after pancreatectomy. Ann Surg Oncol. 2020; 27(Suppl 3): 746–7.
161. Tanaka K., Yamada S., Sonohara F. et al. Pancreatic fat and body composition measurements by computed tomography are associated with pancreatic fistula after pancreatectomy. Ann Surg Oncol. 2021; 28(1): 530–8.
162. Shi H. Y., Lu Z. P., Li M. N. et al. Dual-energy CT iodine concentration to evaluate postoperative pancreatic fistula after pancreatoduodenectomy. Radiology. 2022; 304(1): 65–72.
163. Lee S. E., Jang J. Y., Lim C. S. et al. Measurement of pancreatic fat by magnetic resonance imaging: predicting the occurrence of pancreatic fistula after pancreatoduodenectomy. Ann Surg. 2010; 251(5): 932–6.
164. Al-Haddad M., Khashab M., Zyromski N. et al. Risk factors for hyperechogenic pancreas on endoscopic ultrasound: a case-control study. Pancreas. 2009; 38(6): 672–5.
165. Kusafuka T., Kato H., Iizawa Y. et al. Pancreas-visceral fat CT value ratio and serrated pancreatic contour are strong predictors of postoperative pancreatic fistula after pancreaticojejunostomy. BMC Surg. 2020; 20(1): 129.
166. Zhang C. L., Wang J. J., Li J. N., Yang Y. Nonalcoholic fatty pancreas disease: An emerging clinical challenge. World J Clin Cases. 2021; 9(23): 6624–38.
167. Kobayashi N., Shinohara H., Haruta S. et al. Reducing the risk of postoperative pancreatic fistula in radical gastrectomy: pre-assessment with computed tomography for the diagnosis of pancreatic steatosis. Langenbecks Arch Surg. 2022; 407(2): 587–96.
168. Sano S., Okamura Y., Ohgi K. et al. Histological pancreatic findings correlate with computed tomography attenuation and predict postoperative pancreatic fistula following pancreatoduodenectomy. HPB (Oxford). 2022; 24(9): 1519–26.
169. Perikinchira R. A., Rajan R., P B. N. et al. Role of pancreatic attenuation index in assessing pancreatic fat content and postpancreatectomy outcomes. Indian J Radiol Imaging. 2024; 34(2): 232–8.
170. Laaninen M., Bläuer M., Vasama K. et al. The risk for immediate postoperative complications after pancreaticoduodenectomy is increased by high frequency of acinar cells and decreased by prevalent fibrosis of the cut edge of pancreas. Pancreas. 2012; 41(6): 957–61.
171. Teränen V., Rinta-Kiikka I., Holli-Helenius K. et al. Perioperative acinar cell count method works well in the prediction of postoperative pancreatic fistula and other postoperative complications after pancreaticoduodenectomy. Pancreatology. 2021; 21(2): 487–93.
172. Bi Y., Wang J. L., Li M. L. et al. The association between pancreas steatosis and metabolic syndrome: A systematic review and meta-analysis. Diabetes Metab Res Rev. 2019; 35(5): e3142.
173. Hong W., Ha H. I., Lee J. W. et al. Measurement of pancreatic fat fraction by CT histogram analysis to predict pancreatic fistula after pancreaticoduodenectomy. Korean J Radiol. 2019; 20(4): 599–608.
174. Chang Y. R., Kang J. S., Jang J. Y. et al. Prediction of pancreatic fistula after distal pancreatectomy based on cross-sectional images. World J Surg. 2017; 41(6): 1610–7.
175. Tajima Y., Kawabata Y., Hirahara N. Preoperative imaging evaluation of pancreatic pathologies for the objective prediction of pancreatic fistula after pancreaticoduodenectomy. Surg Today. 2018; 48(2): 140–50.
176. Xingjun G., Feng Z., Meiwen Y. et al. A score model based on pancreatic steatosis and fibrosis and pancreatic duct diameter to predict postoperative pancreatic fistula after pancreatoduodenectomy. BMC Surg. 2019; 19(1): 75.
177. Karasu S., Gungor F., Onak C., Dilek O. N. Relation of computed tomography features of the pancreatic tissue and development of pancreatic fistula after pancreaticoduodenectomy. Clin Imaging. 2021; 72: 114–9.
178. Kiełbowski K., Bakinowska E., Uciński R. Preoperative and intraoperative risk factors of postoperative pancreatic fistula after pancreaticoduodenectomy — systematic review and meta-analysis. Pol Przegl Chir. 2021; 93(6): 1–10.
179. Hong J. J., Park H. J., Lee E. S., Kim M. J. Severity of hyperechoic pancreas on preoperative ultrasonography: high potential as a clinically useful predictor of a postoperative pancreatic fistula. Ultrasonography. 2024; 43(4): 272–83.
180. Tourlakis M. E., Zhong J., Gandhi R. et al. Deficiency of Sbds in the mouse pancreas leads to features of Shwachman-Diamond syndrome, with loss of zymogen granules. Gastroenterology. 2012; 143(2): 481–92.
181. Alberti G., Cantillo T., Pereira A. et al. Prevalence of fatty pancreas and its relation with anthropometric values on the Growth and Obesity Cohort Study. J Pediatr (Rio J). 2025; 101(3): 362–9.
182. Cho J. Y., You S. K., Lim H. H., Kim H. J. Clinical significance of pancreatic fat in children: A single-center experience. Pancreas. 2022; 51(8): 972–5.
183. Pham Y. H., Bingham B. A., Bell C. S. et al. Prevalence of pancreatic steatosis at a pediatric tertiary care center. South Med J. 2016; 109(3): 196–8.
184. Della Corte C., Mosca A., Majo F. et al. Nonalcoholic fatty pancreas disease and Nonalcoholic fatty liver disease: more than ectopic fat. Clin Endocrinol (Oxf). 2015; 83(5): 656–62.
185. Chiyanika C., Chan D. F. Y., Hui S. C. N. et al. 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. Pediatr Obes. 2020; 15(9): e12653.
186. King L. J., Scurr E. D., Murugan N. et al. Hepatobiliary and pancreatic manifestations of cystic fibrosis: MR imaging appearances. Radiographics. 2000; 20(3): 767–77.
187. Han X., Lu S., Gu C. et al. Clinical features, epidemiology, and treatment of Shwachman-Diamond syndrome: a systematic review. BMC Pediatr. 2023; 23(1): 503.
188. Wild K. T., Goldstein A. C., Muraresku C., Ganetzky R. D. Broadening the phenotypic spectrum of Pearson syndrome: Five new cases and a review of the literature. Am J Med Genet A. 2020; 182(2): 365–73.
189. Staaf J., Labmayr V., Paulmichl K. et al. Pancreatic fat is associated with metabolic syndrome and visceral fat but not beta-cell function or body mass index in pediatric obesity. Pancreas. 2017; 46(3): 358–65.
190. Trout A. T., Hunte D. E., Mouzaki M. et al. Relationship between abdominal fat stores and liver fat, pancreatic fat, and metabolic comorbidities in a pediatric population with non-alcoholic fatty liver disease. Abdom Radiol (NY). 2019; 44(9): 3107–14.
191. Cohen M., Syme C., Deforest M. et al. Ectopic fat in youth: the contribution of hepatic and pancreatic fat to metabolic disturbances. Obesity (Silver Spring). 2014; 22(5): 1280–6.
192. Pacifico L., Di Martino M., Anania C. et al. Pancreatic fat and β-cell function in overweight/obese children with nonalcoholic fatty liver disease. World J Gastroenterol. 2015; 21(15): 4688–95.
193. Lee E. H., Kim J. Y., Yang H. R. Ectopic pancreatic fat as a risk factor for hypertension in children and adolescents with nonalcoholic fatty liver disease. J Clin Hypertens (Greenwich). 2021; 23(8): 1506–15.
194. Lee E. H., Kim J. Y., Yang H. R. Association between ectopic pancreatic and hepatic fat and metabolic risk factors in children with non-alcoholic fatty liver disease. Pediatr Obes. 2021; 16(10): e12793.
195. Bi Y., Lin H. Y., Li M. L. et al. The association between pancreatic steatosis and metabolic syndrome: A 5-year follow-up study among a general Chinese population. Pancreas. 2022; 51(8): 1000–6.
196. Ookura R., Usuki N., Miki Y. Correlation between pancreatic fat deposition and metabolic syndrome: relationships with location in the pancreas and sex. Intern Med. 2024; 63(15): 2113–23.
197. Pieńkowska J., Brzeska B., Kaszubowski M. et al. MRI assessment of ectopic fat accumulation in pancreas, liver and skeletal muscle in patients with obesity, overweight and normal BMI in correlation with the presence of central obesity and metabolic syndrome. Diabetes Metab Syndr Obes. 2019; 12: 623–36.
198. Ballester-Vallés C., Flores-Méndez J., Delgado-Moraleda J. et al. Hepatic and pancreatic fat as imaging biomarkers of metabolic syndrome. Radiologia (Engl Ed). 2020; 62(2): 122–30.
199. Rosenblatt R., Mehta A., Snell D. et al. Ultrasonographic nonalcoholic fatty pancreas is associated with advanced fibrosis in NAFLD: A retrospective analysis. Dig Dis Sci. 2019; 64(1): 262–8.
200. Ulasoglu C., Tekin Z. N., Akan K., Yavuz A. Does Nonalcoholic pancreatic steatosis always correlate with nonalcoholic fatty liver disease? Clin Exp Gastroenterol. 2021; 14: 269–75.
201. Bhalla S., Kuchel G. A., Pandol S., Bishehsari F. Association of pancreatic fatty infiltration with age and metabolic syndrome is sex-dependent. Gastro Hep Adv. 2022; 1(3): 344–9.
202. Zhang Y., Liu Y., Petrov M. S. Relationship of fat in the pancreas with cardiovascular disease: A systematic review and meta-analysis. Obes Rev. 2025; 26(7): e13914.
203. Cao M. J., Wu W. J., Chen J. W. et al. Quantification of ectopic fat storage in the liver and pancreas using six-point Dixon MRI and its association with insulin sensitivity and β-cell function in patients with central obesity. Eur Radiol. 2023; 33(12): 9213–22.
204. Yamazaki H., Tauchi S., Wang J. et al. Longitudinal association of fatty pancreas with the incidence of type-2 diabetes in lean individuals: a 6-year computed tomography-based cohort study. J Gastroenterol. 2020; 55(7): 712–21.
205. Begovatz P., Koliaki C., Weber K. et al. Pancreatic adipose tissue infiltration, parenchymal steatosis and beta cell function in humans. Diabetologia. 2015; 58(7): 1646–55.
206. Martin S., Cule M., Basty N. et al. Genetic evidence for different adiposity phenotypes and their opposing influences on ectopic fat and risk of cardiometabolic disease. Diabetes. 2021; 70(8): 1843–56.
207. Sequeira I. R., Yip W. C., Lu L. W. W. et al. Pancreas fat, an early marker of metabolic risk? A magnetic resonance study of Chinese and Caucasian women: TOFI_Asia Study. Front Physiol. 2022; 13: 819606.
208. Hakim O., Bonadonna R. C., Mohandas C. et al. Associations between pancreatic lipids and β-cell function in black African and white European men with type 2 diabetes. J Clin Endocrinol Metab. 2019; 104(4): 1201–10.
209. Ko J., Sequeira I. R., Skudder-Hill L. et al. Metabolic traits affecting the relationship between liver fat and intrapancreatic fat: a mediation analysis. Diabetologia. 2023; 66(1): 190–200.
210. Tushuizen M. E., Bunck M. C., Pouwels P. J. et al. Pancreatic fat content and beta-cell function in men with and without type 2 diabetes. Diabetes Care. 2007; 30(11): 2916–21.
211. Martin S., Sorokin E. P., Thomas E. L. et al. Estimating the effect of liver and pancreas volume and fat content on risk of diabetes: A mendelian randomization study. Diabetes Care. 2022; 45(2): 460–8.
212. Raeder H., Johansson S., Holm P. I. et al. Mutations in the CEL VNTR cause a syndrome of diabetes and pancreatic exocrine dysfunction. Nat Genet. 2006; 38(1): 54–62.
213. Hanafusa H., Morisada N., Nomura T. et al. A girl with CLOVES syndrome with a recurrent PIK3CA somatic mutation and pancreatic steatosis. Hum Genome Var. 2019; 6: 31.
214. Chen S., Zeng K., Liu Q. C. et al. Adropin deficiency worsens HFD-induced metabolic defects. Cell Death Dis. 2017; 8(8): e3008.
215. Gaspar T. B., Jesus T. T., Azevedo M. T. et al. Generation of an obese diabetic mouse model upon conditional atrx disruption. Cancers (Basel). 2023; 15(11): 3018.
216. Nuñez-Durán E., Chanclón B., Sütt S. et al. Protein kinase STK25 aggravates the severity of non-alcoholic fatty pancreas disease in mice. J Endocrinol. 2017; 234(1): 15–27.
217. Jeon S., Lee J., Shin Y., Yoon M. Ascorbic acid reduces insulin resistance and pancreatic steatosis by regulating adipocyte hypertrophy in obese ovariectomized mice. Can J Physiol Pharmacol. 2023; 101(6): 294–303.
218. Gao J., Huang T., Li J. et al. Beneficial effects of n-3 polyunsaturated fatty acids on offspring’s pancreas of gestational diabetes rats. J Agric Food Chem. 2019; 67(48): 13269–81.
219. Sakai T., Kusakabe T., Ebihara K. et al. Leptin restores the insulinotropic effect of exenatide in a mouse model of type 2 diabetes with increased adiposity induced by streptozotocin and high-fat diet. Am J Physiol Endocrinol Metab. 2014; 307(8): E712–9.
220. Barroso Oquendo M., Siegel-Axel D., Gerst F. et al. Pancreatic fat cells of humans with type 2 diabetes display reduced adipogenic and lipolytic activity. Am J Physiol Cell Physiol. 2021; 320(6): C1000–12.
221. Lorza-Gil E., Strauss O. D., Ziegler E. et al. Incretin-responsive human pancreatic adipose tissue organoids: A functional model for fatty pancreas research. Mol Metab. 2025; 91: 102067.
222. Zhang N., Sun Q., Zhang J. et al. Intrapancreatic adipocytes and beta cell dedifferentiation in human type 2 diabetes. Diabetologia. 2025; 68(6): 1242–60.
223. Skytte M. J., Samkani A., Petersen A. D. et al. A carbohydrate-reduced high-protein diet improves HbA(1c) and liver fat content in weight stable participants with type 2 diabetes: a randomised controlled trial. Diabetologia. 2019; 62(11): 2066–78.
224. Al-Mrabeh A., Hollingsworth K. G., Shaw J. A. M. et al. 2-year remission of type 2 diabetes and pancreas morphology: a post-hoc analysis of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2020; 8(12): 939–48.
225. Thomsen M. N., Skytte M. J., Samkani A. et al. Dietary carbohydrate restriction augments weight loss-induced improvements in glycaemic control and liver fat in individuals with type 2 diabetes: a randomised controlled trial. Diabetologia. 2022; 65(3): 506–17.
226. Della Pepa G., Brancato V., Costabile G. et al. An isoenergetic multifactorial diet reduces pancreatic fat and increases postprandial insulin response in patients with type 2 diabetes: A randomized controlled trial. Diabetes Care. 2022; 45(9): 1935–42.
227. Li M., Zheng Q., Miller J. D. et al. Aerobic training reduces pancreatic fat content and improves β-cell function: A randomized controlled trial using IDEAL-IQ magnetic resonance imaging. Diabetes Metab Res Rev. 2022; 38(4): e3516.
228. Wang Y., Liu Y., Petrov M. S. The effects of metabolic bariatric surgery on intra-pancreatic fat deposition and total pancreas volume: a systematic review and meta-analysis. Obes Surg. 2025; 35(4): 1513–24.
229. Salman A. A., Salman M. A., Said M. et al. Improvement of pancreatic steatosis and indices of insulin resistance after metabolic surgery. Front Med (Lausanne). 2022; 9: 894465.
230. Petrov M. S. The Pharmacological landscape for fatty change of the pancreas. Drugs. 2024; 84(4): 375–84.
231. Smits M. M., Tonneijck L., Muskiet M. H. et al. Pancreatic effects of liraglutide or sitagliptin in overweight patients with type 2 diabetes: A 12-week randomized, placebo-controlled trial. Diabetes Care. 2017; 40(3): 301–8.
232. Honka H., Koffert J., Hannukainen J. C. et al. The effects of bariatric surgery on pancreatic lipid metabolism and blood flow. J Clin Endocrinol Metab. 2015; 100(5): 2015–23.
233. Rebours V., Garteiser P., Ribeiro-Parenti L. et al. Obesity-induced pancreatopathy in rats is reversible after bariatric surgery. Sci Rep. 2018; 8(1): 16295.
234. Lautenbach A., Wernecke M., Riedel N. et al. Adaptive changes in pancreas post Roux-en-Y gastric bypass induced weight loss. Diabetes Metab Res Rev. 2018; 34(7): e3025.
235. Umemura A., Sasaki A., Nitta H. et al. Pancreas volume reduction and metabolic effects in Japanese patients with severe obesity following laparoscopic sleeve gastrectomy. Endocr J. 2017; 64(5): 487–98.
236. Petrov M. S. Fateful fat: Intra-pancreatic lipids cause pancreatic cancer. Cell Rep Med. 2024; 5(2): 101428.
237. Frendi S., Martineau C., Cazier H. et al. Role of the fatty pancreatic infiltration in pancreatic oncogenesis. Sci Rep. 2024; 14(1): 6582.
238. Saisho Y., Butler A. E., Meier J. J. et al. Pancreas volumes in humans from birth to age one hundred taking into account sex, obesity, and presence of type-2 diabetes. Clin Anat. 2007; 20(8): 933–42.
239. Rossi A. P., Fantin F., Zamboni G. A. et al. Predictors of ectopic fat accumulation in liver and pancreas in obese men and women. Obesity (Silver Spring). 2011; 19(9): 1747–54.
240. Crane J. D., Yellin S. A., Ong F. J. et al. ELBW survivors in early adulthood have higher hepatic, pancreatic and subcutaneous fat. Sci Rep. 2016; 6: 31560.
2. Smits M. M., van Geenen E. J. The clinical significance of pancreatic steatosis. Nat Rev Gastroenterol Hepatol. 2011; 8(3): 169–77.
3. Ogilvie R. The island of Langerhans in 19 cases of obesity. J Pathol. 1933; 37: 473–81.
4. Váncsa S., Sipos Z., Váradi A. et al. Metabolic-associated fatty liver disease is associated with acute pancreatitis with more severe course: Post hoc analysis of a prospectively collected international registry. United European Gastroenterol J. 2023; 11(4): 371–82.
5. Vlăduț C., Steiner C., Löhr M. et al. High prevalence of pancreatic steatosis in pancreatic cancer patients: A meta-analysis and systematic review. Pancreatology. 2025; 25(1): 98–107.
6. Boltin D., Lambregts D. M., Jones F. et al. UEG framework for the development of high-quality clinical guidelines. United European Gastroenterol J. 2020; 8(8): 851–64.
7. Dominguez-Muñoz J. E., Vujasinovic M., de la Iglesia D. et al. European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations. United European Gastroenterol J. 2025; 13(1): 125–72.
8. Löhr J. M., Beuers U., Vujasinovic M. et al. European Guideline on IgG4-related digestive disease — UEG and SGF evidence-based recommendations. United European Gastroenterol J. 2020; 8(6): 637–66.
9. Löhr J. M., Dominguez-Munoz E., Rosendahl J. et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J. 2017; 5(2): 153–99.
10. Malagelada C., Keller J., Sifrim D. et al. European Guideline on Chronic Nausea and Vomiting-A UEG and ESNM Consensus for Clinical Management. United European Gastroenterol J. 2025; 13(3): 427–71.
11. Speckman R. A., Friedly J. L. Asking structured, answerable clinical questions using the Population, Intervention/Comparator, Outcome (PICO) Framework. Pm R. 2019; 11(5): 548–53.
12. Howick J., Chalmers I., Glasziou P. et al. Oxford centre for evidence-based medicine 2011 levels of evidence. Centre for Evidence-Based Medicine. Retrieved July from: https://www.cebm.net/wp‐content/uploads/2014/06/CEBM‐Levels‐of‐Evidence‐2.1.pdf.
13. Likert R. A technique for the measurement of attitudes. Archives of Psychology. 1932; 22: 1–55.
14. Boone H., Boone D. Analyzing Likert Data. The Journal of Extension. 2012; 50(2).
15. Olsen T. S. Lipomatosis of the pancreas in autopsy material and its relation to age and overweight. Acta Pathol Microbiol Scand A. 1978; 86a(5): 367–73.
16. Gullo L., Salizzoni E., Serra C. et al. Can pancreatic steatosis explain the finding of pancreatic hyperenzymemia in subjects with dyslipidemia? Pancreas. 2006; 33(4): 351–3.
17. Wang H., Maitra A., Wang H. Obesity, intrapancreatic fatty infiltration, and pancreatic cancer. Clin Cancer Res. 2015; 21(15): 3369–71.
18. Souza M., Silva G. P., Junior C. R. O. et al. Prevalence, clinical characteristics, and outcomes of fatty pancreas disease: an updated systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2025; 37(2): 137–46.
19. Robson H. N., Scott G. B. Lipomatous pseudohypertrophy of the pancreas. Gastroenterology. 1953; 23(1): 74–81.
20. Mathur A., Marine M., Lu D. et al. Nonalcoholic fatty pancreas disease. HPB (Oxford). 2007; 9(4): 312–8.
21. Singh R. G., Nguyen N. N., DeSouza S. V. et al. Comprehensive analysis of body composition and insulin traits associated with intra-pancreatic fat deposition in healthy individuals and people with new-onset prediabetes/diabetes after acute pancreatitis. Diabetes Obes Metab. 2019; 21(2): 417–23.
22. Kim M. K., Chun H. J., Park J. H. et al. The association between ectopic fat in the pancreas and subclinical atherosclerosis in type 2 diabetes. Diabetes Res Clin Pract. 2014; 106(3): 590–6.
23. Marks W. M., Filly R. A., Callen P. W. Ultrasonic evaluation of normal pancreatic echogenicity and its relationship to fat deposition. Radiology. 1980; 137(2): 475–9.
24. Redfield E. S., Jr. Isolated fat replacement of body and tail of pancreas; report of a case. U S Armed Forces Med J. 1950; 1(11): 1313–21.
25. Walters M. N. Adipose atrophy of the exocrine pancreas. J Pathol Bacteriol. 1966; 92(2): 547–57.
26. Targher G., Rossi A. P., Zamboni G. A. et al. Pancreatic fat accumulation and its relationship with liver fat content and other fat depots in obese individuals. J Endocrinol Invest. 2012; 35(8): 748–53.
27. Rinella M. E., Lazarus J. V., Ratziu V. et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023; 79(6): 1542–56.
28. Lilly A. C., Astsaturov I., Golemis E. A. Intrapancreatic fat, pancreatitis, and pancreatic cancer. Cell Mol Life Sci. 2023; 80(8): 206.
29. Stamm B. H. Incidence and diagnostic significance of minor pathologic changes in the adult pancreas at autopsy: a systematic study of 112 autopsies in patients without known pancreatic disease. Hum Pathol. 1984; 15(7): 677–83.
30. Coulier B. Pancreatic lipomatosis: An extensive pictorial review. J Belg Soc Radiol. 2016; 100(1): 39.
31. Al-Mrabeh A., Zhyzhneuskaya S. V., Peters C. et al. Hepatic lipoprotein export and remission of human type 2 diabetes after weight loss. Cell Metab. 2020; 31(2): 233–49.e4.
32. Raitano E., Cannella R., Messana D. et al. The role of fat in pancreatic diseases: from pathology to imaging. Journal of Medical Imaging and Interventional Radiology. 2024; 11(1): 26.
33. Soyer P., Spelle L., Pelage J. P. et al. Cystic fibrosis in adolescents and adults: fatty replacement of the pancreas — CT evaluation and functional correlation. Radiology. 1999; 210(3): 611–5.
34. Löhr M., Goertchen P., Nizze H. et al. Cystic fibrosis associated islet changes may provide a basis for diabetes. An immunocytochemical and morphometrical study. Virchows Arch A Pathol Anat Histopathol. 1989; 414(2): 179–85.
35. Raeder H., Haldorsen I. S., Ersland L. et al. Pancreatic lipomatosis is a structural marker in nondiabetic children with mutations in carboxyl-ester lipase. Diabetes. 2007; 56(2): 444–9.
36. Catanzaro R., Cuffari B., Italia A., Marotta F. Exploring the metabolic syndrome: Nonalcoholic fatty pancreas disease. World J Gastroenterol. 2016; 22(34): 7660–75.
37. Pinnick K. E., Collins S. C., Londos C. et al. Pancreatic ectopic fat is characterized by adipocyte infiltration and altered lipid composition. Obesity (Silver Spring). 2008; 16(3): 522–30.
38. Tong X., Dai C., Walker J. T. et al. Lipid droplet accumulation in human pancreatic islets is dependent on both donor age and health. Diabetes. 2020; 69(3): 342–54.
39. Horii T., Kozawa J., Fujita Y. et al. Lipid droplet accumulation in β cells in patients with type 2 diabetes is associated with insulin resistance, hyperglycemia and β cell dysfunction involving decreased insulin granules. Front Endocrinol (Lausanne). 2022; 13: 996716.
40. Olzmann J. A., Carvalho P. Dynamics and functions of lipid droplets. Nat Rev Mol Cell Biol. 2019; 20(3): 137–55.
41. Navina S., Acharya C., DeLany J. P. et al. Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci Transl Med. 2011; 3(107): 107ra10.
42. Schmitz-Moormann P., Pittner P. M., Heinze W. Lipomatosis of the pancreas. A morphometrical investigation. Pathol Res Pract. 1981; 173(1–2): 45–53.
43. Acharya C., Cline R. A., Jaligama D. et al. Fibrosis reduces severity of acute-on-chronic pancreatitis in humans. Gastroenterology. 2013; 145(2): 466–75.
44. Simsek H., Singh M. Effect of prolonged ethanol intake on pancreatic lipids in the rat pancreas. Pancreas. 1990; 5(4): 401–7.
45. Wilson J. S., Colley P. W., Sosula L. et al. Alcohol causes a fatty pancreas. A rat model of ethanol-induced pancreatic steatosis. Alcohol Clin Exp Res. 1982; 6(1): 117–21.
46. Stuart C. E., Ko J., Modesto A. E. et al. Implications of tobacco smoking and alcohol consumption on ectopic fat deposition in individuals after pancreatitis. Pancreas. 2020; 49(7): 924–34.
47. Wang C. Y., Ou H. Y., Chen M. F. et al. Enigmatic ectopic fat: prevalence of nonalcoholic fatty pancreas disease and its associated factors in a Chinese population. J Am Heart Assoc. 2014; 3(1): e000297.
48. Yamazaki H., Tauchi S., Kimachi M. et al. Association between pancreatic fat and incidence of metabolic syndrome: a 5-year Japanese cohort study. J Gastroenterol Hepatol. 2018; 33(12): 2048–54.
49. Wong V. W., Wong G. L., Yeung D. K. et al. Fatty pancreas, insulin resistance, and β-cell function: a population study using fat-water magnetic resonance imaging. Am J Gastroenterol. 2014; 109(4): 589–97.
50. Sepe P. S., Ohri A., Sanaka S. et al. A prospective evaluation of fatty pancreas by using EUS. Gastrointest Endosc. 2011; 73(5): 987–93.
51. Fujii M., Ohno Y., Yamada M. et al. Impact of fatty pancreas and lifestyle on the development of subclinical chronic pancreatitis in healthy people undergoing a medical checkup. Environ Health Prev Med. 2019; 24(1): 10.
52. Muftah A. A., Pecha R. L., Riojas Barrett M. et al. Pancreatic parenchymal changes seen on endoscopic ultrasound are dynamic in the setting of fatty pancreas: A short-term follow-up study. Pancreatology. 2022; 22(8): 1187–94.
53. Lee J. S., Kim S. H., Jun D. W. et al. Clinical implications of fatty pancreas: correlations between fatty pancreas and metabolic syndrome. World J Gastroenterol. 2009; 15(15): 1869–75.
54. Wu W. C., Wang C. Y. Association between non-alcoholic fatty pancreatic disease (NAFPD) and the metabolic syndrome: case-control retrospective study. Cardiovasc Diabetol. 2013; 12: 77.
55. Lesmana C. R., Pakasi L. S., Inggriani S. et al. Prevalence of Non-Alcoholic Fatty Pancreas Disease (NAFPD) and its risk factors among adult medical check-up patients in a private hospital: a large cross sectional study. BMC Gastroenterol. 2015; 15: 174.
56. Uygun A., Kadayifci A., Demirci H. et al. The effect of fatty pancreas on serum glucose parameters in patients with nonalcoholic steatohepatitis. Eur J Intern Med. 2015; 26(1): 37–41.
57. Zhou J., Li M. L., Zhang D. D. et al. The correlation between pancreatic steatosis and metabolic syndrome in a Chinese population. Pancreatology. 2016; 16(4): 578–83.
58. Li S., Su L., Lv G. et al. Transabdominal ultrasonography of the pancreas is superior to that of the liver for detection of ectopic fat deposits resulting from metabolic syndrome. Medicine (Baltimore). 2017; 96(37): e8060.
59. Wang D., Yu X. P., Xiao W. M. et al. Prevalence and clinical characteristics of fatty pancreas in Yangzhou, China: A cross-sectional study. Pancreatology. 2018; 18(3): 263–8.
60. Weng S., Zhou J., Chen X. et al. Prevalence and factors associated with nonalcoholic fatty pancreas disease and its severity in China. Medicine (Baltimore). 2018; 97(26): e11293.
61. Sotoudehmanesh R., Tahmasbi A., Sadeghi A. et al. The prevalence of nonalcoholic fatty pancreas by endoscopic ultrasonography. Pancreas. 2019; 48(9): 1220–4.
62. Koç U., Taydaş O. Evaluation of pancreatic steatosis prevalence and anthropometric measurements using non-contrast computed tomography. Turk J Gastroenterol. 2020; 31(9): 640–8.
63. Okada K., Watahiki T., Horie K. et al. The prevalence and clinical implications of pancreatic fat accumulation identified during a medical check-up. Medicine (Baltimore). 2021; 100(41): e27487.
64. Sezgin O., Yaraş S., Özdoğan O. Pancreatic steatosis is associated with both metabolic syndrome and pancreatic stiffness detected by ultrasound elastography. Dig Dis Sci. 2022; 67(1): 293–304.
65. Chen Y., Zhang P., Lv S. et al. Ectopic fat deposition and its related abnormalities of lipid metabolism followed by nonalcoholic fatty pancreas. Endosc Ultrasound. 2022; 11(5): 407–13.
66. Osman M. A. A., Alkhouly M., Elmohaseb G. F. et al. Relation between non-alcoholic fatty pancreas and clinical and biochemical parameters in women with polycystic ovary syndrome: A multi-centric study. Int J Gen Med. 2022; 15: 8225–33.
67. Berger Z., Orellana F., Cocio R. et al. Pancreatic steatosis: A frequent finding in a Chilean population. Rev Gastroenterol Mex (Engl Ed). 2023; 88(2): 118–24.
68. Abbasoğlu A., Karçaaltıncaba M., Karaosmanoğlu A. D. et al. Associations between hepatic and pancreatic steatosis with lumbar spinal bone marrow fat: A single-center magnetic resonance imaging study. Turk J Gastroenterol. 2023; 34(6): 618–25.
69. Maetzel H., Rutkowski W., Panic N. et al. Non-alcoholic fatty pancreas disease and pancreatic exocrine insufficiency: pilot study and systematic review. Scand J Gastroenterol. 2023; 58(9): 1030–7.
70. Sezgin O., Yaraş S., Cindoruk M. et al. Prevalence of pancreatic steatosis and its associated factors in Turkey: A nation-wide multicenter study. Turk J Gastroenterol. 2024; 35(3): 239–54.
71. Dong X., Zhu Q., Yuan C. et al. Associations of intrapancreatic fat deposition with incident diseases of the exocrine and endocrine pancreas: A UK Biobank Prospective Cohort Study. Am J Gastroenterol. 2024; 119(6): 1158–66.
72. Chung M. J., Park S. W., Lee K. J. et al. Clinical impact of pancreatic steatosis measured by CT on the risk of post-ERCP pancreatitis: a multicenter prospective trial. Gastrointest Endosc. 2024; 99(2): 214–23.e4.
73. Lee Y., Lingvay I., Szczepaniak L. S. et al. Pancreatic steatosis: harbinger of type 2 diabetes in obese rodents. Int J Obes (Lond). 2010; 34(2): 396–400.
74. Souza-Mello V., Gregório B. M., Relvas-Lucas B. et al. Pancreatic ultrastructural enhancement due to telmisartan plus sitagliptin treatment in diet-induced obese C57BL/6 mice. Pancreas. 2011; 40(5): 715–22.
75. Gotoh K., Inoue M., Shiraishi K. et al. Spleen-derived interleukin-10 downregulates the severity of high-fat diet-induced non-alcoholic fatty pancreas disease. PLoS One. 2012; 7(12): e53154.
76. Lipovšek S., Dolenšek J., Dariš B. et al. Western diet-induced ultrastructural changes in mouse pancreatic acinar cells. Front Cell Dev Biol. 2024; 12: 1380564.
77. Tremmel D. M., Feeney A. K., Mitchell S. A. et al. Hypertension, but not body mass index, is predictive of increased pancreatic lipid content and islet dysfunction. Am J Transplant. 2020; 20(4): 1105–15.
78. Dholakia S., Sharples E. J., Ploeg R. J., Friend P. J. Significance of steatosis in pancreatic transplantation. Transplant Rev (Orlando). 2017; 31(4): 225–31.
79. Kato S., Iwasaki A., Kurita Y. et al. Three-dimensional analysis of pancreatic fat by fat-water magnetic resonance imaging provides detailed characterization of pancreatic steatosis with improved reproducibility. PLoS One. 2019; 14(12): e0224921.
80. Nghiem D. D., Olson P. R., Ormond D. The "fatty pancreas allograft": anatomopathologic findings and clinical experience. Transplant Proc. 2004; 36(4): 1045–7.
81. Fullenkamp A. M., Bell L. N., Robbins R. D. et al. Effect of different obesogenic diets on pancreatic histology in Ossabaw miniature swine. Pancreas. 2011; 40(3): 438–43.
82. van Geenen E. J., Smits M. M., Schreuder T. C. et al. Smoking is related to pancreatic fibrosis in humans. Am J Gastroenterol. 2011; 106(6): 1161–6; quiz 7.
83. Gerst F., Wagner R., Kaiser G. et al. Metabolic crosstalk between fatty pancreas and fatty liver: effects on local inflammation and insulin secretion. Diabetologia. 2017; 60(11): 2240–51.
84. Klöppel G., Maillet B. Pseudocysts in chronic pancreatitis: a morphological analysis of 57 resection specimens and 9 autopsy pancreata. Pancreas. 1991; 6(3): 266–74.
85. van Geenen E. J., Smits M. M., Schreuder T. C. et al. Nonalcoholic fatty liver disease is related to nonalcoholic fatty pancreas disease. Pancreas. 2010; 39(8): 1185–90.
86. Wagner R., Jaghutriz B. A., Gerst F. et al. Pancreatic steatosis associates with impaired insulin secretion in genetically predisposed individuals. J Clin Endocrinol Metab. 2020; 105(11): 3518–25.
87. Angrisani M., Ceresoli M., Ippolito D. et al. Estimating fatty pancreas-A preoperative bedside assessment by bioelectric impedance analysis: Implications for pancreatic surgery. Pancreas. 2022; 51(4): 345–50.
88. Mathur A., Zyromski N. J., Pitt H. A. et al. Pancreatic steatosis promotes dissemination and lethality of pancreatic cancer. J Am Coll Surg. 2009; 208(5): 989–94; discussion 94–6.
89. Kim S. Y., Kim H., Cho J. Y. et al. Quantitative assessment of pancreatic fat by using unenhanced CT: pathologic correlation and clinical implications. Radiology. 2014; 271(1): 104–12.
90. Sugimoto M., Takahashi S., Kojima M. et al. In patients with a soft pancreas, a thick parenchyma, a small duct, and fatty infiltration are significant risks for pancreatic fistula after pancreaticoduodenectomy. J Gastrointest Surg. 2017; 21(5): 846–54.
91. Fukui H., Hori M., Fukuda Y. et al. Evaluation of fatty pancreas by proton density fat fraction using 3-T magnetic resonance imaging and its association with pancreatic cancer. Eur J Radiol. 2019; 118: 25–31.
92. Naik R. R., Rajan A., Kalita N. Automated image analysis method to detect and quantify fat cell infiltration in hematoxylin and eosin stained human pancreas histology images. BBA Adv. 2023; 3: 100084.
93. Fukuda Y., Yamada D., Eguchi H. et al. CT density in the pancreas is a promising imaging predictor for pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2017; 24(9): 2762–9.
94. Hori M., Takahashi M., Hiraoka N. et al. Association of pancreatic Fatty infiltration with pancreatic ductal adenocarcinoma. Clin Transl Gastroenterol. 2014; 5(3): e53.
95. Gaujoux S., Cortes A., Couvelard A. et al. Fatty pancreas and increased body mass index are risk factors of pancreatic fistula after pancreaticoduodenectomy. Surgery. 2010; 148(1): 15–23.
96. Tranchart H., Gaujoux S., Rebours V. et al. Preoperative CT scan helps to predict the occurrence of severe pancreatic fistula after pancreaticoduodenectomy. Ann Surg. 2012; 256(1): 139–45.
97. Rosso E., Casnedi S., Pessaux P. et al. The role of "fatty pancreas" and of BMI in the occurrence of pancreatic fistula after pancreaticoduodenectomy. J Gastrointest Surg. 2009; 13(10): 1845–51.
98. Rebours V., Gaujoux S., d’Assignies G. et al. Obesity and fatty pancreatic infiltration are risk factors for pancreatic precancerous lesions (PanIN). Clin Cancer Res. 2015; 21(15): 3522–8.
99. Yamashita Y., Ashida R., Kitano M. Imaging of fibrosis in chronic pancreatitis. Front Physiol. 2021; 12: 800516.
100. Majumder S., Philip N. A., Takahashi N. et al. Fatty pancreas: Should we be concerned? Pancreas. 2017; 46(10): 1251–8.
101. Worthen N. J., Beabeau D. Normal pancreatic echogenicity: relation to age and body fat. AJR Am J Roentgenol. 1982; 139(6): 1095–8.
102. Oh H., Park H. J., Oh J. et al. Hyperechoic pancreas on ultrasonography: an analysis of its severity and clinical implications. Ultrasonography. 2022; 41(2): 335–43.
103. Matsumoto S., Mori H., Miyake H. et al. Uneven fatty replacement of the pancreas: evaluation with CT. Radiology. 1995; 194(2): 453–8.
104. Ünal E., Karaosmanoğlu A. D., Akata D. et al. Invisible fat on CT: making it visible by MRI. Diagn Interv Radiol. 2016; 22(2): 133–40.
105. Previtali C., Sartoris R., Rebours V. et al. Quantitative imaging predicts pancreatic fatty infiltration on routine CT examination. Diagn Interv Imaging. 2023; 104(7–8): 359–67.
106. Reeder S. B., Sirlin C. B. Quantification of liver fat with magnetic resonance imaging. Magn Reson Imaging Clin N Am. 2010; 18(3): 337–57, ix.
107. Filippatos T. D., Alexakis K., Mavrikaki V., Mikhailidis D. P. Nonalcoholic fatty pancreas disease: Role in metabolic syndrome, "prediabetes," diabetes and atherosclerosis. Dig Dis Sci. 2022; 67(1): 26–41.
108. Djuric-Stefanovic A., Masulovic D., Kostic J. et al. CT volumetry of normal pancreas: correlation with the pancreatic diameters measurable by the cross-sectional imaging, and relationship with the gender, age, and body constitution. Surg Radiol Anat. 2012; 34(9): 811–7.
109. Sakai N. S., Taylor S. A., Chouhan M. D. Obesity, metabolic disease and the pancreas-Quantitative imaging of pancreatic fat. Br J Radiol. 2018; 91(1089): 20180267.
110. Kühn J. P., Berthold F., Mayerle J. et al. Pancreatic steatosis demonstrated at MR imaging in the general population: Clinical relevance. Radiology. 2015; 276(1): 129–36.
111. Idilman I. S., Tuzun A., Savas B. et al. Quantification of liver, pancreas, kidney, and vertebral body MRI-PDFF in non-alcoholic fatty liver disease. Abdom Imaging. 2015; 40(6): 1512–9.
112. Singh R. G., Yoon H. D., Wu L. M. et al. Ectopic fat accumulation in the pancreas and its clinical relevance: A systematic review, meta-analysis, and meta-regression. Metabolism. 2017; 69: 1–13.
113. Kim H. J., Byun J. H., Park S. H. et al. Focal fatty replacement of the pancreas: usefulness of chemical shift MRI. AJR Am J Roentgenol. 2007; 188(2): 429–32.
114. Yaman V., Arslan S. Lipomatous pseudohypertrophy of the pancreas: A rare disease with a novel imaging finding. Pancreas. 2025; 54(5): e494–5.
115. Karcaaltincaba M. CT differentiation of distal pancreas fat replacement and distal pancreas agenesis. Surg Radiol Anat. 2006; 28(6): 637–41.
116. Karaosmanoglu D., Karcaaltincaba M., Akata D. et al. Pancreatic lipoma computed tomography diagnosis of 17 patients and follow-up. Pancreas. 2008; 36(4): 434–6.
117. Smereczyński A., Kołaczyk K. Is a fatty pancreas a banal lesion? J Ultrason. 2016; 16(66): 273–80.
118. Pan Z., Chen Q., Lin H. et al. Enhanced accuracy and stability in automated intra-pancreatic fat deposition monitoring of type 2 diabetes mellitus using Dixon MRI and deep learning. Abdom Radiol (NY). 2025; 50: 3685–97.
119. Lin D., Wang Z., Li H. et al. Automated measurement of pancreatic fat deposition on Dixon MRI using nnU-Net. J Magn Reson Imaging. 2023; 57(1): 296–307.
120. Yang J. Z., Zhao J., Nemati R. et al. An adapted deep convolutional neural network for automatic measurement of pancreatic fat and pancreatic volume in clinical multi-protocol magnetic resonance images: a retrospective study with multi-ethnic external validation. Biomedicines. 2022; 10(11): 2991.
121. Ibrahim R. M., Solanki S., Qiao W. et al. Fatty pancreas on EUS: Risk factors, correlation with CT/MRI, and implications for pancreatic cancer screening. Endosc Ultrasound. 2025; 14(1): 13–9.
122. Kawamura A., Takakura K., Torisu Y. et al. Impact of qualitative endoscopic ultrasonography on fatty pancreas at a referral medical center. JGH Open. 2022; 6(1): 44–9.
123. Geeratragool T., Pausawasdi N., Angkathunyakul N. et al. Novel endoscopic ultrasound criteria for pancreatic steatosis: prospective study with histology as the gold standard. Gastrointestinal Endoscopy. 2024; 99: AB859.
124. Sbeit W., Greener T., Kadah A. et al. Pancreatic and hepatobiliary manifestations of nonalcoholic fatty pancreatic disease: a referral multi-center experience. Eur J Gastroenterol Hepatol. 2021; 33(1S Suppl 1): e297–e301.
125. Sbeit W., Khoury T. Fatty pancreas represents a risk factor for acute pancreatitis: A pilot study. Pancreas. 2021; 50(7): 990–3.
126. Abboud Y., Kim K., Samaan J. S. et al. Endoscopic ultrasound guided shear wave elastography is safe with high feasibility and reproducibility when used in the pancreas: findings from a prospective cohort. Pancreas. 2023; 52(2): e115–20.
127. Mohamed G., Zalomek C., El Helou M. et al. Endoscopic ultrasound guided shearwave elastography (EUS-SWE) predicts fat in the pancreas and correlates with fat-fraction on magnetic resonance imaging (MRI): results from a prospective study. Digestive Disease Week 2024: Gastrointestinal Endoscopy DDW ePoster Library; 2024.
128. Konikoff T., Loebl N., Benson A. A. et al. Enhancing detection of various pancreatic lesions on endoscopic ultrasound through artificial intelligence: a basis for computer-aided detection systems. J Gastroenterol Hepatol. 2025; 40(1): 235–40.
129. Matana Kaštelan Z., Brumini I., Poropat G. et al. Pancreatic iodine density and fat fraction on dual-energy computed tomography in acute pancreatitis. Diagnostics (Basel). 2024; 14(9): 955.
130. Al-Ani Z., Ko J., Petrov M. S. Intra-pancreatic fat deposition across the pancreatitis spectrum and the influence of gut hormones. Dig Liver Dis. 2023; 55(8): 1081–90.
131. Szentesi A., Párniczky A., Vincze Á. et al. Multiple hits in acute pancreatitis: Components of metabolic syndrome synergize each other's deteriorating effects. Front Physiol. 2019; 10: 1202.
132. Wongtrakul W., Untaaveesup S., Pausawadi N., Charatcharoenwitthaya P. Bidirectional association between non-alcoholic fatty liver disease and fatty pancreas: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2023; 35(10): 1107–16.
133. Yamazaki H., Heni M., Wagner R. et al. The causal effect of intrapancreatic fat deposition on acute and chronic pancreatitis: A Mendelian randomization study. Am J Gastroenterol. 2024; 119(12): 2540–4.
134. Park C. H., Chung M. J., Park D. H. et al. Impact of pancreatic fat on the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis. Surg Endosc. 2022; 36(8): 5734–42.
135. Prouvot C., Boumaiza M., Maoui K. et al. Pancreatic steatosis is a strong risk factor for post-ERCP pancreatitis: An emerging concept. Dig Liver Dis. 2025; 57(2): 542–8.
136. Bai X. H., Yin J., Yu S. Y. et al. Extracellular volume fraction derived from dual-energy CT: a potential predictor for acute pancreatitis after pancreatoduodenectomy. Eur Radiol. 2024; 34(11): 6957–66.
137. Partelli S., Andreasi V., Schiavo Lena M. et al. The role of acinar content at pancreatic resection margin in the development of postoperative pancreatic fistula and acute pancreatitis after pancreaticoduodenectomy. Surgery. 2021; 170(4): 1215–22.
138. Xie J., Xu L., Pan Y. et al. Nonalcoholic fatty pancreas disease is related independently to the severity of acute pancreatitis. Eur J Gastroenterol Hepatol. 2019; 31(8): 973–8.
139. Panc K., Gundogdu H., Sekmen S. et al. Liver and pancreatic fat fractions as predictors of disease severity in acute pancreatitis: an MRI IDEAL-IQ study. Abdom Radiol (NY). 2025; 50(8): 3734–43.
140. Mahmoudi S., Martin S., Koch V. et al. Value of dual-energy CT perfusion analysis in patients with acute pancreatitis: Correlation and discriminative diagnostic accuracy with varying disease severity. Diagnostics (Basel). 2022; 12(11): 2601.
141. Sbeit W., Abu Elheja F., Msheiil B. et al. Fatty pancreas was associated with a higher acute pancreatitis Systemic Inflammatory Response Syndrome score at hospital admission. Eur J Gastroenterol Hepatol. 2023; 35(9): 980–4.
142. Shintani S., Inatomi O., Bamba S. et al. Larger volume and higher fat content of the pancreatic head are predictive factors for postendoscopic retrograde cholangiopancreatography pancreatitis. Pancreas. 2022; 51(1): 28–34.
143. Pokhrel B., Choi E. K., Khalid O. et al. Increased fat in pancreas not associated with risk of pancreatitis post-endoscopic retrograde cholangiopancreatography. Clin Exp Gastroenterol. 2014; 7: 199–204.
144. Miyake H., Sakagami J., Yasuda H. et al. Association of fatty pancreas with pancreatic endocrine and exocrine function. PLoS One. 2018; 13(12): e0209448.
145. Vendrik K. E. W., Tonneijck L., Muskiet M. H. A. et al. Pancreatic steatosis is not associated with exocrine pancreatic function in overweight type 2 diabetes patients. Pancreas. 2017; 46(9): e75–6.
146. Kromrey M. L., Friedrich N., Hoffmann R. T. et al. Pancreatic steatosis is associated with impaired exocrine pancreatic function. Invest Radiol. 2019; 54(7): 403–8.
147. Rana S. S., Ancil S., Jayanna S. H. et al. Clinical features and outcomes of total pancreatic lipomatosis with chronic pancreatitis: a case series. Ann Gastroenterol. 2025; 38(1): 100–4.
148. Engjom T., Kavaliauskiene G., Tjora E. et al. Sonographic pancreas echogenicity in cystic fibrosis compared to exocrine pancreatic function and pancreas fat content at Dixon-MRI. PLoS One. 2018; 13(7): e0201019.
149. Otsuka N., Shimizu K., Taniai M., Tokushige K. Risk factors for fatty pancreas and effects of fatty infiltration on pancreatic cancer. Front Physiol. 2023; 14: 1243983.
150. Kashiwagi K., Seino T., Fukuhara S. et al. Pancreatic fat content detected by computed tomography and its significant relationship with intraductal papillary mucinous neoplasm. Pancreas. 2018; 47(9): 1087–92.
151. Sotozono H., Kanki A., Yasokawa K. et al. Value of 3-T MR imaging in intraductal papillary mucinous neoplasm with a concomitant invasive carcinoma. Eur Radiol. 2022; 32(12): 8276–84.
152. Evrimler S., Yip-Schneider M. T., Swensson J. et al. Magnetic resonance imaging-derived fat fraction predicts risk of malignancy in intraductal papillary mucinous neoplasm. Abdom Radiol (NY). 2021; 46(10): 4779–86.
153. Yamada D., Kobayashi S., Takahashi H. et al. Pancreatic CT density is an optimal imaging biomarker for earlier detection of malignancy in the pancreas with intraductal papillary mucinous neoplasm. Pancreatology. 2022; 22(4): 488–96.
154. Capurso G., Crippa S., Vanella G. et al. Factors associated with the risk of progression of low-risk branch-duct intraductal papillary mucinous neoplasms. JAMA Netw Open. 2020; 3(11): e2022933.
155. Sreedhar U. L., DeSouza S. V., Park B., Petrov M. S. A systematic review of intra-pancreatic fat deposition and pancreatic carcinogenesis. J Gastrointest Surg. 2020; 24(11): 2560–9.
156. Lipp M., Tarján D., Lee J. et al. Fatty pancreas is a risk factor for pancreatic cancer: A systematic review and meta-analysis of 2956 patients. Cancers (Basel). 2023; 15(19): 4876.
157. Chan C. H., Chang C. C., Peng Y. C. The clinical significance of pancreatic steatosis in pancreatic cancer: A hospital-based study. Diagnostics (Basel). 2024; 14(19).
158. Yamazaki H., Streicher S. A., Wu L. et al. Evidence for a causal link between intra-pancreatic fat deposition and pancreatic cancer: A prospective cohort and Mendelian randomization study. Cell Rep Med. 2024; 5(2): 101391.
159. Zhou L., Xiao W. M., Li C. P. et al. Impact of fatty pancreas on postoperative pancreatic fistulae: A meta-analysis. Front Oncol. 2021; 11: 622282.
160. Tanaka K., Yamada S., Hayashi M., Kodera Y. ASO authors reflections: Preoperative pancreatic fat and body composition measurements influence the incidence of grade B/C postoperative pancreatic fistula after pancreatectomy. Ann Surg Oncol. 2020; 27(Suppl 3): 746–7.
161. Tanaka K., Yamada S., Sonohara F. et al. Pancreatic fat and body composition measurements by computed tomography are associated with pancreatic fistula after pancreatectomy. Ann Surg Oncol. 2021; 28(1): 530–8.
162. Shi H. Y., Lu Z. P., Li M. N. et al. Dual-energy CT iodine concentration to evaluate postoperative pancreatic fistula after pancreatoduodenectomy. Radiology. 2022; 304(1): 65–72.
163. Lee S. E., Jang J. Y., Lim C. S. et al. Measurement of pancreatic fat by magnetic resonance imaging: predicting the occurrence of pancreatic fistula after pancreatoduodenectomy. Ann Surg. 2010; 251(5): 932–6.
164. Al-Haddad M., Khashab M., Zyromski N. et al. Risk factors for hyperechogenic pancreas on endoscopic ultrasound: a case-control study. Pancreas. 2009; 38(6): 672–5.
165. Kusafuka T., Kato H., Iizawa Y. et al. Pancreas-visceral fat CT value ratio and serrated pancreatic contour are strong predictors of postoperative pancreatic fistula after pancreaticojejunostomy. BMC Surg. 2020; 20(1): 129.
166. Zhang C. L., Wang J. J., Li J. N., Yang Y. Nonalcoholic fatty pancreas disease: An emerging clinical challenge. World J Clin Cases. 2021; 9(23): 6624–38.
167. Kobayashi N., Shinohara H., Haruta S. et al. Reducing the risk of postoperative pancreatic fistula in radical gastrectomy: pre-assessment with computed tomography for the diagnosis of pancreatic steatosis. Langenbecks Arch Surg. 2022; 407(2): 587–96.
168. Sano S., Okamura Y., Ohgi K. et al. Histological pancreatic findings correlate with computed tomography attenuation and predict postoperative pancreatic fistula following pancreatoduodenectomy. HPB (Oxford). 2022; 24(9): 1519–26.
169. Perikinchira R. A., Rajan R., P B. N. et al. Role of pancreatic attenuation index in assessing pancreatic fat content and postpancreatectomy outcomes. Indian J Radiol Imaging. 2024; 34(2): 232–8.
170. Laaninen M., Bläuer M., Vasama K. et al. The risk for immediate postoperative complications after pancreaticoduodenectomy is increased by high frequency of acinar cells and decreased by prevalent fibrosis of the cut edge of pancreas. Pancreas. 2012; 41(6): 957–61.
171. Teränen V., Rinta-Kiikka I., Holli-Helenius K. et al. Perioperative acinar cell count method works well in the prediction of postoperative pancreatic fistula and other postoperative complications after pancreaticoduodenectomy. Pancreatology. 2021; 21(2): 487–93.
172. Bi Y., Wang J. L., Li M. L. et al. The association between pancreas steatosis and metabolic syndrome: A systematic review and meta-analysis. Diabetes Metab Res Rev. 2019; 35(5): e3142.
173. Hong W., Ha H. I., Lee J. W. et al. Measurement of pancreatic fat fraction by CT histogram analysis to predict pancreatic fistula after pancreaticoduodenectomy. Korean J Radiol. 2019; 20(4): 599–608.
174. Chang Y. R., Kang J. S., Jang J. Y. et al. Prediction of pancreatic fistula after distal pancreatectomy based on cross-sectional images. World J Surg. 2017; 41(6): 1610–7.
175. Tajima Y., Kawabata Y., Hirahara N. Preoperative imaging evaluation of pancreatic pathologies for the objective prediction of pancreatic fistula after pancreaticoduodenectomy. Surg Today. 2018; 48(2): 140–50.
176. Xingjun G., Feng Z., Meiwen Y. et al. A score model based on pancreatic steatosis and fibrosis and pancreatic duct diameter to predict postoperative pancreatic fistula after pancreatoduodenectomy. BMC Surg. 2019; 19(1): 75.
177. Karasu S., Gungor F., Onak C., Dilek O. N. Relation of computed tomography features of the pancreatic tissue and development of pancreatic fistula after pancreaticoduodenectomy. Clin Imaging. 2021; 72: 114–9.
178. Kiełbowski K., Bakinowska E., Uciński R. Preoperative and intraoperative risk factors of postoperative pancreatic fistula after pancreaticoduodenectomy — systematic review and meta-analysis. Pol Przegl Chir. 2021; 93(6): 1–10.
179. Hong J. J., Park H. J., Lee E. S., Kim M. J. Severity of hyperechoic pancreas on preoperative ultrasonography: high potential as a clinically useful predictor of a postoperative pancreatic fistula. Ultrasonography. 2024; 43(4): 272–83.
180. Tourlakis M. E., Zhong J., Gandhi R. et al. Deficiency of Sbds in the mouse pancreas leads to features of Shwachman-Diamond syndrome, with loss of zymogen granules. Gastroenterology. 2012; 143(2): 481–92.
181. Alberti G., Cantillo T., Pereira A. et al. Prevalence of fatty pancreas and its relation with anthropometric values on the Growth and Obesity Cohort Study. J Pediatr (Rio J). 2025; 101(3): 362–9.
182. Cho J. Y., You S. K., Lim H. H., Kim H. J. Clinical significance of pancreatic fat in children: A single-center experience. Pancreas. 2022; 51(8): 972–5.
183. Pham Y. H., Bingham B. A., Bell C. S. et al. Prevalence of pancreatic steatosis at a pediatric tertiary care center. South Med J. 2016; 109(3): 196–8.
184. Della Corte C., Mosca A., Majo F. et al. Nonalcoholic fatty pancreas disease and Nonalcoholic fatty liver disease: more than ectopic fat. Clin Endocrinol (Oxf). 2015; 83(5): 656–62.
185. Chiyanika C., Chan D. F. Y., Hui S. C. N. et al. 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. Pediatr Obes. 2020; 15(9): e12653.
186. King L. J., Scurr E. D., Murugan N. et al. Hepatobiliary and pancreatic manifestations of cystic fibrosis: MR imaging appearances. Radiographics. 2000; 20(3): 767–77.
187. Han X., Lu S., Gu C. et al. Clinical features, epidemiology, and treatment of Shwachman-Diamond syndrome: a systematic review. BMC Pediatr. 2023; 23(1): 503.
188. Wild K. T., Goldstein A. C., Muraresku C., Ganetzky R. D. Broadening the phenotypic spectrum of Pearson syndrome: Five new cases and a review of the literature. Am J Med Genet A. 2020; 182(2): 365–73.
189. Staaf J., Labmayr V., Paulmichl K. et al. Pancreatic fat is associated with metabolic syndrome and visceral fat but not beta-cell function or body mass index in pediatric obesity. Pancreas. 2017; 46(3): 358–65.
190. Trout A. T., Hunte D. E., Mouzaki M. et al. Relationship between abdominal fat stores and liver fat, pancreatic fat, and metabolic comorbidities in a pediatric population with non-alcoholic fatty liver disease. Abdom Radiol (NY). 2019; 44(9): 3107–14.
191. Cohen M., Syme C., Deforest M. et al. Ectopic fat in youth: the contribution of hepatic and pancreatic fat to metabolic disturbances. Obesity (Silver Spring). 2014; 22(5): 1280–6.
192. Pacifico L., Di Martino M., Anania C. et al. Pancreatic fat and β-cell function in overweight/obese children with nonalcoholic fatty liver disease. World J Gastroenterol. 2015; 21(15): 4688–95.
193. Lee E. H., Kim J. Y., Yang H. R. Ectopic pancreatic fat as a risk factor for hypertension in children and adolescents with nonalcoholic fatty liver disease. J Clin Hypertens (Greenwich). 2021; 23(8): 1506–15.
194. Lee E. H., Kim J. Y., Yang H. R. Association between ectopic pancreatic and hepatic fat and metabolic risk factors in children with non-alcoholic fatty liver disease. Pediatr Obes. 2021; 16(10): e12793.
195. Bi Y., Lin H. Y., Li M. L. et al. The association between pancreatic steatosis and metabolic syndrome: A 5-year follow-up study among a general Chinese population. Pancreas. 2022; 51(8): 1000–6.
196. Ookura R., Usuki N., Miki Y. Correlation between pancreatic fat deposition and metabolic syndrome: relationships with location in the pancreas and sex. Intern Med. 2024; 63(15): 2113–23.
197. Pieńkowska J., Brzeska B., Kaszubowski M. et al. MRI assessment of ectopic fat accumulation in pancreas, liver and skeletal muscle in patients with obesity, overweight and normal BMI in correlation with the presence of central obesity and metabolic syndrome. Diabetes Metab Syndr Obes. 2019; 12: 623–36.
198. Ballester-Vallés C., Flores-Méndez J., Delgado-Moraleda J. et al. Hepatic and pancreatic fat as imaging biomarkers of metabolic syndrome. Radiologia (Engl Ed). 2020; 62(2): 122–30.
199. Rosenblatt R., Mehta A., Snell D. et al. Ultrasonographic nonalcoholic fatty pancreas is associated with advanced fibrosis in NAFLD: A retrospective analysis. Dig Dis Sci. 2019; 64(1): 262–8.
200. Ulasoglu C., Tekin Z. N., Akan K., Yavuz A. Does Nonalcoholic pancreatic steatosis always correlate with nonalcoholic fatty liver disease? Clin Exp Gastroenterol. 2021; 14: 269–75.
201. Bhalla S., Kuchel G. A., Pandol S., Bishehsari F. Association of pancreatic fatty infiltration with age and metabolic syndrome is sex-dependent. Gastro Hep Adv. 2022; 1(3): 344–9.
202. Zhang Y., Liu Y., Petrov M. S. Relationship of fat in the pancreas with cardiovascular disease: A systematic review and meta-analysis. Obes Rev. 2025; 26(7): e13914.
203. Cao M. J., Wu W. J., Chen J. W. et al. Quantification of ectopic fat storage in the liver and pancreas using six-point Dixon MRI and its association with insulin sensitivity and β-cell function in patients with central obesity. Eur Radiol. 2023; 33(12): 9213–22.
204. Yamazaki H., Tauchi S., Wang J. et al. Longitudinal association of fatty pancreas with the incidence of type-2 diabetes in lean individuals: a 6-year computed tomography-based cohort study. J Gastroenterol. 2020; 55(7): 712–21.
205. Begovatz P., Koliaki C., Weber K. et al. Pancreatic adipose tissue infiltration, parenchymal steatosis and beta cell function in humans. Diabetologia. 2015; 58(7): 1646–55.
206. Martin S., Cule M., Basty N. et al. Genetic evidence for different adiposity phenotypes and their opposing influences on ectopic fat and risk of cardiometabolic disease. Diabetes. 2021; 70(8): 1843–56.
207. Sequeira I. R., Yip W. C., Lu L. W. W. et al. Pancreas fat, an early marker of metabolic risk? A magnetic resonance study of Chinese and Caucasian women: TOFI_Asia Study. Front Physiol. 2022; 13: 819606.
208. Hakim O., Bonadonna R. C., Mohandas C. et al. Associations between pancreatic lipids and β-cell function in black African and white European men with type 2 diabetes. J Clin Endocrinol Metab. 2019; 104(4): 1201–10.
209. Ko J., Sequeira I. R., Skudder-Hill L. et al. Metabolic traits affecting the relationship between liver fat and intrapancreatic fat: a mediation analysis. Diabetologia. 2023; 66(1): 190–200.
210. Tushuizen M. E., Bunck M. C., Pouwels P. J. et al. Pancreatic fat content and beta-cell function in men with and without type 2 diabetes. Diabetes Care. 2007; 30(11): 2916–21.
211. Martin S., Sorokin E. P., Thomas E. L. et al. Estimating the effect of liver and pancreas volume and fat content on risk of diabetes: A mendelian randomization study. Diabetes Care. 2022; 45(2): 460–8.
212. Raeder H., Johansson S., Holm P. I. et al. Mutations in the CEL VNTR cause a syndrome of diabetes and pancreatic exocrine dysfunction. Nat Genet. 2006; 38(1): 54–62.
213. Hanafusa H., Morisada N., Nomura T. et al. A girl with CLOVES syndrome with a recurrent PIK3CA somatic mutation and pancreatic steatosis. Hum Genome Var. 2019; 6: 31.
214. Chen S., Zeng K., Liu Q. C. et al. Adropin deficiency worsens HFD-induced metabolic defects. Cell Death Dis. 2017; 8(8): e3008.
215. Gaspar T. B., Jesus T. T., Azevedo M. T. et al. Generation of an obese diabetic mouse model upon conditional atrx disruption. Cancers (Basel). 2023; 15(11): 3018.
216. Nuñez-Durán E., Chanclón B., Sütt S. et al. Protein kinase STK25 aggravates the severity of non-alcoholic fatty pancreas disease in mice. J Endocrinol. 2017; 234(1): 15–27.
217. Jeon S., Lee J., Shin Y., Yoon M. Ascorbic acid reduces insulin resistance and pancreatic steatosis by regulating adipocyte hypertrophy in obese ovariectomized mice. Can J Physiol Pharmacol. 2023; 101(6): 294–303.
218. Gao J., Huang T., Li J. et al. Beneficial effects of n-3 polyunsaturated fatty acids on offspring’s pancreas of gestational diabetes rats. J Agric Food Chem. 2019; 67(48): 13269–81.
219. Sakai T., Kusakabe T., Ebihara K. et al. Leptin restores the insulinotropic effect of exenatide in a mouse model of type 2 diabetes with increased adiposity induced by streptozotocin and high-fat diet. Am J Physiol Endocrinol Metab. 2014; 307(8): E712–9.
220. Barroso Oquendo M., Siegel-Axel D., Gerst F. et al. Pancreatic fat cells of humans with type 2 diabetes display reduced adipogenic and lipolytic activity. Am J Physiol Cell Physiol. 2021; 320(6): C1000–12.
221. Lorza-Gil E., Strauss O. D., Ziegler E. et al. Incretin-responsive human pancreatic adipose tissue organoids: A functional model for fatty pancreas research. Mol Metab. 2025; 91: 102067.
222. Zhang N., Sun Q., Zhang J. et al. Intrapancreatic adipocytes and beta cell dedifferentiation in human type 2 diabetes. Diabetologia. 2025; 68(6): 1242–60.
223. Skytte M. J., Samkani A., Petersen A. D. et al. A carbohydrate-reduced high-protein diet improves HbA(1c) and liver fat content in weight stable participants with type 2 diabetes: a randomised controlled trial. Diabetologia. 2019; 62(11): 2066–78.
224. Al-Mrabeh A., Hollingsworth K. G., Shaw J. A. M. et al. 2-year remission of type 2 diabetes and pancreas morphology: a post-hoc analysis of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2020; 8(12): 939–48.
225. Thomsen M. N., Skytte M. J., Samkani A. et al. Dietary carbohydrate restriction augments weight loss-induced improvements in glycaemic control and liver fat in individuals with type 2 diabetes: a randomised controlled trial. Diabetologia. 2022; 65(3): 506–17.
226. Della Pepa G., Brancato V., Costabile G. et al. An isoenergetic multifactorial diet reduces pancreatic fat and increases postprandial insulin response in patients with type 2 diabetes: A randomized controlled trial. Diabetes Care. 2022; 45(9): 1935–42.
227. Li M., Zheng Q., Miller J. D. et al. Aerobic training reduces pancreatic fat content and improves β-cell function: A randomized controlled trial using IDEAL-IQ magnetic resonance imaging. Diabetes Metab Res Rev. 2022; 38(4): e3516.
228. Wang Y., Liu Y., Petrov M. S. The effects of metabolic bariatric surgery on intra-pancreatic fat deposition and total pancreas volume: a systematic review and meta-analysis. Obes Surg. 2025; 35(4): 1513–24.
229. Salman A. A., Salman M. A., Said M. et al. Improvement of pancreatic steatosis and indices of insulin resistance after metabolic surgery. Front Med (Lausanne). 2022; 9: 894465.
230. Petrov M. S. The Pharmacological landscape for fatty change of the pancreas. Drugs. 2024; 84(4): 375–84.
231. Smits M. M., Tonneijck L., Muskiet M. H. et al. Pancreatic effects of liraglutide or sitagliptin in overweight patients with type 2 diabetes: A 12-week randomized, placebo-controlled trial. Diabetes Care. 2017; 40(3): 301–8.
232. Honka H., Koffert J., Hannukainen J. C. et al. The effects of bariatric surgery on pancreatic lipid metabolism and blood flow. J Clin Endocrinol Metab. 2015; 100(5): 2015–23.
233. Rebours V., Garteiser P., Ribeiro-Parenti L. et al. Obesity-induced pancreatopathy in rats is reversible after bariatric surgery. Sci Rep. 2018; 8(1): 16295.
234. Lautenbach A., Wernecke M., Riedel N. et al. Adaptive changes in pancreas post Roux-en-Y gastric bypass induced weight loss. Diabetes Metab Res Rev. 2018; 34(7): e3025.
235. Umemura A., Sasaki A., Nitta H. et al. Pancreas volume reduction and metabolic effects in Japanese patients with severe obesity following laparoscopic sleeve gastrectomy. Endocr J. 2017; 64(5): 487–98.
236. Petrov M. S. Fateful fat: Intra-pancreatic lipids cause pancreatic cancer. Cell Rep Med. 2024; 5(2): 101428.
237. Frendi S., Martineau C., Cazier H. et al. Role of the fatty pancreatic infiltration in pancreatic oncogenesis. Sci Rep. 2024; 14(1): 6582.
238. Saisho Y., Butler A. E., Meier J. J. et al. Pancreas volumes in humans from birth to age one hundred taking into account sex, obesity, and presence of type-2 diabetes. Clin Anat. 2007; 20(8): 933–42.
239. Rossi A. P., Fantin F., Zamboni G. A. et al. Predictors of ectopic fat accumulation in liver and pancreas in obese men and women. Obesity (Silver Spring). 2011; 19(9): 1747–54.
240. Crane J. D., Yellin S. A., Ong F. J. et al. ELBW survivors in early adulthood have higher hepatic, pancreatic and subcutaneous fat. Sci Rep. 2016; 6: 31560.