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  • Review Article
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Intra-pancreatic fat deposition: bringing hidden fat to the fore

Nature Reviews Gastroenterology & Hepatology volume 19, pages 153–168 (2022)Cite this article

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Abstract

Development of advanced modalities for detection of fat within the pancreas has transformed understanding of the role of intra-pancreatic fat deposition (IPFD) in health and disease. There is now strong evidence for the presence of minimal (but not negligible) IPFD in healthy human pancreas. Diffuse excess IPFD, or fatty pancreas disease (FPD), is more frequent than type 2 diabetes mellitus (T2DM) (the most common disease of the endocrine pancreas) and acute pancreatitis (the most common disease of the exocrine pancreas) combined. FPD is not strictly a function of high BMI; it can result from the excess deposition of fat in the islets of Langerhans, acinar cells, inter-lobular stroma, acinar-to-adipocyte trans-differentiation or replacement of apoptotic acinar cells. This process leads to a wide array of diseases characterized by excess IPFD, including but not limited to acute pancreatitis, chronic pancreatitis, pancreatic cancer, T2DM, diabetes of the exocrine pancreas. There is ample evidence for FPD being potentially reversible. Weight loss-induced decrease of intra-pancreatic fat is tightly associated with remission of T2DM and its re-deposition with recurrence of the disease. Reversing FPD will open up opportunities for preventing or intercepting progression of major diseases of the exocrine pancreas in the future.

Key points

  • A small amount of intra-pancreatic fat is a constituent of the normal human pancreas.

  • Chemical shift-encoded MRI is the modality of choice for in vivo quantification of intra-pancreatic fat in humans.

  • Excess intra-pancreatic fat is important in type 2 diabetes mellitus pathogenesis but is not necessarily a consequence of general obesity.

  • Excess intra-pancreatic fat has a major role in transition from acute to chronic pancreatitis.

  • Progressive increase in intra-pancreatic fat can be a harbinger of pancreatic cancer.

  • Intra-pancreatic fat is often labile and fatty pancreas disease is, in principle, reversible.

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Fig. 1: Prevalence of fatty pancreas disease in the general population.
Fig. 2: Principal components of intra-pancreatic fat deposition.
Fig. 3: Possible causative role of fatty pancreas disease in major diseases of the exocrine and endocrine pancreas.

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Acknowledgements

M.S.P. is the recipient of a Rutherford Discovery Fellowship by the Royal Society of New Zealand.

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  1. School of Medicine, University of Auckland, Auckland, New Zealand

    Maxim S. Petrov

  2. Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK

    Roy Taylor

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M.S.P and R.T. discussed the article content, researched data for the article, wrote, reviewed and edited the manuscript.

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Petrov, M.S., Taylor, R. Intra-pancreatic fat deposition: bringing hidden fat to the fore. Nat Rev Gastroenterol Hepatol 19, 153–168 (2022). https://doi.org/10.1038/s41575-021-00551-0

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