A prospective evaluation of fatty pancreas by using EUS

Background: Fatty liver is associated with obesity, diabetes, hyperlipidemia, and the metabolic syndrome. The pathophysiology of fatty pancreas is poorly understood, but it may be closely related to fatty liver.

Objective: The aim of our study was to determine the prevalence of fatty pancreas and risk factors associated with its development.

Design: Prospective, single center study.

Setting: Tertiary-care academic medical center.

Patients: This study involved 250 consecutive patients referred for EUS examination.

Intervention: All patients undergoing EUS at our institution were prospectively identified. Information regarding demographics, tobacco use, alcohol use, blood test results, and comorbidities were collected before EUS. Pancreatic echogenicity was graded in comparison to the spleen at the time of EUS by using an a priori specified grading scheme.

Main outcome measurements: Prevalence of fatty pancreas and factors associated with its development.

Results: During the study period, 250 consecutive patients were prospectively enrolled. The prevalence of fatty pancreas was 27.8% (95% CI, 22.1-34.1). Fatty liver was seen in 22.6% of patients. Factors associated with fatty pancreas on univariate analysis were increasing body mass index (BMI) (P=.004), fatty liver (P<.0001), hyperlipidemia (P=.04), and the metabolic syndrome (odds ratio [OR] 3.13, P=.004). The presence of any metabolic syndrome components, that is, BMI≥30, hyperlipidemia, diabetes, or hypertension, increased the prevalence of fatty pancreas by 37% (OR 1.37, P=.01). Factors independently associated with fatty pancreas on multivariate analysis were increasing BMI (OR 1.05, P=.03) and fatty liver (OR 3.61, P<.001). We found no association between fatty pancreas and chronic pancreatitis or adenocarcinoma of the pancreas.

Limitations: Single institution study. All patients were referred for EUS, which limits generalizability. Lack of histological confirmation of pancreatic fat.

Conclusion: We found a strong association between fatty pancreas and the metabolic syndrome.