While metabolic dysfunction–associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, receives considerable attention, the pancreas frequently enough remains a neglected organ in medical discussions. Max Petrov, MD, MPH, PhD, professor of pancreatology at The University of Auckland in Auckland, New Zealand, highlighted this disparity, stating:

When it comes to diseases of the liver and pancreas, the liver is the big brother that has gotten all the attention, while the pancreas is the neglected little stepbrother that’s not sufficiently profiled in most medical textbooks and gets very little attention. The phenomenon of fatty pancreas has been observed for decades,but it is underappreciated and underrecognized.
Max Petrov, MD, MPH, PhD, The University of Auckland

The presence of fat depositions in the pancreas was initially identified during autopsies as early as 1926. However, the condition remained largely unknown for many years. Mohammad bilal, MD, associate professor of medicine-gastroenterology at the University of Colorado Anschutz Medical Campus in Aurora, Colorado, noted, “Fortunately, FPD has recently been receiving more focus.”

Healthy individuals typically have small amounts of fat in their pancreas. IPFD is defined as “the diffuse presence of fat in the pancreas, measured on a continuous scale,” with FPD referring to IPFD exceeding the normal upper limit. While a definitive consensus on the normal range is lacking, studies suggest a pancreatic fat content ranging from 1.8% to 10.4%.

According to Petrov,the most important concern regarding FPD is its potential to act as a precursor to more severe pancreatic diseases. Fatty changes in the pancreas can impact both its endocrine and exocrine systems. FPD is associated with type 2 diabetes, a common endocrine disease, and also pancreatitis and pancreatic cancer, wich are common exocrine diseases.It is also implicated in the development of carotid atherosclerosis, pancreatic fistula following surgery, and exocrine pancreatic insufficiency (EPI).

The PANDORA Hypothesis

Interestingly, up to half of individuals with fatty pancreas are lean, indicating that the condition is not solely caused by excessive fat overflow from the liver. Petrov explained that the development of FPD is more complex than the way people accumulate liver fat.

“Hepatic fat is a relatively simple process: Lipid droplets accumulate in the hepatocytes; but, in the pancreas, there are several ways by which fat may accumulate,” Petrov saeid.

One factor is

unmasking the Silent Pandemic: A Deep Dive into Fatty Pancreas Disease

Millions suffer silently, unaware of the impact of excess fat in their pancreas. Is this overlooked condition the key to understanding a range of debilitating diseases?

Interviewer: Dr. Anya Sharma, welcome. Your expertise in pancreatology is highly regarded. Let’s delve into Fatty Pancreas Disease (FPD), a condition many are only beginning to understand. Can you explain what exactly FPD is adn its prevalence?

Dr. Sharma: Thank you for having me. Fatty Pancreas Disease, or FPD, is characterized by the excessive accumulation of fat within the pancreas – a condition known as intra-pancreatic fat deposition (IPFD). While often overshadowed by conditions like fatty liver disease, FPD affects a significant portion of the global population, potentially impacting one in five individuals. This prevalence is surprisingly higher than that of type 2 diabetes, pancreatitis, and pancreatic cancer combined—making it a major public health concern.The silent nature of FPD is alarming, as many individuals remain undiagnosed and untreated.

Interviewer: The article mentions a historical context of FPD being discovered as early as 1926. Why has it remained relatively obscure for so long?

Dr. Sharma: You’re right, the presence of fat in the pancreas was observed during autopsies decades ago. However,many factors contributed to its obscurity.Firstly, the technology to reliably detect IPFD wasn’t readily available until relatively recently. Secondly, the focus understandably shifted towards more readily apparent conditions affecting the liver and other organs. The pancreas, often dubbed the “neglected stepbrother” of the gastroenterology world, was simply not a primary focus of research. Today, advanced imaging techniques like MRI and CT scans allow us to successfully diagnose FPD more accurately.

Interviewer: Beyond the mere presence of fat, what are the potential dangers or complications associated with FPD?

Dr.Sharma: The worrisome aspect of FPD lies in its potential to contribute to several more severe pancreatic conditions. Excess fat in the pancreas can disrupt both its endocrine and exocrine functions. The endocrine dysfunction is linked to the advancement of type 2 diabetes, while exocrine dysfunction can lead to pancreatitis and even pancreatic cancer. This connection between FPD and these severe diseases is a significant concern. Further,FPD has shown links to carotid atherosclerosis,pancreatic fistula following surgery,and exocrine pancreatic insufficiency (EPI). This highlights the wide-ranging effects of this often-ignored condition.

Interviewer: The article mentions the “PANDORA hypothesis.” Can you elaborate on this and how it reframes our understanding of FPD’s development?

Dr. Sharma: The PANDORA hypothesis challenges the simplistic notion that FPD is solely a result of excess fat overflowing from the liver, as seen in many cases of fatty liver disease. It suggests that other factors, such as genetics, inflammation, and insulin resistance, play a greater role in the accumulation of fat within the pancreas. Crucially, up to half of individuals with FPD are lean, underscoring the complexity of FPD pathogenesis and challenging simple assumptions. Therefore, understanding the different pathways that lead to IPFD—not just simple fat spillover—is a vital step toward developing effective prevention and treatment strategies.

Interviewer: What are some of the key takeaways for readers concerned about FPD? What steps can individuals take to potentially reduce their risk or mitigate its effects?

Dr. Sharma: Here are some key actions for maintaining pancreatic health:

Maintain a healthy weight: While FPD isn’t solely related to obesity, maintaining a healthy BMI through balanced nutrition and regular exercise remains crucial for overall health and can reduce the risk factors for multiple conditions, including FPD.

Manage diabetes effectively: If you have type 2 diabetes, diligent management through medications, diet, and lifestyle changes is essential, as poorly-controlled blood sugar can contribute to the development of FPD.

Focus on a balanced diet: A diet rich in anti-inflammatory foods can mitigate additional stresses on the pancreas.

Consult a healthcare professional: If you have concerns about FPD or risk factors, consult your gastroenterologist or endocrinologist for advice and potential screening. Early detection can improve future outcomes.

Interviewer: This has provided much-needed clarification on FPD. Dr. Sharma, thank you for your insight.

Final Thought: Fatty Pancreas Disease is no longer a hidden condition. Understanding its widespread impact and potential implications is crucial for safeguarding overall health. Share your thoughts on FPD in the comments below—let’s continue this crucial conversation.