Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2016; 22(34): 7660-7675
Published online Sep 14, 2016. doi: 10.3748/wjg.v22.i34.7660
Exploring the metabolic syndrome: Nonalcoholic fatty pancreas disease
Roberto Catanzaro, Biagio Cuffari, Angelo Italia, Francesco Marotta
Roberto Catanzaro, Biagio Cuffari, Angelo Italia, Department of Clinical and Experimental Medicine, Gastroenterology and Hepatology Service, Internal Medicine Unit, University Hospital Policlinico “G. Rodolico”, University of Catania, 95123 Catania, Italy
Francesco Marotta, ReGenera Research Group for Aging-Intervention, 20144 Milano, Italy
Author contributions: Catanzaro R and Cuffari B contributed equally to this work; Catanzaro R and Cuffari B designed and performed the research, analyzed data and wrote the paper; all authors contributed to revision and approval of the final version of this paper.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Roberto Catanzaro, MD, PhD, Department of Clinical and Experimental Medicine, Gastroenterology and Hepatology Service, Internal Medicine Unit, University of Catania, Policlinico “G. Rodolico”, Via S. Sofia 78, 95123 Catania, Italy.
Telephone: +39-95-3782902 Fax: +39-95-3782376
Received: June 4, 2016
Peer-review started: June 4, 2016
First decision: July 12, 2016
Revised: July 25, 2016
Accepted: August 10, 2016
Article in press: August 10, 2016
Published online: September 14, 2016

After the first description of fatty pancreas in 1933, the effects of pancreatic steatosis have been poorly investigated, compared with that of the liver. However, the interest of research is increasing. Fat accumulation, associated with obesity and the metabolic syndrome (MetS), has been defined as “fatty infiltration” or “nonalcoholic fatty pancreas disease” (NAFPD). The term “fatty replacement” describes a distinct phenomenon characterized by death of acinar cells and replacement by adipose tissue. Risk factors for developing NAFPD include obesity, increasing age, male sex, hypertension, dyslipidemia, alcohol and hyperferritinemia. Increasing evidence support the role of pancreatic fat in the development of type 2 diabetes mellitus, MetS, atherosclerosis, severe acute pancreatitis and even pancreatic cancer. Evidence exists that fatty pancreas could be used as the initial indicator of “ectopic fat deposition”, which is a key element of nonalcoholic fatty liver disease and/or MetS. Moreover, in patients with fatty pancreas, pancreaticoduodenectomy is associated with an increased risk of intraoperative blood loss and post-operative pancreatic fistula.

Keywords: Metabolic syndrome, Nonalcoholic fatty liver disease, Pancreatic steatosis, Pancreatic lipomatosis, Nonalcoholic fatty pancreas disease, Fatty pancreas, Pancreatic fat, Pancreatic fatty replacement, Pancreatic fatty infiltration, Pancreatic cancer

Core tip: Nonalcoholic fatty pancreas disease is a very common yet neglected pathological condition. It can be considered an early marker of the metabolic syndrome and, as so, its clinical significance spaces between internal and surgical diseases, such as type 2 diabetes mellitus, atherosclerosis, acute pancreatitis and even pancreatic cancer. This review collects current knowledge of worldwide opinion leaders and researchers of this matter.