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Computed tomography assessment of pancreatic steatosis in association with anthropometric measurements: A retrospective cohort study

Year 2018, Volume: 3 Issue: 2, 63 - 66, 10.06.2018
https://doi.org/10.25000/acem.413101

Abstract

Aim: Pancreatic steatosis is the fat accumulation in the
pancreatic parenchyma. It is suggested that pancreatic fat infiltration may
play an important role in the prognosis of diseases such as diabetes,
malignancy and pancreatitis, leading to some inflammatory processes and
fibrosis, and may even play an etiological role in the progress of
pancreas-related diseases. However, a limited number of studies on pancreatic
steatosis are available in the literature.

The aim of this study was to investigate the relation of
pancreatic steatosis with age, sex, hepatic steatosis, subcutaneous fat tissue
and visceral fat tissue thickness.

Methods: Hundred patients without a history of previously
known pancreas disease or diabetes mellitus were included in the study. All
patients had gone under abdominal tomography scan for a suspected kidney stone.
Pancreas density, visceral and subcutaneous fat tissue thickness were reviewed
retrospectively. The presence of coexisting hepatosteatosis was investigated.

Results: Pancreatic steatosis was detected in 54% of 100
cases examined.
  There were no
significant difference between the pancreatic steatosis and normal pancreas
groups in terms of gender and subcutaneous fat tissue thickness (p=0.115 and p=0.511,
respectively). Pancreatic steatosis increased significantly with increasing age
and visceral fat tissue thickness (p=0.001 and p = 0.001, respectively). The
incidence of hepatic steatosis was 42% in patients with pancreatic steatosis.









Conclusion: According to our results, pancreatic
steatosis increases with age and increased visceral fat tissue thickness. Thus,
elderly patients with increased visceral fat tissue must be investigated for
pancreatic steatosis.

References

  • 36. Patel NS, Peterson MR, Brenner DA, Heba E, Sirlin C, Loomba R. Association between novel MRI-estimated pancreatic fat and liver histology-determined steatosis and fibrosis in nonalcoholic fatty liver disease. Aliment Pharmacol Ther. 2013;37:630-9.
  • 35. Gan L, Chitturi S, Farrell GC. Mechanisms and implications of age-related changes in the liver: nonalcoholic Fatty liver disease in the elderly. Curr Gerontol Geriatr Res. 2011;2011:831536.
  • 34. Noronha M, Salgadinho A, Ferreira De Almeida MJ, Dreiling DA, Bordalo O. Alcohol and the pancreas. I. Clinical associations and histopathology of minimal pancreatic inflammation. Am J Gastroenterol. 1981;76:114-9.
  • 33. Olsen TS. Lipomatosis of the pancreas in autopsy material and its relation to age and overweight. Acta Pathol Microbiol Scand A. 1978;86:367-73.
  • 32. Wu W-C, Wang C-Y. Association between non-alcoholic fatty pancreatic disease (nafpd) and the metabolic syndrome: case–control retrospective study. Cardiovascular Diabetology. 2013;12:77.
  • 31. Tiikkainen M, Bergholm R, Vehkavaara S, Rissanen A, Häkkinen AM, Tamminen M, et al. Effects of identical weight loss on body composition and features of insulin resistance in obese women with high and low liver fat content. Diabetes. 2003;52:701-7.
  • 30. Tushuizen ME, Bunck MC, Pouwels PJ, Bontemps S, van Waesberghe JH, Schindhelm RK, et al. Pancreatic fat content and beta-cell function in men with and without type 2 diabetes. Diabetes Care. 2007;30:2916-21.
  • 29. Seidell JC, Oosterlee A, Thijssen MA, Burema J, Deurenberg P, Hautvast JG, et al. Assessment of intra-abdominal and subcutaneous abdominal fat: relation between anthropometry and computed tomography. Am J Clin Nutr. 1987;45:7–13.
  • 28. Wong VW, Wong GL, Yeung DK, Abrigo JM, Kong AP, Chan RS, Chim AM, et al. Fatty pancreas, insulin resistance, and β-cell function: a population study using fat-water magnetic resonance imaging. Am J Gastroenterol. 2014;109:589-97.
  • 27. Cnop M, Hannaert JC, Hoorens A, Eizirik DL, Pipeleers DG. Inverse relationship between cytotoxicity of free fatty acids in pancreatic islet cells and cellular triglyceride accumulation. Diabetes. 2001;50:1771-7.
  • 26. van Raalte DH, van der Zij NJ, Diamant M. Pancreatic steatosis in humans: cause or marker of lipotoxicity? Curr Opin Clin Nutr Metab Care. 2010;13:478-85.
  • 25. Dağdeviren M, Altay M, Nalbant E. Pancreatic steatosis: diagnosis and clinical significance. J Contemp Med. 2017;7:1-6.
  • 24. Seidell JC, Bakker CJ, van der Kooy K. Imaging techniques for measuring adipose-tissue distribution -- a comparison between computed tomography and 1.5-T magnetic resonance. Am J Clin Nutr. 1990;51:953–7.
  • 23. Wang D, Yu XP, Xiao WM, Jiao XP, Wu J, Teng DL, et al. Prevalence and clinical characteristics of fatty pancreas in Yangzhou, China: A cross-sectional study. Pancreatology. 2018;18:263-8.
  • 22. Ou HY, Wang CY, Yang YC, Chen MF, Chang CJ. The association between nonalcoholic fatty pancreas disease and diabetes. PLoS One. 2013;8.
  • 21. Shuster A, Patlas M, Pinthus JH, Mourtzakis M. The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol. 2012;85:1-10.
  • 20. Speliotes EK, Massaro JM, Hoffmann U, Foster MC, Sahani DV, Hirschhorn JN, et al. Liver fat is reproducibly measured using computed tomography in the Framingham Heart Study. J Gastroenterol Hepatol. 2008;23:894–9.
  • 19. Patel AV, Rodriguez C, Bernstein L, Chao A, Thun MJ, Calle EE. Obesity, recreational physical activity, and risk of pancreatic cancer in a large US cohort. Cancer Epidemiol Biomarkers Prev. 2005;14:459–66.
  • 18. Larsson SC, Orsini N, Wolk A. Body mass index and pancreatic cancer risk: a meta-analysis of prospective studies. Int J Cancer. 2007;120:1993-8.
  • 17. Michaud DS. Epidemiology of pancreatic cancer. Minerva Chir. 2004;59:99-111.
  • 16. Tariq H, Nayudu S, Akella S, Glandt M, Chilimuri S. Non-Alcoholic Fatty Pancreatic Disease: A Review of Literature. Gastroenterology Res. 2016;9:87-91.
  • 15. van Geenen EJ, Smits MM, Schreuder TC, van der Peet DL, Bloemena E, Mulder CJ. Nonalcoholic fatty liver disease is related to nonalcoholic fatty pancreas disease. Pancreas. 2010;39:1185-90.
  • 14. Mathur A, Hernandez J, Shaheen F, Shroff M, Dahal S, Morton C, et al. Preoperative computed tomography measurements of pancreatic steatosis and visceral fat: prognostic markers for dissemination and lethality of pancreatic adenocarcinoma. HPB. 2011;13:404-10.
  • 13. Kim J, Lim H, Lee SI, Kim YJ. Thickness of Rectus Abdominis Muscle and Abdominal Subcutaneous Fat Tissue in Adult Women: Correlation with Age, Pregnancy, Laparotomy, and Body Mass Index. Arch Plast Surg. 2012;39:528-33.
  • 12. Park SH, Kim PN, Kim KW, Lee SW, Yoon SE, Park SW, et al. Macrovesicular hepatic steatosis in living donors: use of CT for quantitative and qualitative assessment. Radiology. 2006;239:105–12.
  • 11. Kawamoto S, Soyer PA, Fishman EK, Bluemke DA. Nonneoplastic liver disease: evaluation with CT and MR imaging. RadioGraphics. 1998;18:827–48.
  • 10. Lee JS, Kim SH, Jun DW, Han JH, Jang EC, Park JY, et al. Clinical implications of fatty pancreas: Correlations between fatty pancreas and metabolic syndrome. World J Gastroenterol. 2009;15:1869-75.
  • 9. Kim SY, Kim H, Cho JY, Lim S, Cha K, Lee KH, et al. Quantitative assessment of pancreatic fat by using unenhanced CT: pathologic correlation and clinical implications. Radiology. 2014;271:104–12.
  • 8. Navina S, Acharya C, DeLany JP, Orlichenko LS, Baty CJ, Shiva SS, et al. Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci Transl Med. 2011;3:110.
  • 7. Mathur A, Marine M, Lu D, Swartz-Basile DA, Saxena R, Zyromski NJ, et al. Nonalcoholic fatty pancreas disease. HPB. 2007;9:312–18.
  • 6. Carter R, Mouralidarane A, Soeda J, Ray S, Pombo J, Saraswati R, et al. Non-alcoholic fatty pancreas disease pathogenesis: a role for developmental programming and altered circadian rhythms. PLoS One. 2014;21:9:89505
  • 5. Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006;43:99–112.
  • 4. Ogilvie RF. The islands of Langerhans in 19 cases of obesity. J Pathol Bacteriol. 1933;37:473-8.
  • 3. de Oliveira Andrade LJ, Guimarães LR, Cadete RBF, Sá Sodré H, Santana de Melo PR, Conrado de Souza E. Pancreatic steatosis and its association with nonalcoholic fatty liver disease evaluated by ultrasonography. BJMHH. 2015;3:37-43.
  • 2. Mortelé KJ, Rocha TC, Streeter JL, Taylor AJ. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics. 2006;26:715-31.
  • 1. Patel S, Bellon EM, Haaga J, Park CH. Fat replacement of the exocrine pancreas. Am J Roentgenol. 1980;135: 843-5.

Pankreatik steatozun antropometrik ölçümler ile ilişkisinin bilgisayarlı tomografi değerlendirmesi: Retrospektif kohort çalışma

Year 2018, Volume: 3 Issue: 2, 63 - 66, 10.06.2018
https://doi.org/10.25000/acem.413101

Abstract

Amaç: Pankreatik yağlanma, pankreas parankiminde yağ
birikimidir. Bazı inflamatuar süreçlere ve fibrozise yol açarak diyabet,
malignite, pankreatit gibi hastalıkların prognozunda etkili olabileceği ve
hatta pankreasla ilgili hastalıkların gelişiminde etiyolojik rol oynayabileceği
öne sürülmektedir. Pankreatik yağ birikiminin yaşla, cinsiyetle ve obeziteyle
artış gösterdiği düşünülmektedir.  
Ancak
literatürde pankreas yağlanması ile ilgili sınırlı sayıda çalışma mevcuttur.

Bu çalışmada pankreas yağlanmasının; yaş, cinsiyet,
subkutan yağ doku kalınlığı, visseral yağ doku kalınlığı ve hepatosteatoz ile
ilişkisini araştırmak amaçlandı.

Yöntemler: Araştırmaya; bilinen pankreas hastalığı ve
diabetes mellitus öyküsü bulunmayan, üriner sistem taşı araştırılması amacıyla
tomografi incelemesi yapılan 100 olgu dahil edildi. Retrospektif olarak yeniden
değerlendirilen tomografi görüntüleri üzerinden pankreas parankim dansitesi,
visseral ve subkutan yağ doku kalınlıkları ölçüldü. Eşlik eden hepatosteatoz varlığı
araştırıldı.

Bulgular: Çalışmaya dahil edilen 100 olgunun %54’ünde
pankreatik yağlanma saptandı. Pankreatik yağlanma olan ve olmayan olgular
karşılaştırıldığında; cinsiyet ve subkutan yağ doku kalınlığı açısından fark
yoktu (sırası ile p=0,115 ve p=0,511). Pankreas yağlanması yaş ve visseral yağ
doku kalınlığı arttıkça istatistiksel olarak anlamlı şekilde artmıştı (sırası
  ile p=0,001ve p = 0,001). Pankreatik yağlanması
olan olgularda karaciğer yağlanması insidansı %42 olarak bulundu.









Sonuç:  Bulgularımıza göre; yaş ve visseral yağ doku kalınlığı
arttıkça pankreas yağlanması da artış göstermiştir. Bu nedenle visseral yağ
doku kalınlığı artmış, ileri yaştaki olgular pankreas yağlanması 
açısından da araştırılmalıdır.

References

  • 36. Patel NS, Peterson MR, Brenner DA, Heba E, Sirlin C, Loomba R. Association between novel MRI-estimated pancreatic fat and liver histology-determined steatosis and fibrosis in nonalcoholic fatty liver disease. Aliment Pharmacol Ther. 2013;37:630-9.
  • 35. Gan L, Chitturi S, Farrell GC. Mechanisms and implications of age-related changes in the liver: nonalcoholic Fatty liver disease in the elderly. Curr Gerontol Geriatr Res. 2011;2011:831536.
  • 34. Noronha M, Salgadinho A, Ferreira De Almeida MJ, Dreiling DA, Bordalo O. Alcohol and the pancreas. I. Clinical associations and histopathology of minimal pancreatic inflammation. Am J Gastroenterol. 1981;76:114-9.
  • 33. Olsen TS. Lipomatosis of the pancreas in autopsy material and its relation to age and overweight. Acta Pathol Microbiol Scand A. 1978;86:367-73.
  • 32. Wu W-C, Wang C-Y. Association between non-alcoholic fatty pancreatic disease (nafpd) and the metabolic syndrome: case–control retrospective study. Cardiovascular Diabetology. 2013;12:77.
  • 31. Tiikkainen M, Bergholm R, Vehkavaara S, Rissanen A, Häkkinen AM, Tamminen M, et al. Effects of identical weight loss on body composition and features of insulin resistance in obese women with high and low liver fat content. Diabetes. 2003;52:701-7.
  • 30. Tushuizen ME, Bunck MC, Pouwels PJ, Bontemps S, van Waesberghe JH, Schindhelm RK, et al. Pancreatic fat content and beta-cell function in men with and without type 2 diabetes. Diabetes Care. 2007;30:2916-21.
  • 29. Seidell JC, Oosterlee A, Thijssen MA, Burema J, Deurenberg P, Hautvast JG, et al. Assessment of intra-abdominal and subcutaneous abdominal fat: relation between anthropometry and computed tomography. Am J Clin Nutr. 1987;45:7–13.
  • 28. Wong VW, Wong GL, Yeung DK, Abrigo JM, Kong AP, Chan RS, Chim AM, et al. Fatty pancreas, insulin resistance, and β-cell function: a population study using fat-water magnetic resonance imaging. Am J Gastroenterol. 2014;109:589-97.
  • 27. Cnop M, Hannaert JC, Hoorens A, Eizirik DL, Pipeleers DG. Inverse relationship between cytotoxicity of free fatty acids in pancreatic islet cells and cellular triglyceride accumulation. Diabetes. 2001;50:1771-7.
  • 26. van Raalte DH, van der Zij NJ, Diamant M. Pancreatic steatosis in humans: cause or marker of lipotoxicity? Curr Opin Clin Nutr Metab Care. 2010;13:478-85.
  • 25. Dağdeviren M, Altay M, Nalbant E. Pancreatic steatosis: diagnosis and clinical significance. J Contemp Med. 2017;7:1-6.
  • 24. Seidell JC, Bakker CJ, van der Kooy K. Imaging techniques for measuring adipose-tissue distribution -- a comparison between computed tomography and 1.5-T magnetic resonance. Am J Clin Nutr. 1990;51:953–7.
  • 23. Wang D, Yu XP, Xiao WM, Jiao XP, Wu J, Teng DL, et al. Prevalence and clinical characteristics of fatty pancreas in Yangzhou, China: A cross-sectional study. Pancreatology. 2018;18:263-8.
  • 22. Ou HY, Wang CY, Yang YC, Chen MF, Chang CJ. The association between nonalcoholic fatty pancreas disease and diabetes. PLoS One. 2013;8.
  • 21. Shuster A, Patlas M, Pinthus JH, Mourtzakis M. The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol. 2012;85:1-10.
  • 20. Speliotes EK, Massaro JM, Hoffmann U, Foster MC, Sahani DV, Hirschhorn JN, et al. Liver fat is reproducibly measured using computed tomography in the Framingham Heart Study. J Gastroenterol Hepatol. 2008;23:894–9.
  • 19. Patel AV, Rodriguez C, Bernstein L, Chao A, Thun MJ, Calle EE. Obesity, recreational physical activity, and risk of pancreatic cancer in a large US cohort. Cancer Epidemiol Biomarkers Prev. 2005;14:459–66.
  • 18. Larsson SC, Orsini N, Wolk A. Body mass index and pancreatic cancer risk: a meta-analysis of prospective studies. Int J Cancer. 2007;120:1993-8.
  • 17. Michaud DS. Epidemiology of pancreatic cancer. Minerva Chir. 2004;59:99-111.
  • 16. Tariq H, Nayudu S, Akella S, Glandt M, Chilimuri S. Non-Alcoholic Fatty Pancreatic Disease: A Review of Literature. Gastroenterology Res. 2016;9:87-91.
  • 15. van Geenen EJ, Smits MM, Schreuder TC, van der Peet DL, Bloemena E, Mulder CJ. Nonalcoholic fatty liver disease is related to nonalcoholic fatty pancreas disease. Pancreas. 2010;39:1185-90.
  • 14. Mathur A, Hernandez J, Shaheen F, Shroff M, Dahal S, Morton C, et al. Preoperative computed tomography measurements of pancreatic steatosis and visceral fat: prognostic markers for dissemination and lethality of pancreatic adenocarcinoma. HPB. 2011;13:404-10.
  • 13. Kim J, Lim H, Lee SI, Kim YJ. Thickness of Rectus Abdominis Muscle and Abdominal Subcutaneous Fat Tissue in Adult Women: Correlation with Age, Pregnancy, Laparotomy, and Body Mass Index. Arch Plast Surg. 2012;39:528-33.
  • 12. Park SH, Kim PN, Kim KW, Lee SW, Yoon SE, Park SW, et al. Macrovesicular hepatic steatosis in living donors: use of CT for quantitative and qualitative assessment. Radiology. 2006;239:105–12.
  • 11. Kawamoto S, Soyer PA, Fishman EK, Bluemke DA. Nonneoplastic liver disease: evaluation with CT and MR imaging. RadioGraphics. 1998;18:827–48.
  • 10. Lee JS, Kim SH, Jun DW, Han JH, Jang EC, Park JY, et al. Clinical implications of fatty pancreas: Correlations between fatty pancreas and metabolic syndrome. World J Gastroenterol. 2009;15:1869-75.
  • 9. Kim SY, Kim H, Cho JY, Lim S, Cha K, Lee KH, et al. Quantitative assessment of pancreatic fat by using unenhanced CT: pathologic correlation and clinical implications. Radiology. 2014;271:104–12.
  • 8. Navina S, Acharya C, DeLany JP, Orlichenko LS, Baty CJ, Shiva SS, et al. Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci Transl Med. 2011;3:110.
  • 7. Mathur A, Marine M, Lu D, Swartz-Basile DA, Saxena R, Zyromski NJ, et al. Nonalcoholic fatty pancreas disease. HPB. 2007;9:312–18.
  • 6. Carter R, Mouralidarane A, Soeda J, Ray S, Pombo J, Saraswati R, et al. Non-alcoholic fatty pancreas disease pathogenesis: a role for developmental programming and altered circadian rhythms. PLoS One. 2014;21:9:89505
  • 5. Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006;43:99–112.
  • 4. Ogilvie RF. The islands of Langerhans in 19 cases of obesity. J Pathol Bacteriol. 1933;37:473-8.
  • 3. de Oliveira Andrade LJ, Guimarães LR, Cadete RBF, Sá Sodré H, Santana de Melo PR, Conrado de Souza E. Pancreatic steatosis and its association with nonalcoholic fatty liver disease evaluated by ultrasonography. BJMHH. 2015;3:37-43.
  • 2. Mortelé KJ, Rocha TC, Streeter JL, Taylor AJ. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics. 2006;26:715-31.
  • 1. Patel S, Bellon EM, Haaga J, Park CH. Fat replacement of the exocrine pancreas. Am J Roentgenol. 1980;135: 843-5.
There are 36 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Research
Authors

Yeliz Aktürk

Serra Özbal Güneş

Publication Date June 10, 2018
Published in Issue Year 2018 Volume: 3 Issue: 2

Cite

Vancouver Aktürk Y, Özbal Güneş S. Computed tomography assessment of pancreatic steatosis in association with anthropometric measurements: A retrospective cohort study. Arch Clin Exp Med. 2018;3(2):63-6.