From the Guidelines
Fatty pancreas, also known as pancreatic steatosis, requires immediate attention to prevent complications such as pancreatic dysfunction, inflammation, and increased risk of pancreatitis and pancreatic cancer, and management should focus on lifestyle modifications, primarily weight loss through a balanced diet and regular exercise, as recommended by the most recent guidelines 1.
Key Considerations
- The condition is reversible in its early stages, and addressing it promptly through lifestyle changes can significantly improve pancreatic health and prevent complications.
- A 5-10% reduction in body weight through a Mediterranean or low-carb diet, limiting processed foods, refined carbohydrates, and saturated fats, is a suitable goal.
- Exercise regularly for at least 150 minutes per week, combining aerobic activities with strength training, to improve pancreatic health.
- Avoid alcohol and smoking, which can worsen pancreatic inflammation.
Nutrition and Supplementation
- While no specific medications directly treat fatty pancreas, addressing underlying conditions like diabetes with metformin or GLP-1 agonists may help improve pancreatic health 1.
- Pancreatic enzyme replacement therapy (PERT) may be necessary for patients with exocrine pancreatic insufficiency (EPI), and the initial treatment should include at least 40,000 USP units of lipase during each meal in adults, as recommended by the AGA clinical practice update 1.
- Routine supplementation and monitoring of fat-soluble vitamin levels are appropriate, and dietary modifications include a low-moderate fat diet with frequent smaller meals and avoiding very-low-fat diets 1.
Monitoring and Follow-up
- Regular monitoring through imaging and blood tests is important to track progress and adjust treatment as needed.
- Measures of successful treatment include reduction in steatorrhea and associated gastrointestinal symptoms, a gain of weight, muscle mass, and muscle function, and improvement in fat-soluble vitamin levels 1.
- Baseline measurements of nutritional status should be obtained, including body mass index, quality-of-life measure, and fat-soluble vitamin levels, and a baseline dual-energy x-ray absorptiometry scan should be obtained and repeated every 1–2 years 1.
From the Research
Definition and Prevalence of Fatty Pancreas
- Fatty pancreas, also known as pancreatic steatosis, is a condition characterized by the accumulation of fat in the pancreatic gland 2, 3, 4, 5.
- The prevalence of pancreatic steatosis has been described in various studies, with rates ranging from 16% to 35% 2.
- Pancreatic steatosis is associated with several conditions, including obesity, metabolic syndrome, type 2 diabetes mellitus, and nonalcoholic fatty liver disease 2, 3, 4, 6.
Diagnosis and Complications of Fatty Pancreas
- Pancreatic steatosis can be diagnosed using imaging techniques such as transabdominal ultrasound, computed tomography scan, and magnetic resonance imaging 3, 4, 5.
- The condition can lead to complications such as pancreatitis, diabetes mellitus, and pancreatic cancer 3, 4.
- Fatty infiltration in the pancreas may also lead to pancreatic endocrine and exocrine dysfunction 2.
Association with Metabolic Syndrome
- Pancreatic steatosis has been found to be significantly associated with an increased risk of metabolic syndrome and its components, including hypertension, nonalcoholic fatty liver disease, diabetes mellitus, and central obesity 6.
- The association between pancreatic steatosis and hyperlipidaemia was not found to be statistically significant 6.
- Further research is needed to elaborate on the causality between pancreatic steatosis and metabolic syndrome 6.