MRI assessment of pancreatic steatosis in obese Chinese adolescents with non-alcoholic fatty liver disease: Correlation with beta-cell dysfunction and metabolic syndrome

Background The worldwide prevalence of childhood obesity has been increasing since 1970s, with its associated comorbidities posing an important global health threat. Various studies have assessed the relationship between fatty liver and its long term obesity-related complications, but limited studies have been performed to investigate the relationship between pancreatic steatosis and obesity-related complications especially in Asian populations. Purpose To evaluate the relationship between pancreatic steatosis and obesity-related complications in obese Chinese adolescents with non-alcoholic fatty liver disease. Methods Obese Chinese adolescents with non-alcoholic fatty liver disease were included. Chemical-shift encoded MRI was performed on all subjects using a 3T scanner to evaluate the pancreatic and liver fat fraction (FF). The pancreatic volume, abdominal subcutaneous and visceral adipose tissue volume were also measured. Clinical data including age, sex, body weight and height, waist circumference, blood pressure, as well as, laboratory tests including liver function test, insulin levels, glucose and lipid profile were obtained. Metabolic Syndrome was defined according to the International Diabetes Federation criteria while Homeostasis model assessment-beta was used to study pancreatic beta cells function. Statistical analysis was performed using Mann-Whitney U test, multiple linear/ binary logistic regression analyses and odds ratios. Results A total of 52 subjects were included, of which 50% of them had pancreatic steatosis (defined as MRI pancreatic FF ≥ 5%). 38% of the subjects had metabolic syndrome. Pancreatic FF and liver FF were independent predictors of beta cell dysfunction (p=0.015 and p=0.050) and metabolic syndrome (p=0.021 and p=0.041). Liver FF and visceral adipose tissue volume were independent predictors of insulin resistance (p=0.006 and p=0.016). Conclusion Pancreatic steatosis is an important predictor of beta cell dysfunction and metabolic syndrome. Presence of fatty pancreas at imaging should not be considered as a benign finding but rather as an imaging biomarker of emerging pancreatic metabolic and endocrine dysfunction