Non-alcoholic fatty pancreas disease and pancreatic exocrine insufficiency: pilot study and systematic review

AbstractIntroduction The prevalence of non-alcoholic fatty pancreas disease (NAFPD) is estimated as 2–46% among patients without known pancreatic diseases. An association between NAFPD and non-alcoholic fatty liver disease (NAFLD) has been proposed, as well as an association between NAFPD and pancreatic exocrine insufficiency (PEI).Patients and methods Patients with histologically confirmed NAFLD were included in the study. The control group consisted of individuals included in a surveillance screening program. Magnetic resonance imaging (MRI) of the pancreas was performed in all patients and fat measurement was made using 2-point Dixon imaging. Fecal elastase-1 (FE-1) was performed to evaluate pancreatic exocrine function. Additionally, a 13C-mixed triglyceride breath test (13 C-MTG-BT) was performed in patients with FE-1 < 200 μg/g.Results Imaging signs of NAFPD were present in 17 (71%) patients; 11 (85%) from the NAFLD group and 6 (55%) from the control group. FE-1 < 200 μg/g was found in six (25%) patients (four in the NAFLD group and two in the control group); however, none of them had clinical symptoms of PEI. Therefore, in five out of six patients with low FE-1, a 13C-MTG-BT was performed, showing normal results (>20.9%) in all tested patients. Furthermore, the serum nutritional panel was normal in all patients with low FE-1. A systematic review identified five studies relevant to the topic.Conclusion NAFPD was found in 85% of patients with NAFLD and in 55% of control patients. We did not diagnose PEI in either group. A literature review showed PEI in 9–56% of patients with NAFPD.Keywords: Metabolic syndromenon-alcoholic fatty liver diseasenon-alcoholic fatty pancreas diseasefatty pancreaspancreatic exocrine insufficiency AcknowledgmentsThe authors thank the Swedish Society for Development of Pancreatology (SveSuP) for continuing support, promotion, and creating awareness of pancreas diseases in Swedish society. We also thank our research nurses Maura Krook and Parnia Najjar for their research support.Author contributionsStudy conception and design: MV, JML. Acquisition of data: HM, WR, MV, AH, PS, TB, PK, SP, PK. Systematic review: NP, AM, MV. Drafting of the manuscript: HM, WR, MV, NP, AM, TB, JML. Critical review and writing of the final manuscript: all authors.Disclosure statementMV: Abbott (lecture fee and support for organization of scientific conferences), Viatris (lecture fee and support for organization of scientific conferences and scientific book); AH: Viatris (lecture fee); JML: Abbott (lecture fee and support for organization of scientific conferences), Viatris (lecture fee and support for organization of scientific conferences and scientific book); PS: lecture fee from MSD, Eisai, Roche, and AlbireoAdditional informationFundingStudy (MV) is supported by the Swedish Magtarmfondens stipendium for research and Ruth and Richard Julin Foundation for research. PS was supported by Stockholm County Council K2017-4579 and ALF RS2020-0731 (not related to this study).