Advertisement

Digestive Diseases and Sciences

, Volume 64, Issue 1, pp 262–268 | Cite as

Ultrasonographic Nonalcoholic Fatty Pancreas Is Associated with Advanced Fibrosis in NAFLD: A Retrospective Analysis

  • Russell Rosenblatt
  • Amit Mehta
  • David Snell
  • Erika Hissong
  • Andrea Siobhan Kierans
  • Sonal KumarEmail author
Original Article

Abstract

Background

Nonalcoholic fatty pancreas disease (NAF-P) is strongly linked with nonalcoholic fatty liver disease (NAFLD), but its relationship with advanced liver disease is unknown.

Aims

This study investigated the association between NAF-P and both advanced fibrosis and nonalcoholic steatohepatitis (NASH).

Methods

This retrospective study evaluated adults with biopsy-proven NAFLD with a sonogram within 1 year of liver biopsy. NAF-P was diagnosed by comparing the echogenicity of the pancreas to the kidney and was graded by severity. The primary outcome was the effect of NAF-P on the presence of advanced fibrosis and NASH, while secondary outcomes included the association of extensive NAF-P (grade II/III). Propensity score matching for independent risk factors of advanced fibrosis (age, gender, body mass index, and diabetes) was performed.

Results

One hundred and four patients were included in the study and 91 (87.5%) had NAF-P. After propensity score matching, NAF-P was significantly associated with advanced fibrosis (OR 10.52, p < 0.001) but not NASH (p = 0.27). Extensive NAF-P was predictive of advanced fibrosis (OR 3.35, p = 0.006) and NASH (OR 5.37, p < 0.001). NAF-P had a negative predictive value (NPV) of 93% for advanced fibrosis. When matching for the NAFLD fibrosis score in addition to the variables above, both NAF-P (OR 5.36, p = 0.001) and extensive NAF-P (OR 5.38, p = 0.002) still significantly predicted advanced fibrosis.

Conclusion

NAF-P is predictive of advanced fibrosis, even when controlling for independent predictors of advanced fibrosis and the NAFLD fibrosis score. NAF-P has an excellent NPV and is a safe, inexpensive finding that can rule out advanced fibrosis.

Keywords

Nonalcoholic fatty liver disease Pancreas NASH Hepatic fibrosis 

Notes

Compliance with ethical standards

Conflict of interest

Sonal Kumar has received an advisory meeting honorarium from Gilead Sciences. The other authors have no conflicts to disclose.

Supplementary material

10620_2018_5295_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 kb)

References

  1. 1.
    Bellentani S, Scaglioni F, Marino M, Bedogni G. Epidemiology of nonalcoholic fatty liver disease. Dig Dis. 2010;28:155–161.CrossRefGoogle Scholar
  2. 2.
    Browning J, Szczepaniak L, Dobbins R, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;116:1413–1419.Google Scholar
  3. 3.
    Matteoni C, Younossi Z, Gramlich T, Bopari N, Liu Y, Mccullough A. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116:1413–1419.CrossRefGoogle Scholar
  4. 4.
    Dulai PS, Singh S, Patel J, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology. 2017;65:1557–1565.CrossRefGoogle Scholar
  5. 5.
    Lammert E, Cleaver O, Melton D. Role of endothelial cells in early pancreas and liver development. Mech Dev. 2003;120:59–64.CrossRefGoogle Scholar
  6. 6.
    Donnelly KL, Smith CI, Schwarzenberg SJ, Jessurun J, Boldt MD, Parks EJ. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. J Clin Invest. 2005;115:1343–1351.CrossRefGoogle Scholar
  7. 7.
    Lee JS, Kim SH, Jun DW, et al. Clinical implications of fatty pancreas: correlations between fatty pancreas and metabolic syndrome. World J Gastroenterol. 2009;15:1869–1875.CrossRefGoogle Scholar
  8. 8.
    Boyd W. Text-book of pathology: An introduction to medicine. 3rd ed. Philadelphia: Lea & Febiger; 1938.Google Scholar
  9. 9.
    Ou HY, Wang CY, Yang YC, Chen MF, Chang CJ. The association between nonalcoholic fatty pancreas disease and diabetes. PLoS ONE. 2013.  https://doi.org/10.1371/journal.pone.0062561.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Wang CY, Ou HY, Chen MF, Chang TC, Chang CJ. Enigmatic ectopic fat: prevalence of nonalcoholic fatty pancreas disease and its associated factors in a Chinese population. J Am Heart Assoc. 2014;3:e000297.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Lesmana C, Pakasi L, Inggriani S, Aidawati M, Lesmana L. Prevalence of nonalcoholic fatty pancreas disease (NAFPD) and its risk factors among adult medical check-up patients in a private hospital: a large cross sectional study. BMC Gastroenterol. 2015;15:174.CrossRefGoogle Scholar
  12. 12.
    Della Corte C, Mosca A, Majo F, et al. Nonalcoholic fatty pancreas disease and Nonalcoholic fatty liver disease: more than ectopic fat. Clin Endocrinol (Oxf). 2015;83:656–662.CrossRefGoogle Scholar
  13. 13.
    Uygun A, Kadayifci A, Demirci H, et al. The effect of fatty pancreas on serum glucose parameters in patients with nonalcoholic steatohepatitis. Eur J Intern Med. 2015;26:37–41.CrossRefGoogle Scholar
  14. 14.
    Khoury T, Asombang AW, Berzin TM, Cohen J, Pleskow DK, Mizrahi M. The clinical implications of fatty pancreas: a concise review. Dig Dis Sci. 2017;62:2658–2667.  https://doi.org/10.1007/s10620-017-4700-1.CrossRefPubMedGoogle Scholar
  15. 15.
    Hori M, Takahashi M, Hiraoka N, et al. Association of pancreatic fatty infiltration with pancreatic ductal adenocarcinoma. Clin Transl Gastroenterol. 2014;5:e53.CrossRefGoogle Scholar
  16. 16.
    Lingvay I, Esser V, Legendre JL, et al. Noninvasive quantification of pancreatic fat in humans. J Clin Endocrinol Metab. 2009;94:4070–4076.CrossRefGoogle Scholar
  17. 17.
    Yamazaki H, Tauchi S, Kimachi M, et al. The association between pancreatic fat and incidence of metabolic syndrome: a 5-year Japanese cohort study. J Gastroenterol Hepatol. 2018.  https://doi.org/10.1111/jgh.14266.CrossRefPubMedGoogle Scholar
  18. 18.
    Heni M, Machann J, Staiger H, et al. Pancreatic fat is negatively associated with insulin secretion in individuals with impaired fasting glucose and/or impaired glucose tolerance: a nuclear magnetic resonance study. Diabetes Metab Res Rev. 2010;26:200–205.CrossRefGoogle Scholar
  19. 19.
    Mathur A, Marine M, Lu D, et al. Nonalcoholic fatty pancreas disease. HPB (Oxford). 2007;9:312–318.CrossRefGoogle Scholar
  20. 20.
    Seeff LB, Everson GT, Morgan TR, et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol Hepatol. 2010;8:877–883.CrossRefGoogle Scholar
  21. 21.
    Lupşor-Platon M, Stefǎnescu H, Muresçan D, et al. Noninvasive assessment of liver steatosis using ultrasound methods. Med Ultrason. 2014;16:236–245.PubMedGoogle Scholar
  22. 22.
    Zezos P, Renner EL. Liver transplantation and nonalcoholic fatty liver disease. World J Gastroenterol. 2014;20:15532–15538.CrossRefGoogle Scholar
  23. 23.
    Xiao G, Zhu S, Xiao X, et al. Comparison of laboratory tests, ultrasound, or MRE to detect fibrosis in patients with nonalcoholic fatty liver disease: a meta-analysis. Hepatology. 2017;66:1486–1501.CrossRefGoogle Scholar
  24. 24.
    Myers RP, Pomier-Layrargues G, Kirsch R, et al. Discordance in fibrosis staging between liver biopsy and transient elastography using the FibroScan XL probe. J Hepatol. 2012;56:564–570.CrossRefGoogle Scholar
  25. 25.
    Szabo G, Petrasek J. Inflammasome activation and function in liver disease. Nat Rev Gastroenterol Hepatol. 2015;12:387–400.CrossRefGoogle Scholar
  26. 26.
    Ceccarelli S, Panera N, Mina M, et al. LPS-induced TNF-α factor mediates pro-inflammatory and pro-fibrogenic pattern in nonalcoholic fatty liver disease. Oncotarget. 2015;6:41434–41452.CrossRefGoogle Scholar
  27. 27.
    Oben JA, Patel T, Mouralidarane A, et al. Maternal obesity programmes offspring development of nonalcoholic fatty pancreas disease. Biochem Biophys Res Commun. 2010;394:24–28.CrossRefGoogle Scholar
  28. 28.
    Patel NS, Peterson MR, Lin GY, et al. Insulin resistance increases MRI-estimated pancreatic fat in nonalcoholic fatty liver disease and normal controls. Gastroenterol Res Pract. 2013;2013:1–8.CrossRefGoogle Scholar
  29. 29.
    Saadeh S, Younossi ZM, Remer EM, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology. 2002;123:745–750.CrossRefGoogle Scholar
  30. 30.
    Catanzaro R, Cuffari B, Italia A, Marotta F. Exploring the metabolic syndrome: nonalcoholic fatty pancreas disease. World J Gastroenterol. 2016;22:7660–7675.CrossRefGoogle Scholar
  31. 31.
    Sepe PS, Ohri A, Sanaka S, et al. A prospective evaluation of fatty pancreas by using EUS. Gastrointest Endosc. 2011;73:987–993.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Russell Rosenblatt
    • 1
  • Amit Mehta
    • 2
  • David Snell
    • 2
  • Erika Hissong
    • 3
  • Andrea Siobhan Kierans
    • 4
  • Sonal Kumar
    • 1
    Email author
  1. 1.Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkUSA
  2. 2.Department of MedicineWeill Cornell MedicineNew YorkUSA
  3. 3.Department of Pathology and Laboratory MedicineWeill Cornell MedicineNew YorkUSA
  4. 4.Division of RadiologyWeill Cornell MedicineNew YorkUSA

Personalised recommendations