Pancreatic Fat Research Articles

Clinical Significance of Pancreatic Fat in Children

Recently, interest in pancreatic fat has increased, and fatty pancreas is considered to be related to nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome. We aimed to evaluate the prevalence of echogenic pancreas in children and its related factors. We retrospectively analyzed the data of patients aged 5 to 18 years who had undergone abdominal sonography between January 2020 and December 2020. Patients with chronic or pancreatic diseases were excluded. Of 102 patients, 27 (26.5%) had echogenic pancreas and 55 (53.9%) had NAFLD. Among the 55 patients with NAFLD, 18 (32.7%) had an echogenic pancreas. Patients with echogenic pancreas had significantly higher fasting glucose, low-density lipoprotein cholesterol, and triglyceride levels than those without echogenic pancreas. The proportion of NAFLD and obesity was higher in the echogenic group; however, only the proportion of obese subjects showed a significant difference. In multivariate analysis, family history of diabetes mellitus (DM) and/or dyslipidemia and presence of DM and/or dyslipidemia were factors related to the presence of echogenic pancreas. Echogenic pancreas is relatively common in children. Echogenic pancreas, typically observed in patients with a family history of DM and/or dyslipidemia, was strongly associated with metabolic syndrome, even in the absence of fatty liver.

Impact of pancreatic fat infiltration on postoperative pancreatic fistula occurrence in patients undergoing invagination pancreaticojejunostomy

BackgroundNo studies to date have determined the impact of pancreatic fat infiltration on postoperative pancreatic fistula (POPF) occurrence in patients undergoing invagination pancreaticojejunostomy (IV-PJ). MethodsThe medical records of patients with a soft pancreas who underwent pancreatoduodenectomy followed by IV-PJ were reviewed . The pancreatic fat ratio on computed tomography (CT) images (I-PFR) was determined using preoperative CT and verified by histologic examination. The relationship between the I-PFR and POPF occurrence was determined. Patients were classified into 2 groups based on I-PFR value (fatty and non-fatty pancreas). Postoperative outcomes were compared between the two groups, and specifically among patients who developed POPF. ResultsOf 221 patients, POPF occurred in 67 (30.3%). I-PFR was positively correlated with histologic-calculated fat ratio (ρ = 0.517, p < 0.001). This index was shown to be an independent predictor of POPF. Based on an I-PFR cut-off value of 3.2%, 92 patients were classified in the fatty pancreas group. Subgroup analysis of the patients who developed POPF showed that incidence of abscess formation and hemorrhage tended to be higher in patients with fatty pancreas than in those with non-fatty pancreas. ConclusionsPancreatic fat infiltration is highly associated with POPF and possibly causes subsequent serious complications in patients undergoing IV-PJ.

Quantitative MRI of chronic pancreatitis: results from a multi-institutional prospective study, magnetic resonance imaging as a non-invasive method for assessment of pancreatic fibrosis (MINIMAP).

PurposeTo determine if quantitative MRI techniques can be helpful to evaluate chronic pancreatitis (CP) in a setting of multi-institutional study.MethodsThis study included a subgroup of participants (n = 101) enrolled in the Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies (PROCEED) study (NCT03099850) from February 2019 to May 2021. MRI was performed on 1.5 T using Siemens and GE scanners at seven clinical centers across the USA. Quantitative MRI parameters of the pancreas included T1 relaxation time, extracellular volume (ECV) fraction, apparent diffusion coefficient (ADC), and fat signal fraction. We report the diagnostic performance and mean values within the control (n = 50) and CP (n = 51) groups. The T1, ECV and fat signal fraction were combined to generate the quantitative MRI score (Q-MRI).ResultsThere was significantly higher T1 relaxation time; mean 669 ms (± 171) vs. 593 ms (± 82) (p = 0.006), ECV fraction; 40.2% (± 14.7) vs. 30.3% (± 11.9) (p < 0.001), and pancreatic fat signal fraction; 12.2% (± 5.5) vs. 8.2% (± 4.4) (p < 0.001) in the CP group compared to controls. The ADC was similar between groups (p = 0.45). The AUCs for the T1, ECV, and pancreatic fat signal fraction were 0.62, 0.72, and 0.73, respectively. The composite Q-MRI score improved the diagnostic performance (cross-validated AUC: 0.76).ConclusionQuantitative MR parameters evaluating the pancreatic parenchyma (T1, ECV fraction, and fat signal fraction) are helpful in the diagnosis of CP. A Q-MRI score that combines these three MR parameters improves diagnostic performance. Further studies are warranted with larger study populations including patients with acute and recurrent acute pancreatitis and longitudinal follow-ups.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s00261-022-03654-7.

Links between ectopic and abdominal fat and systemic inflammation: New insights from the SHIP-Trend study.

Excessive fat accumulation in adipose tissue depots and organs such as the pancreas and the liver is associated with systemic low-grade chronic inflammation. To investigate the association between abdominal, hepatic, and pancreatic fat and the circulating level of inflammatory biomarkers. We used data from a subsample of the Study of Health in Pomerania (SHIP-Trend, n=469). The plasma concentration of 37 inflammatory biomarkers was measured using the Bio-Plex-Pro™-Human-Inflammation-Panel-1. Subcutaneous and visceral adipose tissue (SAT and VAT), as well as hepatic and pancreatic fat, were determined by magnetic resonance imaging. We assessed the associations between fat content and inflammatory biomarkers using multiple linear regression. Hepatic fat was associated with MMP-2 (β -0.11), PTX3 (β -0.14), and TNFSF12 (β -0.06). Pancreatic fat was associated with sTNFR1 (β 0.15), sTNFR2 (β 0.11), and sCD163 (β 0.13). VAT and SAT were associated with sCD163 (βVAT 0.20, βSAT 0.16), MMP-2 (βVAT -0.12, βSAT -0.10), OSTCN (βVAT -0.16, βSAT -0.10), sTNFR1 (βVAT 0.13, βSAT 0.13), sTNFR2 (βVAT 0.13, βSA 0.12), TNFSF12 (βVAT -0.11, βSAT -0.08), and TNFSF14 (βVAT 0.21, βSAT 0.20). VAT was additionally associated with TNFSF13B (β 0.08) and CHI3L1 (β 0.07). Our findings provide new insights into the involvement of hepatic and pancreatic fat on systemic inflammation.

Effects of an isoenergetic multifactorial diet on pancreatic fat and insulin secretion in patients with type 2 diabetes: A randomized controlled trial

Background and Aims : Pancreatic fat (PF) accumulation may impair beta-cell function. We investigated whether an isocaloric diet able to reduce liver fat in type 2 diabetes (T2D) also affected PF and postprandial insulin secretion.

Effects of body fat components on early renal functions of individuals following kidney donation

Objective: Obesity stands as a risk factor for the chronic kidney disease. The objective of this study was to investigate the relationship between early renal function following kidney donation and the measurements of body fat components. Methods: In total, 86 donors followed up for at least 6 months postoperatively were included. Height and weight measurements and results of laboratory analysis of all donors were recorded retrospectively. Visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), hepatic fat (HF), pancreatic fat (PF) and splenic fat (SF) measurements were performed, and pancreatic splenic fat fraction difference (P−S) and pancreatic splenic fat fraction ratio (P/S) were calculated by a radiologist using the records of preoperative computed tomography scans of donors. Results: The estimated glomerular filtration rate (eGFR), serum creatinine and spot urinary microalbumin/creatinine ratio values of the donors at the sixth month postoperatively were statistically different from those of the preoperative values ( p &lt; 0.001). In addition, the individuals were divided into two categories based on the postoperative eGFR: ⩾ 60 mL/min/1.73 m2 and &lt; 60 mL/min/1.73 m2. Age, low-density lipoprotein (LDL) level and VAT/SAT ratio were lower in group eGFR: ⩾ 60 ( p &lt; 0.001, p = 0.03, p = 0.007, respectively). Age and VAT/SAT ratio were the parameters found to be affecting the eGFR significantly, and VAT/SAT ratio (0.729, 95% CI: 0.602–0.856, p = 0.007) had higher predictive value in receiver operating characteristic curve (ROC). Conclusion: Preoperative measurements of body fat components may provide significant information to predict postoperative renal functions of kidney donor candidates. Level of evidence: Not applicable.

An Isoenergetic Multifactorial Diet Reduces Pancreatic Fat and Increases Postprandial Insulin Response in Patients With Type 2 Diabetes: A Randomized Controlled Trial.

To compare the effect of an isocaloric multifactorial diet with a diet rich in monounsaturated fatty acids (MUFA) and similar macronutrient composition on pancreatic fat (PF) and postprandial insulin response in type 2 diabetes (T2D). According to a randomized controlled parallel-group design, 39 individuals with T2D, 35-75 years old, in satisfactory blood glucose control, were assigned to an 8 week isocaloric intervention with a multifactorial diet rich in MUFA, polyunsaturated fatty acids, fiber, polyphenols, and vitamins (n = 18) or a MUFA-rich diet (n = 21). Before/after the intervention, PF content was measured by the proton-density fat fraction using a three-dimensional mDIXON MRI sequence, and plasma insulin and glucose concentrations were measured over a 4 h test meal with a similar composition as the assigned diet. After 8 weeks, PF significantly decreased after the multifactorial diet (from 15.7 ± 6.5% to 14.1 ± 6.3%; P = 0.024), while it did not change after the MUFA diet (from 17.1 ± 10.1% to 18.6 ± 10.6%; P = 0.139) with a significant difference between diets (P = 0.014). Postprandial glucose response was similar in the two groups. Early postprandial insulin response (incremental postprandial areas under the curve [iAUC0-120]) significantly increased with the multifactorial diet (from 36,340 ± 34,954 to 44,138 ± 31,878 pmol/L/min; P = 0.037), while it did not change significantly in the MUFA diet (from 31,754 ± 18,446 to 26,976 ± 12,265 pmol/L/min; P = 0.178), with a significant difference between diets (P = 0.023). Changes in PF inversely correlated with changes in early postprandial insulin response (r = -0.383; P = 0.023). In patients with T2D, an isocaloric multifactorial diet, including several beneficial dietary components, markedly reduced PF. This reduction was associated with an improved postprandial insulin response.

Using Free-Breathing MRI to Quantify Pancreatic Fat and Investigate Spatial Heterogeneity in Children.

MRI acquisition for pediatric pancreatic fat quantification is limited by breath-holds (BH). Full segmentation (FS) or small region of interest (ROI) analysis methods may not account for pancreatic fat spatial heterogeneity, which may limit accuracy. To improve MRI acquisition and analysis for quantifying pancreatic proton-density fat fraction (pPDFF) in children by investigating free-breathing (FB)-MRI, characterizing pPDFF spatial heterogeneity, and relating pPDFF to clinical markers. Prospective. A total of 34 children, including healthy (N=16, 8 female) and overweight (N=18, 5 female) subjects. 3 T; multiecho gradient-echo three-dimensional (3D) stack-of-stars FB-MRI, multiecho gradient-echo 3D Cartesian BH-MRI. A radiologist measured FS- and ROI-based pPDFF on FB-MRI and BH-MRI PDFF maps, with anatomical images as references. Regional pPDFF in the pancreatic head, body, and tail were measured on FB-MRI. FS-pPDFF, ROI-pPDFF, and regional pPDFF were compared, and related to clinical markers, including hemoglobin A1c. T-test, Bland-Altman analysis, Lin's concordance correlation coefficient (CCC), one-way analysis of variance, and Spearman's rank correlation coefficient were used. P < 0.05 was considered significant. FS-pPDFF and ROI-pPDFF from FB-MRI and BH-MRI had mean difference=0.4%; CCC was 0.95 for FS-pPDFF and 0.62 for ROI-pPDFF. FS-pPDFF was higher than ROI-pPDFF (10.4% ± 6.4% vs. 4.2% ± 2.8%). Tail-pPDFF (11.6% ± 8.1%) was higher than body-pPDFF (8.9% ± 6.3%) and head-pPDFF (8.7% ± 5.2%). Head-pPDFF and body-pPDFF positively correlated with hemoglobin A1c. FB-MRI pPDFF is comparable to BH-MRI. Spatial heterogeneity affects pPDFF quantification. Regional measurements of pPDFF in the head and body were correlated with hemoglobin A1c, a marker of insulin sensitivity. 2 TECHNICAL EFFICACY: Stage 2.

Changes in circulating microRNAs-99/100 and reductions of visceral and ectopic fat depots in response to lifestyle interventions: the CENTRAL trial

MicroRNAs (miRNAs) are short noncoding RNAs and important posttranscriptional regulators of gene expression. Adipose tissue is a major source of circulating miRNAs; adipose-related circulating miRNAs may regulate body fat distribution and glucose metabolism. We investigated how changes in adipose-related circulating microRNAs-99/100 (miR-99/100) in response to lifestyle interventions were associated with improved body fat distribution and reductions of diabetogenic ectopic fat depots among adults with abdominal obesity. This study included adults with abdominal obesity from an 18-mo diet and physical activity intervention trial. Circulating miR-99a-5p, miR-99b-5p, and miR-100-5p were measured at baseline and 18 mo; changes in these miRNAs in response to the interventions were evaluated. The primary outcomes were changes in abdominal adipose tissue [visceral (VAT), deep subcutaneous (DSAT), and superficial subcutaneous (SSAT) adipose tissue; cm2] (n=144). The secondary outcomes were changes in ectopic fat accumulation in the liver (n=141) and pancreas (n=143). Greater decreases in miR-100-5p were associated with more reductions of VAT (β±SE per 1-SD decrease: -9.63±3.13 cm2; P=0.0025), DSAT (β±SE: -5.48±2.36 cm2; P=0.0218), SSAT (β±SE: -4.64±1.68 cm2; P=0.0067), and intrahepatic fat percentage (β±SE: -1.54%±0.49%; P=0.0023) after the interventions. Similarly, participants with greater decrease in miR-99a-5p had larger 18-mo reductions of VAT (β±SE: -10.12±3.31 cm2 per 1-SD decrease; P=0.0027) and intrahepatic fat percentage (β±SE: -1.28%±0.52%; P=0.015). Further, decreases in circulating miR-99b-5p (β±SE: per 1-SD decrease: -0.44%±0.21%; P=0.038) and miR-100-5p (β±SE: -0.50%±0.23%; P=0.033) were associated with a decrease in pancreatic fat percentage, as well as improved glucose metabolism and insulin secretion at 18 mo. Decreases in circulating miR-99-5p/100-5p expression induced by lifestyle interventions were related to improved body fat distribution and ectopic fat accumulation. Our study suggests that changes in circulating adipose-related miR-99-5p/100-5p may be linked to reducing diabetogenic fat depots in patients with abdominal obesity.This trial was registered at clinicaltrials.gov as NCT01530724.

Do preoperative pancreatic computed tomography attenuation index and enhancement ratio predict pancreatic fistula after pancreaticoduodenectomy?

BACKGROUNDThe commonly used predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD) have subjective assessment components and can be used only in the postoperative setting. Also, the available objective predictors based on preoperative cross-sectional imaging were not prospectively studied. AIMTo evaluate the accuracy of the pancreatic attenuation index (PAI) and pancreatic enhancement ratio (PER) for predicting CR-POPF following PD and its correlation with pancreatic fat fraction and fibrosis. METHODSA prospective observational study included patients who underwent PD for benign and malignant pathology of the periampullary region or pancreatic head between February 2019 and February 2021. Patients undergoing extended or total pancreatectomy and those with severe atrophy of pancreatic tissue or extensive parenchymal calcifications in the pancreatic head and neck precluding calculation of PAI and PER were excluded from the study. Preoperatively PAI was measured in the neck of the pancreas by marking regions of interest (ROI) in the non-contrast computed tomography (CT), and PER was measured during the contrast phase of the CT abdomen. Also, the fibrosis score and fat fraction of the pancreatic neck were assessed during the histopathological examination. Demographic, clinical and preoperative radiological indices (PAI, PER) were evaluated to predict CR-POPF. Preoperative pancreatic neck CT indices were correlated with the histopathological assessment of fat fraction and fibrosis. RESULTSOf the 70 patients who underwent PD, 61 patients fulfilling the inclusion criteria were included in the analysis. The incidence of CR-POPF was 29.5% (18/61). PAI had no association with the development of CR-POPF. Of the preoperative parameters, PER (mean ± standard deviation [SD]) was significantly lower in patients developing CR-POPF (0.58 ± 0.20 vs 0.81 ± 0.44, P = 0.006). The area under the curve for the PER was 0.661 (95%CI: 0.517-0.804), which was significant (P = 0.049). PER cut-off of 0.673 predicts CR-POPF with 77.8% sensitivity and 55.8% specificity. PAI and PER had a weak negative correlation (Strength-0.26, P = 0.037). Also, PER showed a moderately positive correlation with fibrosis (Strength 0.50, P < 0.001). Patients with CR-POPF had a significantly higher incidence of the intraabdominal abscess (50% vs 2.3%, P < 0.001), delayed gastric emptying (83.3% vs 30.2, P < 0.001), and prolonged mean (± SD) postoperative hospital stay (26.8 ± 13.9 vs 9.6 ± 3.6, P = 0.001).CONCLUSIONPER exhibited good accuracy in predicting the development of CR-POPF. PER additionally showed a good correlation with PAI and fibrosis scores and may be used as an objective preoperative surrogate for assessing pancreatic texture. However, ROI-based PAI did not show any association with CR-POPF and pancreatic fat fraction.

A novel second-stage surgical strategy for severely obese patient with pancreatic neuroendocrine tumor: a case report

BackgroundSeverely obese patients can have other diseases requiring surgical treatment. In such patients, bariatric surgeries are considered a precursor to operations targeting the original disease for the purpose of reducing severe perioperative complications. Pancreatic ectopic fat deposition increases pancreas volume (PV) and thickness, which can worsen insulin resistance and islet β cell function. To address this problem, we present a novel two-stage surgical strategy performed on a severely obese patient with pancreatic neuroendocrine tumor (PNET) consisting of laparoscopic sleeve gastrectomy (LSG) as a metabolic surgery followed by laparoscopic spleen-preserving distal pancreatectomy (LSPDP).Case presentationA 56-year-old man was referred to our hospital for further investigation of a pancreatic tumor. His initial body weight and body mass index (BMI) were 94.0 kg and 37.2 kg/m2, respectively. Contrast computed tomography revealed an enhanced tumor measuring 15 mm on the pancreatic body. The pancreas thickness and PV were 32 mm and 148 mL, respectively. An endoscopic ultrasonographic fine needle aspiration identified the tumor as PNET-G1. We first performed LSG, the patient’s body weight and BMI had decreased dramatically to 64.0 kg and 25.3 kg/m2 at 6 months after LSG. The pancreas thickness and PV had also decreased to 17 mm and 99 mL, respectively, with no tumor growth. Since LSG has been shown to reduce the perioperative risk factors of LSPDP, and to improve insulin resistance and recovery of islet β cell function, we performed LSPDP for PNET-G1 as a second-stage surgery. The postoperative course was unremarkable, and the patient was discharged on postoperative day 14 without symptomatic postoperative pancreatic fistula (POPF). He was followed without recurrence or type 2 diabetes (T2D) onset for 6 months after LSPDP.ConclusionsWe present a novel two-stage surgical strategy for a severely obese patient with PNET, consisting of LSG as a metabolic surgery for severe obesity, followed by LSPDP after confirmation of good weight loss and metabolic effects. LSG before pancreatectomy may have a potential to reduce pancreas thickness and recovery of islet β cell function in severely obese patients, thereby reducing the risk of clinically relevant POPF and post-pancreatectomy T2D onset.

Improvement of Pancreatic Steatosis and Indices of Insulin Resistance After Metabolic Surgery.

PurposeObesity is associated with fat accumulation in ectopic sites such as the pancreas, the so-called pancreatic steatosis (PS). Bariatric surgery has been shown to be associated with reducing pancreatic fat. This study investigated the effect of laparoscopic sleeve gastrectomy (LSG) on pancreatic volume and its fat content and glucose homeostasis.MethodsThe study enrolled 54 patients subjected to LSG. Metabolic variables and pancreatic exocrine function were assessed immediately before surgery and 12 months after. MRI of the abdomen was performed to measure pancreatic fat content and its total volume and visceral adipose tissue (VAT).ResultsSurgery resulted in a significant reduction in body weight and BMI. HbA1c, fasting insulin, C-peptide levels, HOMA-IR, and Hs-CRP levels decreased significantly. Surgery resulted in significant improvement in lipid profile except for HDL-cholesterol and liver function tests. Total VAT volume decreased significantly. Total pancreas volume decreased by a mean of 9.0 cm3 (95% CI: 6.6–11.3). The median change of pancreatic fat was −26.1% (range: −55.6 to 58.3%). Pancreatic lipase decreased significantly (P < 0.001). There was a positive correlation between the percentage of total weight loss and decrease in pancreatic fat volume (r = 0.295, P = 0.030).ConclusionWeight loss after LSG is associated with a reduction of total VAT volume, total pancreatic volume, and pancreatic fat content. These changes are associated with improved glucose homeostasis, reduced systemic inflammation, and decreased pancreatic lipase secretion.

180-OR: Empagliflozin Does Not Affect Pancreatic Fat Content and Insulin Secretion in Humans with Prediabetes

Introduction: Pancreatic fat accumulation is a potential pathogenic factor in type 2 diabetes. Evidence from hypocaloric diet indicates that reduction of pancreatic fat could contribute to an improvement in ß-cell function. There is no established pharmacological approach to reduce pancreatic steatosis. We now tested the ability of empagliflozin to reduce pancreatic fat content in overweight and obese persons with prediabetes. Methods: In this double-blind, placebo-controlled randomized trial (NCT03227484) , 40 participants were 1:1 randomized to receive 25 mg empagliflozin qd or placebo for 8 weeks. Pancreatic fat was quantified by magnetic resonance imaging (6-point Dixon technique) . Insulin sensitivity and insulin secretion was estimated from 75g oral glucose tolerance test. The study was adequately powered to detect effects on pancreatic fat previously reported from the DiRECT trial. Results: There was no significant change in pancreatic fat content in either treatment group (empagliflozin group -0.88 % ± 2.71 %, placebo group 0.22 % ± 3.02 % [mean±SD], both p≥0.2) and the course of pancreatic fat content was comparable between treatments (p=0.2) . Insulin secretion, as assessed by Disposition Index and AUC-C-peptide0-30/AUC-glucose0-30 (adjusted for insulin sensitivity) did not differ between treatments (p=0.3 and p=0.7, respectively) . Discussion: This randomized, controlled trial did not detect effects of empagliflozin on pancreatic fat content and insulin secretion in persons with prediabetes. This implicates that the beneficial effects of empagliflozin on liver fat and systemic glucose metabolism do not rely on alterations in pancreatic fat. Consequently, further options for pancreatic fat reduction need to be evaluated. Disclosure J.Hummel: None. M.Heni: Advisory Panel; Boehringer Ingelheim International GmbH, Research Support; Boehringer Ingelheim International GmbH, Sanofi, Speaker's Bureau; Amryt Pharma Plc, Boehringer Ingelheim International GmbH, Novo Nordisk. J.Machann: None. C.Dannecker: None. S.Kullmann: Other Relationship; Novo Nordisk. A.L.Birkenfeld: None. H.Häring: None. A.Peter: None. A.Fritsche: Advisory Panel; Boehringer Ingelheim International GmbH, Novo Nordisk, Sanofi-Aventis Deutschland GmbH. R.Wagner: Advisory Panel; Akcea Therapeutics, Daiichi Sankyo, Sanofi-Aventis Deutschland GmbH, Speaker's Bureau; Lilly, Novo Nordisk, Sanofi-Aventis Deutschland GmbH. Funding This study was supported by Boehringer Ingelheim through an Independent Research Grant. Boehringer Ingelheim had role in the study design, in the collection, analysis or interpretation of data, or in writing of this abstract.

60-OR: High Prevalence of Multiorgan Steatosis and Fibroinflammation, Identified by Multiparametric Magnetic Resonance Imaging, in People with Type 2 Diabetes

Type 2 diabetes (T2D) is a multi-system disease characterised by a high prevalence of co-morbidities and micro- and macro-vascular complications. The aim of this study was to provide --comprehensive assessment of multi-organ health and pre-clinical detection of diabetes-related organ damage with a single, non-contrast MRI scan. We recruited 138 adults with T2D (median 62 yrs, 60 % male; BMI 31 kg/m2, 92 % on metformin [NCT04114682]) . MRI data were acquired to derive organ-specific measures of size, fat deposition, fibroinflammation, body composition and aortic distensibility (CoverScan®, Perspectum Ltd.) . Reference values of MRI metrics were based on 92 healthy volunteers and published literature. Statistical significance of co-prevalence was assessed by simulation assuming that values were independently binomially distributed. There was a high prevalence of abnormality in individual organs (Figure, left) . Prevalence of low skeletal muscle index and elevated pancreatic fat were associated with T2D duration. There was further evidence of co-prevalence of organ abnormalities (Figure right; 86 % with at least 2 organs affected) . Aortic stiffness was frequently associated with organ steatosis. MRI assessment can enrich the current blunt assessment of multi-organ abnormalities in T2D to inform earlier intervention and treatments. Disclosure N.Eichert: Employee; Perspectum Ltd. S.Ali: Other Relationship; NICE committee for diabetes. G.Thanabalasingham: Speaker's Bureau; Boehringer Ingelheim International GmbH. D.Cuthbertson: Other Relationship; AstraZeneca, Novo Nordisk. K.Gibbons: None. A.Hamid: None. R.Ramkhelawon: Other Relationship; NICE committee. V.E.Woolgar: None. R.Suriano: None. H.B.Thomaides-brears: Employee; Perspectum Ltd, Stock/Shareholder; Perspectum Ltd. R.Banerjee: Employee; Perspectum Ltd., Other Relationship; Perspectum Ltd., Stock/Shareholder; Perspectum Ltd. G.Kemp: None. Funding Innovate UK (Digital Health Technology Catalyst scheme) ; Perspectum Ltd.

Automated Measurement of Pancreatic Fat Deposition on Dixon MRI Using nnU-Net.

Pancreatic fat accumulation may cause or aggravate the process of acute pancreatitis, β-cell dysfunction, T2DM disease, and even be associated with pancreatic tumors. The pathophysiology of fatty pancreas remains overlooked and lacks effective imaging diagnostics. To automatically measure the distribution of pancreatic fat deposition on Dixon MRI in multicenter/population datasets using nnU-Net models. Retrospective. A total of 176 obese/nonobese subjects (90 males, 86 females; mean age, 27.2 ± 19.7) were enrolled, including a training set (N=132) and a testing set (N=44). A 3 T and 1.5T/gradient echo T1 dual-echo Dixon. The segmentation results of four types of nnU-Net models were compared using dice similarity coefficient (DSC), positive predicted value (PPV), and sensitivity. The ground truth was the manual delineation by two radiologists according to in-phase (IP) and opposed-phase (OP) images. The group difference of segmentation results of four models were assessed by the Kruskal-Wallis H test with Dunn-Bonferroni comparisons. The interobserver agreement of pancreatic fat fraction measurements across three observers and test-retest reliability of human and machine were assessed by intragroup correlation coefficient (ICC). P < 0.05 was considered statistically significant. The three-dimensional (3D) dual-contrast model had significantly improved performance than 2D dual-contrast (DSC/sensitivity) and 3D one-contrast (IP) models (DSC/PPV/sensitivity) and had less errors than 3D one-contrast (OP) model according to higher DSC and PPV (not significant), with a mean DSC of 0.9158, PPV of 0.9105 and sensitivity of 0.9232 in the testing set. The test-retest ICC of this model was above 0.900 in all pancreatic regions, exceeded human. 3D Dual-contrast nnU-Net aided segmentation of pancreas on Dixon images appears to be adaptable to multicenter/population datasets. It fully automates the assessment of pancreatic fat distribution and has high reliability. 3 TECHNICAL EFFICACY: Stage 3.

Pancreatic fat infiltration, β-cell function and insulin resistance: A study of the young patients with obesity

ObjectiveThis study aimed to investigate the relationship between pancreatic fat infiltration (PFI) and glucose metabolism disorder, β-cell function and insulin resistance in patients with obesity. MethodsPancreatic fat fraction (PFF) was quantified by MRI IDEAL-IQ technique. PFF greater than 6.2 % was defined as PFI, and 34 obese patients were divided into PFI and non-PFI groups. The 5-point plasma glucose and insulin values during oral glucose tolerance test (OGTT) were recorded. OGTT-derived indices of insulin resistance and β-cell function were calculated. ResultsGlucose values levels at 0–120 min during OGTT were significantly higher and β-cell function variables were lower in PFI group than non-PFI group. While indices of insulin resistance were not significantly different between two groups. Correlation analysis showed that PFF was positively correlated with glucose levels at 0, 30 and 60 min, negatively correlated with β-cell function variables and not significantly correlated with indices of insulin resistance. However, these associations of PFF with β-cell function and glucose levels were only present in type 2 diabetes mellitus (T2DM) group but not in non-T2DM group. ConclusionThere is an association between PFI and impaired β-cell function, and increased pancreatic fat may be a potential risk factor for the development of T2DM.

Magnetic Resonance Imaging Assessment of Abdominal Ectopic Fat Deposition in Correlation With Cardiometabolic Risk Factors.

PurposeEctopic fat accumulation and abdominal fat distribution may have different cardiometabolic risk profiles. This study aimed to assess the associations between various magnetic resonance imaging (MRI)-acquired fat depots and cardiometabolic risk factors.MethodsA total of 320 subjects with median age of 59 years, 148 men and 172 women, were enrolled in the study. Visceral adipose tissue (VAT) area and fat fraction (FF), subcutaneous adipose tissue (SAT) area and FF at the L1–L2 levels, preperitoneal adipose tissue (pPAT) area and FF, hepatic FF, pancreatic FF, and intramuscular FF were assessed by MRI FF maps. The associations of various MRI-acquired fat depots with blood pressure, glucose, and lipid were examined using sex-stratified linear regression. Logistic regression stratified by sex was used to analyze the association of various MRI-acquired fat depots with the risk of hypertension, T2DM, and dyslipidemia.ResultsThe intraclass correlation coefficient (ICC) values were >0.9, which suggested good interobserver and intraobserver agreement. VAT area, V/S, hepatic fat, pancreatic fat, and pPAT rather than SAT area were significantly associated with multiple cardiometabolic risk factors (all p < 0.05). However, the patterns of these correlations varied by sex and specific risk factors. Also, VAT and SAT FF were only significantly associated with multiple cardiometabolic risk factors in women (all p < 0.05).ConclusionsVAT, hepatic fat, pancreatic fat, and pPAT were associated with cardiovascular metabolic risk factors independent of BMI. The patterns of these correlations were related to gender. These findings further the understanding of the association between ectopic fat deposition and cardiometabolic risk factors and help to better understand the obesity heterogeneity.

Dapagliflozin Improves Body Fat Patterning, and Hepatic and Pancreatic Fat in Patients With Type 2 Diabetes in North India.

Excess hepatic and pancreatic fat may contribute to hyperglycemia. The objective of this study was to examine the effect of dapagliflozin (an SGLT2 inhibitor) on anthropometric profile, liver, and pancreatic fat in patients with type 2 diabetes mellitus (T2DM). This is an observational interventional paired study design without a control group. Patients (n = 30) were given dapagliflozin 10 mg/day (on top of stable dose of metformin and/or sulfonylureas) for 120 days. Changes in anthropometry (circumferences and skinfold thickness), surrogate markers of insulin resistance, body composition, liver, and pancreatic fat (as measured by magnetic resonance imaging (MRI)-derived proton density fat fraction [FF]) were evaluated. After 120 days of treatment with dapagliflozin, a statistically significant reduction in weight, body mass index (BMI), body fat, circumferences, and all skinfold thickness was seen. A statistically significant reduction in blood glucose, glycated hemoglobin A1c, hepatic transaminases, fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and postprandial C-peptide was noted, while HOMA-β, postprandial insulin sensitivity, and fasting adiponectin were statistically significantly increased. There was no change in lean body mass. Compared to baseline there was a statistically significant decrease in mean liver FF (from 15.2% to 10.1%, P < .0001) and mean pancreatic FF (from 7.5% to 5.99%, P < .0083). Reduction in liver fat was statistically significant after adjustment for change in body weight. Dapagliflozin, after 120 days of use, reduced pancreatic and liver fat and increased insulin sensitivity in Asian Indian patients with T2DM.

Differential fat accumulation in early adulthood according to adolescent-BMI and heavy metal exposure.

Heavy metals such as Lead (Pb) and Mercury (Hg) can affect adipose tissue mass and function. Considering the high prevalence of exposure to heavy metals and obesity in Mexico, we aim to examine if exposure to Pb and Hg in adolescence can modify how fat is accumulated in early adulthood. This study included 100 participants from the ELEMENT cohort in Mexico. Adolescent Pb and Hg blood levels were determined at 14-16 years. Age- and sex-specific adolescent BMI Z-scores were calculated. At early adulthood (21-22 years), fat accumulation measurements were performed (abdominal, subcutaneous, visceral, hepatic, and pancreatic fat). Linear regression models with an interaction between adolescent BMI Z-score and Pb or Hg levels were run for each adulthood fat accumulation outcome with normal BMI as reference. In adolescents with obesity compared to normal BMI, as Pb exposure increased, subcutaneous (p-interaction=0.088) and visceral (p-interaction<0.0001) fat accumulation increases. Meanwhile, Hg was associated with subcutaneous (p-interaction=0.027) and abdominal (p-interaction=0.022) fat deposition among adolescents with obesity. Heavy metal exposure in adolescence may alter how fat is accumulated in later periods of life.

152 Improving Imaging in Acute Pancreatitis

Abstract Aim In the UK it is not a current practice to perform early (&amp;lt; 3 days) CT for detection and staging of severe cases of acute pancreatitis. Findings of pancreatic necrosis, fat stranding and intraperitoneal fluid should be included in the CT scan report as they are important prognostic factors. Furthermore, radiological facilities should be available to permit US examination of the gallbladder &amp;lt;24 hours of the diagnosis. The aim was to meet 95% for all standards. Method Retrospective baseline data were obtained for 83 patients presented with acute pancreatitis between January 2020 and February 2021. Several interventions were implemented including educational posters, emails and lectures to general surgeons and radiologists. Re-auditing was conducted between May and August 2021 to measure the effectiveness of these interventions. Results Baseline showed low compliance to standards, and 62% of presented patients underwent early CT (&amp;lt; 3 days). Only 78% received US scan within 24 hours of admission. Second cycle showed increased adherence to NICE guidelines with 56% of patients had CT scan in optimal timing. Reports of CT scans showed minimal improvement in terms of including the prognostic factors. US examination of gall bladder improved with 83% of patients diagnosed with acute pancreatitis. Conclusions Early CT may underestimate final severity of acute pancreatitis. Low adherence to guidelines was noticed in the first audit cycle which was increased after the interventions. Further interventions and auditing will be needed.