The relationship between non-alcoholic fatty liver disease and non-alcoholic fatty pancreatic disease and pancreatic functional disorder

Aim: Recently, with the increase in the incidence of obesity and metabolic syndrome, the incidence of non-alcoholic fatty liver disease (NAFLD) is gradually increasing. NAFLD is currently the most common cause of chronic liver disease in western countries, and it is a clinical and pathological condition of increasing importance that can progress to end-stage liver disease. Recent studies have shown that the clinical burden of NAFLD is not only limited to the liver, but also a multi-system disease that affects extrahepatic organs and regulatory pathways. It is known that obesity and metabolic syndrome are associated with ectopic fat accumulation in the liver as well as in other organs including the pancreas. This ectopic fat accumulation process underlying the pathogenesis of NAFLD leads to cytokine-mediated inflammation, lipotoxicity and oxidative stress, resulting in hepatocellular damage, inflammation and steatosis, resulting in a progressive liver disease called non-alcoholic steatohepatitis (NASH). It has been suggested that fat accumulation in the pancreas in the setting of the metabolic syndrome may lead to a similar process called non-alcoholic steatopancreatitis (NASP) [6] In our study, we aimed to examine the presence of NASP in patients with NAFLD and it's relationship with NAFLD. Materials and Methods: In our study, patients with non-alcoholic fatty liver disease followed up in Zonguldak Bülent Ecevit University Medical Faculty Hospital Gastroenterology clinic between 2016 and 2022 included as patient group and for the control group, individuals who underwent abdominal MRI for any reason or pre-diagnosis and who did not have fatty liver were included. The data of the patients who applied to the gastroenterology outpatient clinic and were registered in the automation system were analyzed retrospectively. In the study, many laboratory parameters such as demographic characteristics, height, body weight, body mass index, fasting blood glucose, HbA1c, fasting insulin, HOMA-IR, liver function tests, complete blood count, and albumin were recorded in all patient groups.Afterwards, all MRIs of this patient group were re-examined by an experienced and expert radiologist in terms of pancreatic and hepatic steatosis, and statistical comparisons were made between the groups. In addition, pancreatic volumes were measured on MRIs with the support of the anatomy department, with a program called OsiriX MD, a medical image viewer that can make 3-dimensional measurements. The relationship between NAFLD and NASP was discussed from different aspects, both in terms of laboratory parameters, adiposity by MRI, and pancreatic volumetric. Results: A total of 101 people, 57 of whom were diagnosed with non-alcoholic fatty liver disease and 44 as the control group, who were followed up in the Gastroenterology clinic of Zonguldak Bülent Ecevit University Medical Faculty Hospital between 2016 and 2022, were included in the study. Patients who applied to the gastroenterology outpatient clinic and whose information was available in the automation system, were over 18 years old, had fatty liver disease, and had abdominal MRI taken in the system, were included in the study as a patient group, regardless of gender. In the control group, patients over the age of 18 who had abdominal MRI for any reason without known liver and pancreas disease were included in the study, regardless of gender. While 38 (66.7%) of the patient group were female, 29 (65.9%) of the control group were female. In the study, ALT, AST, ALP, GGT, FAS, HbA1C, PLT, albumin blood values were analyzed in the patient and control groups. There was a statistically significant difference between the two groups in terms of all blood values examined, except for PLT (p<0.001). At the same time, FIB-4 and NAFLD Fibrosis scores were calculated from non-invasive fibrosis scores in these individuals. Both scores were significantly higher in the patient group (p<0.001). There was no significant difference between the patient and control groups in terms of gender and age. BMI and weight were significantly higher in the patient group (p<0.001). When pancreatic volume was evaluated, the mean pancreatic volume was 80.84±31.68 cm3 in the patient group, while it was 84.66±20.67 cm3 in the control group. There was no statistically significant difference between the two groups in terms of volume (p=0.489). While examining pancreatic adiposity rates, pancreatic adiposity rates were measured in 3 sections as head (P1), trunk (P2) and tail (P3), and the average pancreatic adiposity rate was determined by taking the average of these 3 sections. While the mean pancreatic adiposity rate was 11.41±12.71% in the patient group with NAFLD, it was 5.30±8.71% in the control group, which was significantly higher (p<0.001). In the correlation between mean pancreatic steatosis and hepatic steatosis, there was a weak positive correlation in all individuals, a high grade positive correlation in the control group, but no significant correlation was observed in the patient group. When the mean pancreatic adiposity and the amount of liver fattening were examined in the patient group according to the fibrosis stage, there was no statistically significant difference in terms of the mean pancreatic adiposity in the F1, F2, F3 and F4 stages, while a statistically significant difference was found in the fibrosis stages in terms of the amount of liver fattening (p=0.014). The relationships between the demographic data of the individuals with pancreatic volume, mean pancreatic steatosis and hepatic steatosis were evaluated separately in 3 groups as the patient group, control group and all patients. While a weak negative correlation was observed between age and pancreatic volume in all individuals in the whole group and control group, no statistically significant finding was found between age and pancreatic volume in the patient group. When the relationship between pancreatic volumes of individuals and BMI was examined in 3 different arms as the whole group, the patient group and the healthy control group, no statistically significant difference was found in any of the 3 arms. At the same time, pancreatic volume, hepatic steatosis and mean pancreatic adiposity values were analyzed according to gender. While the mean pancreatic volume was 77.22±27.08 cm3 in women, it was 92.91±25.22 cm3 in men, and the pancreatic volume values in men were significantly higher. Conclusion: As a result of the study, the amount of pancreatic fat was statistically significantly higher in the group with fatty liver. There was a weak positive correlation between the mean pancreatic steatosis and the amount of liver steatosis in all individuals, and a high grade positive correlation in the control group. When the patients were evaluated on pancreatic volume, no statistically significant difference was found between the two groups. We think that the prevalence of NAYPH will increase as a result of ectopic fat accumulation in the pancreas with the prevalence of obesity and metabolic syndrome and the gradual increase in diabetes, and we believe that more studies should be done on this subject.