Original Article The effect of fatty pancreas on serum glucose parameters in patients with nonalcoholic steatohepatitis Ahmet Uygun a , Abdurrahman Kadayifci b, ⁎ ,1 , Hakan Demirci a , Mutlu Saglam c , Yusuf S. Sakin a , Kadir Ozturk a , Zulfikar Polat a , Yildirim Karslioglu d , Erol Bolu e a Division of Gastroenterology, Gulhane Military Medical Academy, Ankara, Turkey b Division of Gastroenterology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey c Department of Radiology, Gulhane Military Medical Academy, Ankara, Turkey d Department of Pathology, Gulhane Military Medical Academy, Ankara, Turkey e Division of Endocrinology, Gulhane Military Medical Academy, Ankara, Turkey abstract article info Article history: Received 18 September 2014 Received in revised form 7 November 2014 Accepted 23 November 2014 Available online 7 December 2014 Keywords: Fatty pancreas Prediabetes Diabetes mellitus Glucose Nonalcoholic steatohepatitis Objective: Fatty pancreas (FP) is related to obesity, and may have some clinical implications on glucose metabolism. The frequency and importance of FP in patients with nonalcoholic steatohepatitis (NASH) are not clear. This study aimed to investigate: the frequency of FP in patients with NASH, and its effects on serum glucose parameters. Methods: FP was detected and graded by transabdominal ultrasonography (USG) in patients with biopsy-proven NASH and healthy controls. Body Mass Index and waist circumference were recorded, and serum lipids, fasting serum glucose, HbA1c, OGTT 2-h, insulin level, insulin resistance, type 2 diabetes mellitus (DM) and prediabetes rates were detected. Results: Eighty-four subjects with NASH and 35 healthy controls were enrolled in the study. There was no FP in 41 (48.8%) of the NASH patients according to the study criteria. Forty-three of the NASH patients and 5 of the controls had different grades of fat in their pancreas (51.2% vs. 14%, p = 0.001). The HbA1c and OGTT 2-h results were significantly higher in NASH patients with FP compared to those without FP (p = 0.003 and p = 0.018). The rates of both prediabetes and DM were also found to be significantly increased in NASH patients with FP (p = 0.004). The mean waist circumference was higher in patients with FP (p = 0.027). Grade of FP by USG showed no effect on study parameters in subgroup analysis. Conclusion: FP is common in patients with NASH and increases the rate of prediabetes and DM. The coexistence of both NASH and FP has a further impact on glucose metabolism and DM frequency. © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. 1. Introduction Nonalcoholic fatty liver disease (NAFLD) and its more severe form nonalcoholic steatohepatitis (NASH) are the leading causes of liver disease in the western world. The most significant underlying risk factor for NASH is obesity and hyperlipidemia. Obesity and hyperlipidemia cause ectopic fat accumulation in many organ systems including the liver, heart, skeletal muscle and pancreas. The excess fat in these organs can interfere with cellular functions, may produce a proinflammatory condition and results with development of chronic disease and metabolic consequences. The most significant metabolic complication of obesity is insulin resistance (IR) which is also closely related to metabolic syndrome (MS), type II diabetes mellitus (DM), increased cardiovascular disease (CVD) risk and NASH. Fat accumulation in the pancreas has been implicated in recent studies with some clinical consequences and defined as nonalcoholic fatty pancreatic disease (NAFPD) because of the close association with NAFLD [1]. Increased risk of pancreatic fistula after a pancreatoduodenoctomy surgery has been shown to be related to the presence of fatty pancreas (FP) [2]. Pancreatic fat was associated with the aggravation of acute pancreatitis and multisystem organ failure in another study [3]. Fatty infiltration of pancreas and mitochondrial fatty acid beta-oxidation have been found to be related to carcinogenesis in animal studies [4,5]. The degree of pancreatic fat was also associated significantly with pancreatic ductal adenocancer in a clinical study [6]. Patients with sonographic FP showed higher insulin resistance and visceral fat area than subjects with normal pancreas [7]. FP also showed a strong correlation with metabolic syndrome [7]. IR has been found to be increased in subjects with FP in a recent population study [8]. European Journal of Internal Medicine 26 (2015) 37–41 ⁎ Corresponding author at: University of Gaziantep, Faculty of Medicine, Division of Gastroenterology, Gaziantep 27310, Turkey. Tel.: +90 532 6149080; fax: +90 342 3601922. E-mail addresses: kadayifci@hotmail.com, kadayifci@gantep.edu.tr, akadayifci@mgh.harvard.edu (A. Kadayifci). 1 Present address: 3-H GI Associates, Zero Emerson Place, Blossom St., Massachusetts General Hospital, Boston 02114, MA, USA. Tel.: +1 857 919 9934; fax: +1 617 724 5997. http://dx.doi.org/10.1016/j.ejim.2014.11.007 0953-6205/© 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim