Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Ed. by Bereket, Abdullah / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Fei Hong / Mericq, Veronica / Toppari, Jorma


IMPACT FACTOR 2018: 1.239

CiteScore 2018: 1.22

SCImago Journal Rank (SJR) 2018: 0.507
Source Normalized Impact per Paper (SNIP) 2018: 0.562

Print + Online
See all formats and pricing
More options …
Volume 32, Issue 1

Issues

Fatty pancreas in relation to insulin resistance and metabolic syndrome in children with obesity

Marwa ElhadyORCID iD: https://orcid.org/0000-0002-7785-3736 / Amira Aly Ahmed Mahmoud ElazabORCID iD: https://orcid.org/0000-0002-5783-4781 / Karima Abdelfattah Bahagat / Naglaa Abdelmoneam Abdallah / Gamil El-Sayed Ibrahim
Published Online: 2018-12-07 | DOI: https://doi.org/10.1515/jpem-2018-0315

Abstract

Background

Ectopic visceral fat is a major risk factor for obesity complications including insulin resistance and metabolic syndrome. Ultrasonography is a simple bedside screening tool used for the assessment of ectopic visceral fat including fatty pancreas. This study investigates the association between insulin resistance, metabolic syndrome and fatty pancreas detected by ultrasound in children with obesity.

Methods

This case-control study included 50 prepubertal obese (body mass index [BMI] ≥95th age- and sex-specific percentiles) and 30 lean children (BMI 5th–85th age- and sex-specific percentiles) as the control group. Clinical and laboratory parameters of metabolic syndrome including anthropometric indices of central obesity, blood pressure, fasting glucose and lipid profile were measured. Homeostasis model assessment-insulin resistance (HOMA-IR) was used to assess insulin resistance. Ultrasonographic assessment for pancreatic fat was done for all children.

Results

Fifty-eight percent of obese children had fatty pancreas. Obese children with fatty pancreas had a higher rate of metabolic syndrome (p=0.013) and insulin resistance than those with non-fatty pancreas (p=0.012). Regression analysis revealed that fatty pancreas is an independent predictor of metabolic syndrome and insulin resistance. Fatty pancreas increases the risk for metabolic syndrome (odds ratio [OR] 11.40; 95% confidence interval [CI]: 2.69–48.22) and insulin resistance (OR 7.85; 95% CI: 2.20–28.05) in children with obesity.

Conclusions

Obese children have higher pancreatic fat accumulation than lean children. Obese children with fatty pancreas are more susceptible to insulin resistance and metabolic syndrome.

Keywords: fatty pancreas; insulin resistance; metabolic syndrome; obesity; ultrasonography

References

  • 1.

    Lopes HF, Corrêa-Giannella ML, Consolim-Colombo FM, Egan BM. Visceral adiposity syndrome. Diabetol Metab Syndrome 2016;8:40.CrossrefGoogle Scholar

  • 2.

    Patel P, Abate N. Body fat distribution and insulin resistance. Nutrients 2013;5:2019–27.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 3.

    Ou HY, Wang CY, Yang YC, Chen MF, Chang CJ. The association between nonalcoholic fatty pancreas disease and diabetes. Sookoian SC, editors. PLoS One 2013;8:e62561.CrossrefGoogle Scholar

  • 4.

    Catanzaro R, Cuffari B, Italia A, Marotta F. Exploring the metabolic syndrome: nonalcoholic fatty pancreas disease. World J Gastroenterol 2016;22:7660–75.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 5.

    Matsuda A, Makino N, Tozawa T, Shirahata N, Honda T, et al. Pancreatic fat accumulation, fibrosis, and acinar cell injury in the Zucker diabetic fatty rat fed a chronic high-fat diet. Pancreas 2014;43:735–43.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 6.

    Wong VW, Wong GL, Yeung DK, Abrigo JM, Kong AP, et al. Fatty pancreas, insulin resistance, and β-cell function: a population study using fat-water magnetic resonance imaging. Am J Gastroenterol 2014;109:589–97.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 7.

    Pacifico L, Di Martino M, Anania C, Andreoli GM, Bezzi M, et al. Pancreatic fat and β-cell function in overweight/obese children with nonalcoholic fatty liver disease. World J Gastroenterol: WJG 2015;21:4688–95.CrossrefGoogle Scholar

  • 8.

    Ramic E, Prasko S, Mujanovic OB, Gavran L. Metabolic syndrome – theory and practice. Materia Socio-Medica 2016;28:71–3.CrossrefPubMedGoogle Scholar

  • 9.

    WHO. Global status report on noncommunicable diseases. Chapter 7:79–94. 2014.Google Scholar

  • 10.

    The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114(2 Suppl 4th Report):555–76.Google Scholar

  • 11.

    Tanner J. Growth at Adolescence, 2nd ed. Springfield: Thomas. 1962.Google Scholar

  • 12.

    Ghalli I, Salah N, Hussien F, Erfan M, El-Ruby M, et al. In: Proceedings of the 1st National Congress for Egyptian Growth Curves, Cairo University, 11 December 2003. Published in: Sartorio A, Buckler JM, Marazzi N. Egyptian Growth Curves 2002 for Infants, Children and Adolescents. Crescere nel mondo, 2008, Ferring Publisher.

  • 13.

    Bacopoulou F, Efthymiou V, Landis G, Rentoumis A, Chrousos GP, et al. Waist circumference, waist-to-hip ratio and waist-to-height ratio reference percentiles for abdominal obesity among Greek adolescents. BMC Pediatrics 2015;15:50.CrossrefWeb of SciencePubMedGoogle Scholar

  • 14.

    Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, Kendirici M, Keskin M, et al. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol 2010;2:100–6.PubMedCrossrefGoogle Scholar

  • 15.

    Zimmet P, Alberti G, Kaufman F. International Diabetes Federation Task Force on Epidemiology and Prevention of Diabetes: The metabolic syndrome in children and adolescents. Lancet 2007;369:2059–61.CrossrefPubMedGoogle Scholar

  • 16.

    Lee JS, Kim SH, Jun DW, Han JH, Jang EC, et al. Clinical implications of fatty pancreas: correlations between fatty pancreas and metabolic syndrome. World J Gastroenterol 2009;15:1869–75.CrossrefWeb of SciencePubMedGoogle Scholar

  • 17.

    Chan RS, Woo J. Prevention of overweight and obesity: how effective is the current public health approach. Int J Environ Res Public Health 2010;7:765–83.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 18.

    Misra A, Anoop S, Gulati S, Mani K, Bhatt SP, et al. Body fat patterning, hepatic fat and pancreatic volume of non-obese Asian Indians with type 2 diabetes in North India: a case-control study. Alisi A, ed. PLoS One 2015;10:e0140447.CrossrefGoogle Scholar

  • 19.

    Staaf J, Labmayr V, Paulmichl K, Manell H, Cen J, et al. Pancreatic fat is associated with metabolic syndrome and visceral fat but not beta-cell function or body mass index in pediatric obesity. Pancreas 2017;46:358–65.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 20.

    Toledo-Corral CM, Alderete TL, Hu HH, Nayak K, Esplana S, et al. Ectopic fat deposition in prediabetic overweight and obese minority adolescents. J Clin Endocrinol Metab 2013;98:1115–21.Web of SciencePubMedCrossrefGoogle Scholar

  • 21.

    Makino N, Shirahata N, Honda T, Ando Y, Matsuda A, et al. Pancreatic hyperechogenicity associated with hypoadiponectinemia and insulin resistance: a Japanese population study. World J Hepatol 2016;8:1452–8.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 22.

    Raeder H, Haldorsen IS, Ersland L, Grüner R, Taxt T, et al. Pancreatic lipomatosis is a structural marker in nondiabetic children with mutations in carboxyl-ester lipase. Diabetes 2007;56: 444–9.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 23.

    Heni M, Machann J, Staiger H, Schwenzer NF, Peter A, 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;26:200–5.CrossrefWeb of SciencePubMedGoogle Scholar

  • 24.

    Begovatz P, Koliaki C, Weber K, Strassburger K, Nowotny B, et al. Pancreatic adipose tissue infiltration, parenchymal steatosis and beta cell function in humans. Diabetologia 2015;58:1646–55.Web of ScienceCrossrefPubMedGoogle Scholar

  • 25.

    Tushuizen ME, Bunck MC, Pouwels PJ, Bontemps S, van Waesberghe JH, et al. Pancreatic fat content and beta-cell function in men with and without type 2 diabetes. Diabetes Care 2007;30:2916–21.Web of ScienceCrossrefPubMedGoogle Scholar

  • 26.

    Lê KA, Ventura EE, Fisher JQ, Davis JN, Weigensberg MJ, et al. Ethnic differences in pancreatic fat accumulation and its relationship with other fat depots and inflammatory markers. Diabetes Care 2011;34:485–90.Web of ScienceCrossrefPubMedGoogle Scholar

  • 27.

    Ræder H, Vesterhus M, El Ouaamari A, Paulo JA, McAllister FE, et al. Absence of diabetes and pancreatic exocrine dysfunction in a transgenic model of carboxyl-ester lipase-MODY (maturity-onset diabetes of the young). PLoS One 2013;8:e60229.Web of ScienceCrossrefGoogle Scholar

  • 28.

    Chang CJ, Jian DY, Lin MW, Zhao J-Z, Ho L-T, et al. Evidence in obese children: contribution of hyperlipidemia, obesity-inflammation, and insulin sensitivity. Peterson J, ed. PLoS One 2015;10:e0125935.CrossrefGoogle Scholar

  • 29.

    Singh RG, Yoon HD, Poppitt SD, Plank LD, Petrov MS. Ectopic fat accumulation in the pancreas and its biomarkers: a systematic review and meta-analysis. Diabetes Metab Res Rev 2017;33:e2918.CrossrefWeb of ScienceGoogle Scholar

  • 30.

    Fraulob JC, Ogg-Diamantino R, Fernandes-Santos C, AguilaMB, Mandarim-de-Lacerda CA. A mouse model of metabolic syndrome: insulin resistance, fatty liver and non-alcoholic fatty pancreas disease (NAFPD) in C57BL/6 mice fed a high fat diet. J Clin Biochem Nutr 2010;46:212–23.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 31.

    Gullo L, Salizzoni E, Serra C, Calculli L, Bastagli L, et al. Can pancreatic steatosis explain the finding of pancreatic hyperenzymemia in subjects with dyslipidemia? Pancreas 2006;33:351–3.CrossrefPubMedGoogle Scholar

  • 32.

    Cusi K. The role of adipose tissue and lipotoxicity in the pathogenesis of type 2 diabetes. Curr Diab Rep 2010;10:306–15.CrossrefPubMedGoogle Scholar

  • 33.

    Sepe PS, Ohri A, Sanaka S, Berzin TM, Sekhon S, et al. A prospective evaluation of fatty pancreas by using EUS. Gastrointest Endosc 2011;73:987–93.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 34.

    Maggio AB, Mueller P, Wacker J, Viallon M, Belli DC, et al. Increased pancreatic fat fraction is present in obese adolescents with metabolic syndrome. J Pediatr Gastroenterol Nutr 2012;54:720–6.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 35.

    Singh RG, Yoon HD, Wu LM, Lu J, Plank LD, et al. Ectopic fat accumulation in the pancreas and its clinical relevance: a systematic review, meta-analysis, and meta-regression. Metabolism 2017;69:1–13.CrossrefWeb of SciencePubMedGoogle Scholar

  • 36.

    Rossi AP, Fantin F, Zamboni GA, Mazzali G, Zoico E, et al. Effect of moderate weight loss on hepatic, pancreatic and visceral lipids in obese subjects. Nutr Diabetes 2012;2:e32.Web of SciencePubMedCrossrefGoogle Scholar

  • 37.

    Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, Martínez-Abundis E, Ramos-Zavala MG, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab 2010;95:3347–51.Web of ScienceCrossrefPubMedGoogle Scholar

About the article

Received: 2018-07-13

Accepted: 2018-11-11

Published Online: 2018-12-07

Published in Print: 2019-01-28


Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Conflict of interest: None.

Funding: None.

No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.


Citation Information: Journal of Pediatric Endocrinology and Metabolism, Volume 32, Issue 1, Pages 19–26, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2018-0315.

Export Citation

©2019 Walter de Gruyter GmbH, Berlin/Boston.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

[1]
Mohammad Aghaali and Seyed Saeed Hashemi-Nazari
Journal of Pediatric Endocrinology and Metabolism, 2019, Volume 32, Number 5, Page 439

Comments (0)

Please log in or register to comment.
Log in