Karaevren Tahsin Taner, Yorulmaz Refika, Cerit Mahinur, Şendur Halit Nahit, Kalafat Burak, Aydın Gizem Yaz, Gülbahar Özlem, Yalçın Mehmet Muhittin, Karakoç Ayhan, Aktürk Müjde, Törüner Füsun Baloş, Altınova Alev Eroğlu, Çetin Taha Enes, Cerit Ethem Turgay
Faculty of Medicine, Department of Internal Medicine, Gazi University, Ankara, Turkey.
Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi University, Yenimahalle, 06560, Ankara, Turkey.
Diabetol Metab Syndr. 2025 Mar 28;17(1):107. doi: 10.1186/s13098-025-01663-2.
Fatty pancreas disease (FPD) is characterized by abnormal fat accumulation in pancreatic tissue and is often associated with obesity, metabolic syndrome, and type 2 diabetes mellitus (T2DM). While its pathophysiology and impact on pancreatic functions have been explored, the interplay between FPD, glycemic control, and exocrine dysfunction in T2DM remains inadequately defined. This study aimed to evaluate the presence of FPD, the factors affecting it, and its relationship with endocrine and exocrine pancreatic functions in newly diagnosed T2DM.
A total of 126 individuals were included in the study, comprising 63 newly diagnosed T2DM patients and 63 healthy controls matched for age, sex, body mass index and body fat distribution. Body composition, biochemical parameters (glucose, insulin, C-peptide, HbA1c), fecal elastase levels, and pancreatic/hepatic steatosis grades (evaluated using ultrasonography) were assessed.
Newly diagnosed T2DM patients presented significantly higher hepatic steatosis grades (p = 0.018) and lower fecal elastase levels (p < 0.001) compared to controls. Pancreatic exocrine insufficiency was more prevalent in the T2DM group (p < 0,001). A positive correlation was observed between the FPD grade, hepatic steatosis grade, and hepatic fat fraction. A negative and statistically significant correlation (p < 0.05) was observed between FPD grade and fecal elastase level (r = -0.264). HbA1c levels demonstrated a nonlinear (inverse U-shaped) relationship with FPD, peaking at 9.8% and declining thereafter, while showing a continuous negative relationship with fecal elastase levels. HbA1c predicted low fecal elastase (< 200 μg/g) with a cutoff value of 7.4%. Patients with HbA1c levels > 9.8% presented with reduced FPD alongside persistent exocrine insufficiency.
Fatty pancreas disease is closely associated with hepatic steatosis, glycemic control, and exocrine pancreatic dysfunction in newly diagnosed T2DM patients. The interplay between FPD, glycemic control, and exocrine dysfunction highlights the need for comprehensive metabolic assessments in this population.
胰腺脂肪性疾病（FPD）的特征是胰腺组织中脂肪异常堆积，常与肥胖、代谢综合征和2型糖尿病（T2DM）相关。虽然其病理生理学及对胰腺功能的影响已得到研究，但FPD、血糖控制和T2DM患者外分泌功能障碍之间的相互作用仍未得到充分阐明。本研究旨在评估新诊断T2DM患者中FPD的存在情况、影响因素及其与胰腺内分泌和外分泌功能的关系。
共有126人纳入本研究，包括63例新诊断的T2DM患者和63名年龄、性别、体重指数和体脂分布相匹配的健康对照。评估身体成分、生化参数（血糖、胰岛素、C肽、糖化血红蛋白）、粪便弹性蛋白酶水平以及胰腺/肝脏脂肪变性分级（采用超声评估）。
与对照组相比，新诊断的T2DM患者肝脏脂肪变性分级显著更高（p = 0.018），粪便弹性蛋白酶水平更低（p < 0.001）。T2DM组胰腺外分泌功能不全更为普遍（p < 0.001）。观察到FPD分级、肝脏脂肪变性分级和肝脏脂肪分数之间呈正相关。FPD分级与粪便弹性蛋白酶水平之间存在负相关且具有统计学意义（p < 0.05）（r = -0.264）。糖化血红蛋白水平与FPD呈非线性（倒U形）关系，在9.8%时达到峰值，此后下降，同时与粪便弹性蛋白酶水平呈持续负相关。糖化血红蛋白预测粪便弹性蛋白酶水平低（< 200 μg/g）的临界值为7.4%。糖化血红蛋白水平> 9.8%的患者FPD减轻，但外分泌功能不全持续存在。
在新诊断的T2DM患者中，胰腺脂肪性疾病与肝脏脂肪变性、血糖控制和胰腺外分泌功能障碍密切相关。FPD、血糖控制和外分泌功能障碍之间的相互作用凸显了对该人群进行全面代谢评估的必要性。
