Associations of intra-pancreatic fat deposition with incident diseases of the exocrine and endocrine pancreas: A UK Biobank prospective cohort study.

OBJECTIVE:Investigate whether increased IPFD heightens the risk of diseases of the exocrine and endocrine pancreas. METHODS:A prospective cohort study was conducted using data from the UK Biobank. IPFD was quantified using MRI and a deep learning-based framework called nnUNet. The prevalence of fatty change of the pancreas (FP) was determined using gender- and age-specific thresholds. Associations between IPFD and pancreatic diseases were assessed with multivariate Cox proportional hazard model adjusted for age, sex, ethnicity, body mass index, smoking and drinking status, central obesity, hypertension, dyslipidemia, liver fat content, and spleen fat content. RESULTS:Of the 42,599 participants included in the analysis, the prevalence of FP was 17.86%. Elevated IPFD levels were associated with an increased risk of acute pancreatitis (AP) (HR per one quintile change [95%CI]: 1.513 [1.179-1.941]), pancreatic cancer (PC) (HR per one quintile change [95%CI]: 1.365 [1.058-1.762]) and diabetes mellitus (DM) (HR per one quintile change [95%CI]: 1.221 [1.132-1.318]). FP was also associated with a higher risk of AP (HR [95%CI]: 3.982 [2.192-7.234]), PC (HR [95%CI]: 1.976 [1.054-3.704]), and DM (HR [95%CI]: 1.337 [1.122-1.593], P=0.001). CONCLUSIONS:FP is a common pancreatic disorder. Fat in the pancreas is an independent risk factor for diseases of both the exocrine pancreas and endocrine pancreas.