Pancreatic steatosis is not associated with advanced steatohepatitis or fibrosis in metabolic dysfunction-associated steatotic liver disease

BACKGROUND Visceral fat deposition in the pancreas in the absence of significant alcohol use is termed non-alcoholic fatty pancreas disease (NAFPD) and is closely associated with metabolic dysfunction-associated steatotic liver disease (MASLD). However, few studies have assessed the relationship between the severity of NAFPD and the degree of hepatic inflammation and fibrosis in patients with MASLD. AIM To evaluate how NAFPD correlates with degrees of hepatic steatosis, steatohepatitis, and hepatic fibrosis in patients with MASLD. METHODS We performed a retrospective cohort study of patients in the Yale New Haven Health System with a diagnosis of MASLD. Chart and primary imaging data were reviewed to evaluate the degree of pancreatic steatosis and its relationship to hepatic steatosis, steatohepatitis, fibrosis, and other metabolic parameters. RESULTS Ninety-nine participants were identified who met additional inclusion criteria (liver biopsy and non-contrast enhanced computed tomography scan of the abdomen). 76 out of the 99 patients in our cohort met the imaging criteria for NAFPD. However, there was no association between the degree of pancreatic steatosis and hepatic steatosis (either on imaging or biopsy), or the degree of pancreatic steatosis and advanced forms of MASLD, such as the degree of metabolic dysfunction-associated steatohepatitis or stage of hepatic fibrosis. CONCLUSION MASLD and NAFPD are co-occurring diseases resulting from and contributing to metabolic dysregulation. Our study confirms this association but does not support a strong association between pancreatic steatosis and hepatic steatohepatitis or fibrosis in this cohort; larger prospective, longitudinal studies are needed in the future to better define the complex interplay of MASLD, NAFPD, and metabolic health.