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Pancreatic Steatosis Is Associated With Impaired Exocrine Pancreatic Function

Kromrey, Marie-Luise, MD*; Friedrich, Nele, PhD; Hoffmann, Ralf-Thorsten, MD; Bülow, Robin, MD*; Völzke, Henry, MD§; Weiss, Frank U., PhD; Lerch, Markus M., MD; Motosugi, Utaroh, MD, PhD; Kühn, Jens-Peter, MD*,‡

doi: 10.1097/RLI.0000000000000554
Original Articles

Objectives The aim of this study was to investigate if pancreatic steatosis measured by proton density fat fraction (PDFF) is associated with exocrine pancreatic function defined by fecal elastase concentrations.

Materials and Methods A total of 1458 volunteers (777 women; age range, 21–88 years) underwent magnetic resonance imaging of the pancreas, and organ fat content was quantified by using confounder corrected PDFF. Exocrine pancreatic function was categorized by fecal elastase levels using defined cutoffs: greater than 200 μg/g normal function (n = 1319) and 200 μg/g or less impaired function (n = 139). Statistical analysis to correlate pancreatic fat content with fecal elastase included linear regression, and analyses were adjusted for known confounders for pancreatic steatosis, such as age, sex, and body mass index.

Results Overall mean (±standard deviation) of pancreatic fat content was 7.50% ± 3.78%. Pancreatic fat content was significantly higher in subjects with impaired pancreatic exocrine function (9.36% ± 4.95%) compared with subjects with normal function (7.30% ± 3.59%; P < 0.01). Linear regression analyses showed an inverse correlation between pancreatic fat and fecal elastase levels over the whole study population (beta, −7.19 [standard error, 1.39]; P < 0.01) as well as in the subgroup of subjects with normal function (−4.26 [1.32]; P < 0.01). Among subjects with impaired pancreatic exocrine function, a trend toward an inverse relation was detected (−1.28 [0.84]; P < 0.13).

Conclusions An inverse correlation between PDFF of the pancreas and fecal elastase suggests an association between pancreatic steatosis and impaired pancreatic exocrine function.

From the *Institute of Diagnostic Radiology and Neuroradiology, and

Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald;

Clinic and Policlinic for Radiology, Carl Gustav Carus University Hospital, TU Dresden, Dresden;

§Institute for Community Medicine, and

Department of Internal Medicine A, University Medicine Greifswald, Greifswald, Germany; and

Department of Radiology, University of Yamanashi, Shimokato, Chuo, Japan.

Received for publication November 21, 2018; and accepted for publication, after revision, December 29, 2018.

Conflicts of interest and sources of funding: SHIP is part of the Community Medicine Research net of the University of Greifswald, Germany, which is funded by the Federal Ministry of Education and Research (grants 01ZZ9603, 01ZZ0103, 01ZZ0403, 01ZZ0701, 03ZIK012), the Ministry of Cultural Affairs, as well as the Social Ministry of the Federal State of Mecklenburg-West Pomerania, Federal Ministry of Nutrition, Agriculture and Consumer's Safety (07HS003), German Research Foundation (projects Gr 1912/5-1, Ko 799/5-1, Vo 955/5-1, Vo 955/6-1, Vo 955/10-1), Competence Network Heart Failure (01GI0205), Competence Network Diabetes (01GI0855), German Asthma and COPD Network (COSYCONET; BMBF 01GI0883), Genopathomik (BMBF FZK 03138010), Alfried Krupp von Bohlen und Halbach Foundation, Alexander v. Humboldt Foundation, Leibniz Society, Siemens AG, Health Care Sector (Erlangen, Germany), Pfizer Pharma GmbH (SBU Endocrinology and Ophthalmology; Berlin Germany), Novo Nordisk (Mainz, Germany), Data Input GmbH (Darmstadt, Germany), GABA International AG (Therwil, Switzerland), Imedos Systems (Jena, Germany), and Heinen and Löwenstein (Bad Ems, Germany). Whole-body magnetic resonance imaging including secretin was supported by a joint grant from Siemens Healthcare, Erlangen, Germany, and the Federal State of Mecklenburg-Vorpommern. The University of Greifswald is a member of the Center of Knowledge Interchange program of the Siemens AG. Exocrine pancreatic function assessment was supported by the Deutsche Forschungsgemeinschaft (DFG GRK 1947;A3), the Federal Ministry of Education and Research (BMBF GANI-MED 03IS2061A and BMBF 0314107, 01ZZ9603, 01ZZ0103, 01ZZ0403, 03ZIK012), the European Union (EU-FP-7: EPC-TM), V-630-S-150-2012/132/133, and PePPP Center of Excellence MV (ESF/14-BM-A55-0045/16), as well as unrestricted grants from Bioserv/R-Biopharm and Nordmark.

Correspondence to: Marie-Luise Kromrey, MD, Department of Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald, D-17475 Germany. E-mail:

Online date: February 27, 2019

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