1 in 5 French people have a fatty pancreas, according to a study.
It’s a disease that we don’t talk about much: fatty pancreas, or “pancreatic steatosis”, is experiencing renewed interest among researchers. It is an excessive accumulation of fat in the pancreas, a gland that secretes digestive enzymes and hormones essential for the body to function. A review of the scientific literature estimates that one in 5 people in France would be affected and that it would be more common than type 2 diabetes, pancreatitis and pancreatic cancer combined.
Questioned by us on this subject, Professor Renato Micelli Lupinacci, pancreatic surgeon, is more nuanced. He emphasizes that this study, although important, has limitations: already, researchers do not agree on the quantity of fat necessary to define a pancreas as “excessively fatty”. Additionally, there are no standardized criteria for diagnosing fat infiltration in the pancreas. Finally, there is a risk that the same groups of patients were studied several times in different publications, distorting the overall results. So to date, “the proportion of people with various pancreatic diseases that can be attributed to fatty pancreas is unknown” the specialist tells us.
As with fatty liver disease, the fatty pancreas is most often asymptomatic (silent) and is often discovered by chance during imaging tests (ultrasound, CT, MRI). “If there are symptoms and we manage to establish a causal link, these would not be specific strictly speaking and would be linked to diseases that could be associated (pancreatitis attacks, symptoms of diabetes or cancer, etc.)“, underlines the expert.
However, when the accumulation of fat is such that it leads to exocrine pancreatic insufficiency, a symptom can occur: steatorrhea. This is the presence of fat in the stools. The stools are then “oily”, pale, bulky, shiny, very smelly and generally float in the bowl. This indicates that the pancreas can no longer produce enough enzymes to digest dietary lipids, which is an important indicator requiring medical investigation. The crucial question for doctors is whether excess fat in the pancreas is the direct cause of pancreatic diseases (such as acute pancreatitis, diabetes, or even pancreatic cancer) or whether it is simply a marker that appears at the same time as these diseases, without directly causing them.
Currently, the studies are not strong enough to resolve this question. This is why research is limited, believes our interlocutor. According to him, there is an urgent need to establish an international consensus on the exact definition of pancreatic steatosis and the best way to diagnose it. Long considered a simple consequence of obesity, the accumulation of fat in the pancreas must be seen as a central element in the development of many pancreatic diseases.
Thanks to Professor Renato MICELLI LUPINACCI, pancreatic, hepatobiliary and oncological surgeon at Ambroise-Paré Hospital. APHP Paris Saclay University
