TOPLINE

Moderate-to-severe fatty pancreas was independently associated with prevalent and incident type 2 diabetes (T2D), incident chronic kidney disease (CKD), and incident major adverse cardiovascular events (MACEs).

METHODOLOGY

• Researchers evaluated the association between fatty pancreas and prevalent and incident T2D, CKD, and MACEs using data from the UK Biobank.
• They included 19,255 adult participants of European ancestry (median age, 65 years; 49.1% men) from the UK Biobank imaging substudy who underwent an abdominal MRI scan.
• Pancreatic fat was measured using MRI-derived proton density fat fraction (PDFF), and participants were classified as those with normal pancreas (< 6%; n = 6679), mild fatty pancreas (6% to < 16%; n = 8886), and moderate-to-severe fatty pancreas (≥ 16%; n = 3690) according to 2026 international consensus thresholds.
• Primary outcomes were prevalent and incident T2D, CKD, and MACEs, which were identified using standardised diagnostic codes.

TAKEAWAY

• Moderate-to-severe fatty pancreas was associated with higher odds of prevalent T2D (adjusted odds ratio [aOR], 3.25; P < .001), with a similar association observed between mild fatty pancreas and prevalent T2D (aOR, 2.37; P < .001).
• After the exclusion of participants with prevalent T2D at or before MRI, moderate-to-severe and mild fatty pancreas were linked to a higher risk for incident T2D (adjusted hazard ratio [aHR], 2.72 and 2.19, respectively; P < .001 for both).
• Each 5% increase in pancreatic PDFF was linked to higher odds of prevalent T2D (aOR, 1.16; P < .001) and an increased risk for incident T2D (aHR, 1.17; P < .001).
• Moderate-to-severe fatty pancreas was associated with a higher risk for incident CKD (aHR, 1.82; P < .001), with each 5% increase in pancreatic PDFF linked to a higher risk (aHR, 1.11; P < .001). Both mild and moderate-to-severe fatty pancreas were associated with an increased risk for incident MACEs (aHR, 1.29 and 1.30, respectively; P < .05 for both).

IN PRACTICE

"[The study] findings support the clinical relevance of consensus-based PDFF thresholds within integrated cardiometabolic risk assessment in European-ancestry populations," the authors wrote.

SOURCE

This study was led by Nicola Pugliese, Department of Medicine, Centre for Reproduction, Metabolism and Molecular Medicine, Karolinska Institutet, Stockholm, Sweden. It was published online on July 02, 2026, in United European Gastroenterology Journal.

LIMITATIONS

The observational design limited the ability to draw causal conclusions. Pancreatic PDFF was assessed using a slice-based MRI measurement at a single timepoint, which may not have fully captured regional heterogeneity in pancreatic fat and prevented the evaluation of changes over time. Data on A1c levels and the estimated glomerular filtration rate were not available during the imaging visit, which may have led to an underestimation of T2D and CKD.

DISCLOSURES

One author received support from the Region Stockholm, Swedish Cancerfonden, Swedish Research Council, and other sources. Some authors declared receiving travel or research grants and lecture or speaking fees and/or serving as speakers or advisors, consultants, and members of advisory boards for various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.