The Fatty Pancreas: Current Evidence, Treatment Implications, and Future Directions

Here, we use the term fatty pancreas (FP), but more recent terminology includes pancreatic steatosis, nonalcoholic FP disease, pancreatic lipomatosis, and fatty atrophy. The absence of a universally accepted definition and standardized diagnostic criteria continues to hinder progress in both clinical practice and research. This condition is marked by abnormal fat content in pancreatic tissue and is becoming more recognized as clinically significant. The diagnosis has implications for metabolic dysfunction and other pancreatic diseases, including pancreatic ductal adenocarcinoma. This review highlights current evidence on the classification, imaging modalities, histopathologic correlates, and clinical relevance of FP as a disease state. We discuss the utility and limitations of imaging techniques, including magnetic resonance imaging, computed tomography, ultrasound, and endoscopic ultrasound, for quantifying pancreatic fat and examine histological findings and their correlation with imaging features. The emerging association between FP and oncogenesis is critically evaluated, particularly in the context of the influence of intrapancreatic fat on acinar cell atrophy, inflammation, and neoplastic transformation. We also examine the therapeutic potential of weight loss through pharmacologic and bariatric surgical interventions in reversing intrapancreatic fat deposition. The possible assistive capabilities of AI in diagnosing FP are discussed. Finally, we emphasize the need for a unified framework to define, measure, and subclassify FP, which could facilitate its use as a marker of disease risk and inform surveillance strategies.