Conceptual framework and expert guidance on intrapancreatic fat deposition: the Melbourne consensus

Intrapancreatic fat deposition (IPFD) has garnered appreciable attention across diverse medical disciplines amid the rising global burden of pancreatitis, pancreatic cancer and type 2 diabetes mellitus. Despite growing interest in the field, there remains no conceptual framework for it. To address this gap, 25 experts from 6 continents were brought together to develop guidance. Drawing on multiple peer-reviewed systematic reviews and applying an iterative, anonymous Delphi process, a consensus document was developed and ratified in Melbourne, Australia. The final document contains 58 recommendations - 30 reached unanimous agreement and 28 attained 90-99% agreement. The consensus formally defines fatty pancreas disorder (FPD) as a distinct pathological state, characterized by excessive IPFD that poses a risk to health. Assessment of IPFD is best performed with MRI. Expert-established diagnostic criteria enable identification and classification of FPD. Recognition of type 1 FPD (in individuals without excess body fat mass) and type 2 FPD (in individuals with excess body fat mass) is instrumental in gaining novel insights and tailoring preventive strategies to the individual. The Melbourne consensus is foundational in operationalizing the dissemination of new knowledge in the field, fostering intercontinental collaborations and, ultimately, addressing the global burden of diseases of the pancreas.