Fatty Pancreas in MASLD: JGH | March 2026

Introduction

Metabolic dysfunction-associated steatotic liver disease is now recognized as a multisystem metabolic disorder affecting not only the liver but also cardiovascular, renal, and endocrine systems. Parallel to this, Fatty pancreas disease—defined by intrapancreatic fat deposition—is emerging as another manifestation of ectopic fat accumulation. Despite increasing recognition, the coexistence of FPD in MASLD and its clinical implications remain poorly defined, even though both conditions share common metabolic pathways such as obesity, insulin resistance, and systemic inflammation.

Problem Statement

The prevalence and clinical significance of fatty pancreas disease in MASLD patients are unclear, limiting its integration into routine metabolic risk assessment and management.

Summary

This systematic review and meta-analysis including over 21,000 patients demonstrates that fatty pancreas disease is highly prevalent in MASLD, affecting approximately 54% of patients. Interestingly, there is marked geographic variation, with lower prevalence in Asian populations compared to non-Asian cohorts.

Clinically, MASLD patients with concomitant FPD exhibit a distinctly worse metabolic phenotype. They tend to be older, have higher BMI, and show significantly higher rates of diabetes, hypertension, and metabolic syndrome. This reinforces the concept that ectopic fat deposition is not organ-specific but represents a systemic metabolic burden.

The study highlights an important shift in understanding—moving from a liver-centric view of MASLD to a “multi-organ fat disease” model involving liver, pancreas, and beyond. Although the prognostic implications are not fully established, the presence of FPD may identify a higher-risk metabolic subgroup.

For clinicians, this suggests that pancreatic fat should not be ignored when incidentally detected on imaging. Future research is needed to determine whether FPD contributes to pancreatic dysfunction, pancreatitis, or cancer risk, and whether it should influence therapeutic strategies in MASLD.