Pancreatic steatosis and iron overload increases cardiovascular risk in non-alcoholic fatty liver disease

Front Endocrinol (Lausanne). 2023 Aug 3:14:1213441. doi: 10.3389/fendo.2023.1213441. eCollection 2023.

Abstract

Objective: To assess the prevalence of pancreatic steatosis and iron overload in non-alcoholic fatty liver disease (NAFLD) and their correlation with liver histology severity and the risk of cardiometabolic diseases.

Method: A prospective, multicenter study including NAFLD patients with biopsy and paired Magnetic Resonance Imaging (MRI) was performed. Liver biopsies were evaluated according to NASH Clinical Research Network, hepatic iron storages were scored, and digital pathology quantified the tissue proportionate areas of fat and iron. MRI-biomarkers of fat fraction (PDFF) and iron accumulation (R2*) were obtained from the liver and pancreas. Different metabolic traits were evaluated, cardiovascular disease (CVD) risk was estimated with the atherosclerotic CVD score, and the severity of iron metabolism alteration was determined by grading metabolic hiperferritinemia (MHF). Associations between CVD, histology and MRI were investigated.

Results: In total, 324 patients were included. MRI-determined pancreatic iron overload and moderate-to severe steatosis were present in 45% and 25%, respectively. Liver and pancreatic MRI-biomarkers showed a weak correlation (r=0.32 for PDFF, r=0.17 for R2*). Pancreatic PDFF increased with hepatic histologic steatosis grades and NASH diagnosis (p<0.001). Prevalence of pancreatic steatosis and iron overload increased with the number of metabolic traits (p<0.001). Liver R2* significantly correlated with MHF (AUC=0.77 [0.72-0.82]). MRI-determined pancreatic steatosis (OR=3.15 [1.63-6.09]), and iron overload (OR=2.39 [1.32-4.37]) were independently associated with high-risk CVD. Histologic diagnosis of NASH and advanced fibrosis were also associated with high-risk CVD.

Conclusion: Pancreatic steatosis and iron overload could be of utility in clinical decision-making and prognostication of NAFLD.

Keywords: cardiovascular risk; iron overload; magnetic resonance imaging (MRI); non-alcoholic fatty liver disease (NAFLD); pancreatic steatosis; proton density fat fraction (PDFF).

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiovascular Diseases* / epidemiology
  • Cardiovascular Diseases* / etiology
  • Heart Disease Risk Factors
  • Humans
  • Iron
  • Iron Overload* / complications
  • Lipid Metabolism Disorders*
  • Non-alcoholic Fatty Liver Disease* / complications
  • Non-alcoholic Fatty Liver Disease* / epidemiology
  • Pancreatic Diseases* / complications
  • Pancreatic Diseases* / diagnostic imaging
  • Prospective Studies
  • Risk Factors

Substances

  • Iron

Grants and funding

This study was funded by the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (PI19/0380), GILEAD Sciences (Grant Number: GLD19/00050) and Sociedad Valenciana de Patología Digestiva (2021/094). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.