AUTHOR=Marti-Aguado David , Ten-Esteve Amadeo , Baracaldo-Silva Carlos Manuel , Crespo Ana , Coello Elena , Merino-Murgui Víctor , Fernandez-Paton Matias , Alfaro-Cervello Clara , Sánchez-Martín Alba , Bauza Mónica , Jimenez-Pastor Ana , Perez-Girbes Alexandre , Benlloch Salvador , Pérez-Rojas Judith , Puglia Víctor , Ferrández Antonio , Aguilera Victoria , Latorre Mercedes , Monton Cristina , Escudero-García Desamparados , Bosch-Roig Ignacio , Alberich-Bayarri Ángel , Marti-Bonmati Luis TITLE=Pancreatic steatosis and iron overload increases cardiovascular risk in non-alcoholic fatty liver disease JOURNAL=Frontiers in Endocrinology VOLUME=14 YEAR=2023 URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1213441 DOI=10.3389/fendo.2023.1213441 ISSN=1664-2392 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.