Pancreatic obesity: what is it and how to treat it

What it is

Opinions differ about what exactly triggers the onset of the disease. Some doctors point to pancreatitis as the direct culprit, while others consider the genetic factor to be the decisive factor.

One thing is certain: lipomatosis is a secondary disease. Having felt a powerful negative impact, the pancreas, obeying the “instinct of self-preservation”, strives to replace the cells that died during pathological changes. In their place, surrogate fat analogues appear, unable to normally perform their immediate functions. Such a reaction of the affected organ to aggression is natural, but, alas, useless.

What is steatosis?

If lipids form individual fatty spots, they speak of focal (focal) steatosis; if they are evenly distributed, they speak of diffuse steatosis.
The initial forms of steatosis are not dangerous, since they do not lead to dysfunction of the organ. But at a certain stage, the fat content reaches a critical point, and when this large amount of tissue lipids is oxidized, inflammation begins (steatohepatitis, steatopancreatitis), which turns into the proliferation of connective tissue (liver cirrhosis) or death of organ cells (pancreatic necrosis).

Depending on the negative consequences caused by the accumulation of excess fat, three stages of steatosis are distinguished:

• accumulation of lipids inside the organ (fatty liver, fatty pancreas);
• development of inflammation followed by death of some cells (hepatitis, pancreatitis);
• proliferation of connective tissue (which replaces normal liver cells), or tissue necrosis (death of a significant number of pancreatic cells).

Hepatic steatosis on a computed tomography image.
Image: Clin Mol Hepatol / ResearchGate (Creative Commons Attribution-NonCommercial 4.0 International license) Fatty degeneration, steatosis are terms that doctors use. Sometimes you can hear about fatty or fatty liver - this is a copy of the English term “fatty liver”, this term in English sounds completely like “alocoholic fatty liver” and corresponds to the Russian term “alcoholic fatty liver”, but the literal translation is “alcoholic fatty liver” " ICD-10 code K70.0

Causes

The causes, and to be more precise, the provoking factors of pancreatic obesity are:

• traumatic damage to its tissues;
• primary diseases of the body: pancreatitis, chronic gastritis, hepatitis, diabetes mellitus;
• undermining general immunity;
• heredity;
• age-related changes;
• excessive consumption of drugs;
• excessive addiction to fatty and fried foods:
• bad habits.

Chronic alcoholics and people prone to being overweight are at the forefront of the risk group.

Condition of the pancreas in obesity in adults and children

Target.

Study of the incidence of non-alcoholic fatty pancreatic disease (NAFLD) in obesity, comparative clinical and biochemical characteristics of this pathology in children and adults.
Patients and methods.
The study included 50 patients (25 adults and 25 children) aged 12 to 60 years with obesity (BMI ≥30 kg/m2 for adults, BMI Z-score ≥2.0 for children), without type 2 diabetes mellitus and severe concomitant pathology. All patients underwent clinical, laboratory, instrumental examination, including anthropometric examination. Ultrasound of the abdominal organs was performed using a Logiq S6 device (General Electric Company). Abdominal CT (n = 14) was performed using an Optima CT660 (General Electric Company).

Results.

According to ultrasound data, secondary changes in the pancreas (PG) were recorded in 46 obese patients (92%), with the same frequency in adults and children. There was no connection between pancreatic steatosis and changes in enzymes characteristic of pancreatic damage (GGTP, ALP, total and pancreatic amylase, lipase). Pancreatic steatosis is associated with age: in the group of patients over 18 years of age, it was significantly more often detected by computed tomography (CT). CT manifestations of steatosis (lipomatosis) of the pancreas are associated with the phenomena of moderate and severe steatosis on ultrasound of the pancreas. The median density of the pancreas in the group of adults was lower than in children: 29.5 [20.0; 32.5] HU versus 47.0 [43.0; 54.0] HU, p = 0.017. The density of the pancreas parenchyma significantly correlated with the age of patients (R = –0.731) and lipid profile indicators: the level of total cholesterol (R = –0.680), LDL cholesterol (R = –0.694), triglycerides (R = –0.614), non-HDL cholesterol (R = –0.698). With mild pancreatic steatosis diagnosed according to ultrasound, in no case were changes in pancreatic density detected on CT.

Conclusion.

Obesity is an important pathogenetic factor in the development of NAFLD. The results of the study will improve the quality of diagnosis and treatment of pancreatic pathology associated with obesity in adults and children.

Keywords:

pancreas, obesity, steatosis, diagnosis, ultrasound.

For quotation:

Pavlovskaya E.V., Starodubova A.V., Strokova T.V., Zeigarnik M.V., Kosyura S.D., Surkov A.G., Bagaeva M.E., Kaganov B.S. Condition of the pancreas in obesity in adults and children. Questions of dietetics. 2016; 6(4): 10–16. DOI: 10.20953/2224-5448-2016-4-10-16

Clinical picture

The insidiousness of pancreatic obesity lies in its asymptomatic nature in the early stages, when the disease can only be diagnosed using ultrasound.

Two main factors that add typos to the clinical picture of the disease:

• disruption of the natural functioning of the pancreas;
• compression of healthy tissue not only of the gland itself, but also of surrounding organs.

The degree of proliferation of adipose tissue may vary, depending on which part of the cells was affected. We can talk about obesity if more than 30 percent of normal gland cells have undergone mutations.

At the same time, it is not so much the number of mutated cells that plays a decisive role in the severity, but rather the location and crowding. When they accumulate in one place, a benign neoplasm is formed - a lipoma. For many years the patient may not even be aware of it. Only if the tumor begins to grow, squeezing the vascular system, nerve processes and ducts, will the symptoms begin to make themselves felt.

The main features are:

• girdle pain under the right hypochondrium, especially after eating;
• bloating accompanied by flatulence;
• incessant thirst;
• the appearance of small ulcers in the mouth;
• permanent urge to vomit, nausea;
• stool disorders, and fat and blood may appear in the stool;
• general weakness and apathy.

The structure of the pancreas
Impaired hormone production contributes to the development of endocrine diseases with a parallel increase in glucose levels. If drastic measures are not taken, the patient is at risk of developing diabetes. In addition, a kind of chain reaction occurs - the process of obesity spreads to another vital organ - the liver, causing the threat of hepatosis.

Fatty hepatosis

Atherosclerosis

Hepatitis

15027 January 27

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Fatty hepatosis: causes, symptoms, diagnosis and treatment methods.

Definition

Fatty hepatosis (fatty liver, steatosis) is a disease in which fat accumulates in liver cells. In this case, inflammatory phenomena are absent or mildly expressed. Fat accumulation can be a reaction of the liver to various toxic influences, for example, drinking alcohol, taking certain medications, and this process is often associated with metabolic syndrome.

Depending on the etiology of the damage, two groups of diseases are distinguished: non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD). Each of these diseases can be limited to hepatosis, or can progress to hepatitis (inflammatory liver disease) or even cirrhosis (replacement of liver tissue with connective tissue). All these are stages of one process.

Causes of hepatosis

The main reason for the development and progression of NAFLD is an unhealthy lifestyle: high-calorie diet, excess consumption of saturated fats (animal products - fatty meats, high-fat dairy products), refined carbohydrates (sugar, bakery and confectionery products) combined with insufficient physical activity.

In most cases, hepatosis as part of NAFLD develops in people with metabolic syndrome.

Metabolic syndrome is a complex of metabolic, hormonal and clinical disorders that are risk factors for the development of cardiovascular diseases, which are based on insulin resistance and compensatory hyperinsulinemia.

Insulin is a hormone produced by the pancreas that allows glucose to move from the blood into the cells. With insulin resistance, the sensitivity of cells to insulin decreases - cell starvation occurs against the background of a sufficient amount of glucose in the blood. To maintain normal glucose transport, an increased concentration of insulin in the blood is required, which becomes the trigger for all components of the metabolic syndrome:

• abdominal obesity – excess fat deposition in the abdomen and upper torso (waist circumference exceeding 80 cm in women, more than 94 cm in men);
• dyslipidemia – increased levels of “bad” cholesterol – low-density lipoprotein (LDL) more than 3.0 mmol/l, decreased “good” cholesterol – high-density lipoprotein (HDL) less than 1.1 mmol/l in women and less than 0.9 mmol /l in men, increased triglycerides more than 1.7 mmol/l;
• early development of atherosclerosis - cholesterol deposits in the inner lining of the arteries with the formation of atherosclerotic plaques, which narrow the lumen of the vessel and disrupt the blood supply to organs; as a result, myocardial infarction and acute cerebrovascular accident (ischemic stroke) may develop;
• arterial hypertension - increased blood pressure over 130/85 mm Hg. Art., which is a risk factor for cerebral hemorrhage (hemorrhagic stroke);
• impaired glucose tolerance (fasting venous blood glucose 6.1-7.0 mmol/l) or development of type 2 diabetes mellitus (fasting venous blood glucose more than 7.0 mmol/l).
  Against the background of “sugarification” of the blood, the vascular wall suffers, which leads to damage to the heart, brain, and kidneys.

The cause of hepatosis in ALD is alcohol consumption.
An important criterion for distinguishing ALD from NAFLD is the patient’s consumption of alcohol in doses toxic to the liver, i.e. more than 40 g of pure ethanol per day for men and more than 20 g for women.

However, the likelihood of liver damage depends not only on the amount of alcoholic beverages consumed, but also on the quality of the alcoholic beverage, the type of alcohol consumption and the time of its exposure, as well as on individual and genetic predisposition, dietary habits, and infection with hepatitis B and C viruses.

Classification of hepatosis
Depending on the type of fat deposition:

• focal disseminated hepatosis (often has no clinical manifestations);
• severe disseminated hepatosis;
• zonal hepatosis (fat accumulates in different parts of the liver);
• diffuse hepatosis (microvesicular steatosis).

Fatty hepatosis can be primary (caused by endogenous metabolic disorders - obesity, diabetes, hyperlipidemia) and secondary, when the cause of its occurrence is external influence (taking certain medications, surgery on the gastrointestinal tract, prolonged fasting).
Symptoms of hepatosis

Most patients with hepatosis do not have any complaints. The disease is often diagnosed accidentally during an examination for another reason. In the case of non-alcoholic fatty liver disease, some patients have various manifestations of metabolic syndrome in their clinical picture: obesity, increased blood pressure, signs of impaired glucose and cholesterol metabolism.

Some patients with hepatosis, regardless of its etiology, present complaints of a nonspecific nature - increased fatigue, aching pain or discomfort in the right hypochondrium without a clear connection with food intake.
Diagnosis of hepatosis
Often, a doctor may suspect a patient has hepatosis already in the process of collecting anamnesis. The specialist evaluates diet and physical activity, clarifies the issue of drinking alcohol and taking medications.

When talking with the patient and reviewing the medical documentation, the doctor may detect manifestations of metabolic syndrome, which will speak in favor of NAFLD.

Laboratory diagnostics play an important role in assessing the condition of the liver. They examine such indicators of biochemical blood tests as AST, ALT, gamma-glutamyl transpeptidase, alkaline phosphatase, total bilirubin, direct bilirubin. With hepatosis, their slight increase may be detected.

Diagnostics

Considering the complex specifics of the disease, at the first suspicion of lipodystrophy, you should immediately contact a gastroenterologist or endocrinologist. At the first stage of diagnosis, he needs to understand the clinical picture of the disease, listening to a detailed story about the complaints.

In particular, he will ask the patient about when the symptoms began to appear, how much he adheres to his diet, what chronic diseases he has suffered, what is the frequency of his consumption of alcoholic beverages? Another mandatory question: does any of your close relatives suffer from pancreatic obesity?

Then, having determined by palpation the approximate condition of the organ being examined, the doctor will refer the patient for laboratory and instrumental examination. Only on the basis of the entire complex of information obtained can the disease be treated by choosing the appropriate treatment regimen.

Treatment

Effective treatment requires an integrated approach and includes:

• combination of traditional medicines with folk remedies;
• adjustment of life routine.

In severe cases, surgery is considered the optimal solution.

The duration of treatment is about two months. Upon completion, new tests are prescribed (blood biochemistry and ultrasound of the abdominal cavity) with the course repeated after six months.

Medications

Drug treatment is based on the use of drugs that correct the functioning of the pancreas and promote digestion processes.

• first of all, these are enzymes like Festal, Pancreatin, Mezim, which cope with heaviness in the stomach;
• Metoclopramide will help to cope with vomiting and nausea;
• antispasmodics (Platifilin, Ibuprofen, No-shpa) are prescribed as painkillers;
• stool disorders can be corrected with antidiarrheal drugs, for example Loperamide;
• Mebeverine calms intestinal spasms;
• Vitamin complexes have a general strengthening effect on the immune system.

If necessary, the doctor will also prescribe insulin therapy.

Additional Methods

Along with drug therapy, you can use folk remedies - infusions and decoctions of herbs, but this should only be done under medical supervision, since unwanted side effects are possible.

Among the common recipes, we note a decoction infused with equal amounts of St. John's wort, valerian, nettle and calendula - 10 grams per glass of boiled water. Taken in equal parts up to seven times a day.

Physiotherapeutic, hirudotherapy (we are talking about leeches), as well as sanitary or spa treatment using mineral waters have good results.

And the most important thing!

No medications will radically correct the situation unless you adhere to a healthy lifestyle and diet. Therefore, if the diagnosis is confirmed, it is necessary:

• forget about the existence of alcohol and cigarettes;
• make friends with physical exercise;
• Constantly control your weight;
• follow a diet.

Diet

The therapeutic diet for pancreatic obesity requires compliance with the following conditions:

• balance your diet: eat often and in small portions;
• avoid snacking before bed;
• reduce your total daily calorie intake;
• eat predominantly carbohydrate- and protein-containing foods.
• eat fiber-rich vegetables, fruits, berries;
• use boiling and stewing as a manufacturing method.

In certain cases, taking into account individual characteristics, the doctor may suggest fasting treatment.

And now - a list of foods that need to be excluded from life, if not forever, then at least until a stable remission occurs:

• any types of fast food;
• pickles and marinades;
• sweetened carbonated drinks;
• sweets, ice cream, butter products;
• meat, fish, dairy products (fresh and canned) with high fat and cholesterol content;
• products containing essential oils: citrus fruits, spicy herbs.