Prevalence of fatty pancreas and its associations with pancreatic disease and metabolic disorders: a systematic review and meta-analysis of 124 studies

Background The prevalence and impact of fatty pancreas (FP) on pancreatic and metabolic disorders remain incompletely characterized. We synthesized current evidence on FP prevalence and its associations with pancreatic and metabolic disorders. Methods We performed a systematic review and meta-analysis of PubMed, Embase, and Cochrane Library through October 22, 2024. Prevalence was analyzed separately in the healthy population and the overall study population, with restricted sensitivity analyses according to population selection. Results From 3,984 records, 124 studies were included. The pooled prevalence was 30.5% among 141,416 healthy or routine-examination participants and 42.3% across all included study populations. After pancreatic disease, pancreatic surgical, and metabolic high-risk populations were excluded, the prevalence was 31.1%. In the healthy population, FP prevalence varied by region, ranging from 12.0% in Africa to 38.8% in the Region of the Americas, although estimates for some regions were based on limited country-level data. Higher prevalence was observed in older age, male sex, high-income countries, and very-high-HDI regions. FP prevalence was higher in 2020–2024 than in the preceding publication period in both the overall study population and the healthy population, while temporal meta-regression showed positive but non-significant slopes. FP was associated with increased risks of pancreatitis (OR 2.66), pancreatic cancer (OR 3.01), fatty liver (OR 4.86), metabolic syndrome (OR 3.90), obesity (OR 2.75), diabetes mellitus (OR 2.43), and hypertension (OR 2.17; all P < 0.001). Conclusion FP was common in the included populations and was associated with several pancreatic and metabolic disorders. Prevalence was higher in recent publication periods, although continuous temporal trends were not statistically significant. These findings support greater clinical attention to FP, particularly among older adults and high-risk populations. Targeted evaluation for associated disorders and appropriate risk-factor management may be considered in individuals with FP. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024499559 , CRD42024499559.