Association of intra-pancreatic fat deposition with bone marrow adiposity in young obese adults

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Obesity with suspected fatty liver disease (n=155). Intervention: Pancreatic fat fraction (PFF). Primary outcome: Bone marrow adipose tissue (BMAT) fraction (β=0.323, 95% CI 0.067 to 0.58, p=0.014).

Q: What does this research mean for the field?

Pancreatic fat fraction has a robust, independent positive association with bone marrow adiposity in young obese adults, exhibiting a greater effect size than hepatic fat fraction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yi Guo; Jiajie Fu; ZhiChao Wang; Ruonan Xiong; Song Wang; Hua Yang; Qiufeng Zhao

doi:10.21037/qims-2026-0444

July 27, 2026Quantitative Imaging in Medicine and SurgeryOpen Access

Association of intra-pancreatic fat deposition with bone marrow adiposity in young obese adults

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Key result

Pancreatic fat fraction links independently to increased bone marrow adiposity in young obese adults.

β=0.323
95% CI 0.067 to 0.58
P=0.014
n=155

Figures

Why the study?

The effect of pancreatic fat fraction on bone marrow adipose tissue in young obese adults remains unclear compared to hepatic fat fraction.

Key Points

To investigate the independent association between pancreatic fat fraction (PFF) and bone marrow adipose tissue (BMAT) in young obese adults and compare it to hepatic fat fraction (HFF).
Analyzed 155 young adults with obesity (mean age 35.01±6.25 years; mean BMI 31.87±4.25 kg/m²).
Quantitatively measured BMAT, whole and regional PFF (head, body, tail), and HFF using chemical shift-encoded magnetic resonance imaging (CSE-MRI-PDFF).
Evaluated associations using multivariable linear regression and restricted cubic spline (RCS) models adjusted for age, gender, BMI, HbA1c, triglycerides, and HFF.
In the fully adjusted model, whole PFF demonstrated an independent positive association with BMAT (β=0.323, 95% CI 0.067 to 0.58, P=0.014), exerting a stronger effect than HFF (β=0.206, 95% CI 0.039 to 0.373, P=0.016).
All pancreatic sub-regions positively correlated with BMAT (rs =0.29–0.34, all P<0.001), with multivariable regression confirming significant associations for the head (β=0.240, 95% CI 0.050 to 0.430, P=0.014) and body (β=0.266, 95% CI 0.029 to 0.502, P=0.028).
Restricted cubic spline models demonstrated a continuous linear dose-response relationship between BMAT and whole pancreas (P for overall =0.006), head (P=0.013), body (P=0.009), and tail (P=0.015), without significant nonlinearity (all P for nonlinear >0.05).

Study Design

Type

Cross-Sectional (n=155)

Multicenter

No

Structured PICO

P

Population

155 young adults aged 18 to 44 years with obesity underwent cross-sectional MRI evaluation to assess the association of pancreatic fat deposition with bone marrow adiposity.

O

Outcome

Independent association between pancreatic fat fraction (PFF) and bone marrow adipose tissue (BMAT) quantified using MRI-PDFFsurrogate

Main Result

Effect estimate: β=0.323 (95% CI 0.067 to 0.58)

p-value: p=0.014

Limitations

Cross-sectional design precludes establishing causal relationships.
Small sample size limited statistical power for some subgroup analyses.
Restriction to young obese adults limits generalizability to the elderly, lean individuals, or diverse ethnic groups.
Potential residual confounding from physical inactivity, dietary patterns, and gonadotropin fluctuations.
Lack of data on inflammatory cytokines, bone turnover markers, and islet function to validate mechanistic pathways.
Lack of histological confirmation via bone biopsy.
Cross-sectional design precludes establishing causal relationships
Small sample size resulting in insufficient statistical power for some subgroup analyses
Limited to young obese adults, restricting generalizability to other populations
Residual confounding effects from physical inactivity, dietary patterns, and gonadotropin fluctuations
Lack of data on inflammatory cytokines, bone turnover markers, and islet function
Lacks histological confirmation via bone biopsy

Implication

Pancreatic fat accumulation is a stronger independent predictor of bone marrow adiposity than hepatic fat in young obese adults, suggesting it may serve as an early marker for skeletal risk.

Abstract

Background: Ectopic fat accumulation is a key factor in impaired bone health in the obese population. Although hepatic fat fraction (HFF) has been established as an important marker of metabolic dysfunction, the effect of pancreatic fat fraction (PFF) on bone marrow adipose tissue (BMAT) in young obese adults remains unclear. The aim of this study was to investigate the independent association between PFF and bone marrow adiposity and to compare it with that of HFF. Methods: ]. BMAT, PFF, and HFF were quantitatively measured using chemical shift-encoded (CSE) magnetic resonance imaging (MRI-PDFF sequence). Statistical analysis employed stratified multivariate linear regression and restricted cubic spline (RCS) models to assess the independent association between PFF and HFF with BMAT. Models were adjusted for age, gender, BMI, glycosylated hemoglobin (HbA1c), and triglycerides (TG). Results: PFF exhibited only a weak correlation with HFF [Spearman correlation coefficient (rs) =0.180, P=0.037]. Consistent positive associations with BMAT were observed across all pancreatic sub-regions (head, body, and tail: rs =0.29-0.34, all P<0.001). In the fully adjusted model, PFF demonstrated a robust and independent positive association with BMAT (β=0.323, P=0.014). Although HFF remained statistically significant, its effect size was substantially smaller than that of PFF (β=0.206, P=0.016). RCS analysis revealed a continuous linear dose-response relationship between BMAT and whole pancreas (P for overall =0.006), head (P=0.013), body (P=0.009), and tail (P=0.015), yet the nonlinearity tests did not reach statistical significance (all P for nonlinear >0.05). Notably, the shape of this linear dose-response trajectory was consistent across the pancreatic head, body, and tail, suggesting a generally uniform pathological impact without an identifiable safety threshold. Conclusions: PFF is a more robust and independent predictor of BMAT than HFF in young adults with obesity. These findings imply the existence of a distinct pathogenic pathway linking the fatty pancreas to marrow degeneration. Consequently, the assessment of pancreatic fat content may serve as an independent associated factor for skeletal risk stratification in this population.

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Cite This Study

Guo et al. (2026) conducted a cross-sectional in Obesity with suspected fatty liver disease (n=155). Pancreatic fat fraction (PFF) was evaluated on Bone marrow adipose tissue (BMAT) fraction (β=0.323, 95% CI 0.067 to 0.58, p=0.014). Pancreatic fat fraction demonstrated a robust and independent positive association with bone marrow adiposity (β=0.323) in young obese adults, with a stronger effect magnitude than hepatic fat.

synapsesocial.com/papers/6ad0fc6c3afa093ea9acfe3d https://doi.org/10.21037/qims-2026-0444

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Association of intra-pancreatic fat deposition with bone marrow adiposity in young obese adults

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association of intra-pancreatic fat deposition with bone marrow adiposity in young obese adults

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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