title: Obesity and Fatty Pancreatic Infiltration Are Risk Factors for Pancreatic Precancerous Lesions (PanIN).
abstract: OBJECTIVE
  The roles of intravisceral and subcutaneous fat are unknown, and the prevalence of precancerous lesions in obese patients was never evaluated. This study aims to assess the frequency and severity of pancreatic intraepithelial neoplasia (PanIN) and to correlate pathologic findings with metabolic abnormalities, type of fat, and fatty pancreatic infiltration.
  
  
  METHODS
  Normal pancreatic tissue from surgical specimens was analyzed. Fatty infiltration and fibrosis in intra- and extralobular locations and PanIN lesions were assessed. General characteristics were collected: body mass index (BMI), diabetes, and tobacco intake. Liver steatosis and subcutaneous and intravisceral fat were assessed by CT scan (ImageJ software).
  
  
  RESULTS
  Of note, 110 patients were included [median age, 53.8 (17-85) years]. Arterial hypertension, diabetes, and tobacco intake were found in 19%, 9%, and 23%, respectively. Median BMI was 24 (16-37; BMI < 25: 45%, 25 ≤ 30: 24%, ≥30: 11%). Overall, PanIN lesions were found in 65% (type I, II, and III PanIN in 62%, 38%, and 1%, respectively). Fibrosis and fatty pancreas (intra- and extralobular locations) were found in 1% and 24% and in 30% and 51%, respectively. A correlation was observed between PanIN lesions and fatty pancreas [extralobular (0.01) and intralobular (<0.0001)], intralobular fibrosis (0.003), high BMI (P = 0.02), and subcutaneous (P = 0.02) and intravisceral fat (P = 0.02). The number of PanIN lesions was correlated with intravisceral fat (r = 0.22, P = 0.04), but not with subcutaneous fat (r = 0.14, P = 0.22). In multivariate analysis, PanIN lesions were associated with intralobular fibrosis [OR, 5.61; 95% confidence interval (CI), 1.18-42.99] and intralobular fat (OR, 17.86; 95% CI, 4.935-88.12).
  
  
  CONCLUSIONS
  Obesity (especially android obesity) and pancreatic fatty infiltration are risk factors for pancreatic precancerous lesions.
authors.affiliation: Pancreatology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France. Inserm U773-CRB3, DHU Unity, Paris-Diderot University, Paris, France. vinciane.rebours@bjn.aphp.fr.
authors.forename: Vinciane
authors.initials: V
authors.lastname: Rebours
authors.affiliation: Inserm U773-CRB3, DHU Unity, Paris-Diderot University, Paris, France. Pancreatic Surgery Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gaujoux
authors.affiliation: Radiology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France.
authors.forename: Gaspard
authors.initials: G
authors.lastname: d'Assignies
authors.affiliation: Pancreatic Surgery Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
authors.affiliation: Pancreatology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France. Inserm U773-CRB3, DHU Unity, Paris-Diderot University, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ruszniewski
authors.affiliation: Pancreatology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lévy
authors.affiliation: Inserm U773-CRB3, DHU Unity, Paris-Diderot University, Paris, France. Pathology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Paradis
authors.affiliation: Inserm U773-CRB3, DHU Unity, Paris-Diderot University, Paris, France. Pathology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bedossa
authors.affiliation: Inserm U773-CRB3, DHU Unity, Paris-Diderot University, Paris, France. Pathology Department, Bichat Hospital, DHU Unity, AP-HP, Paris-Diderot University, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Couvelard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D011230:Precancerous Conditions / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed