CLINICAL AND FUNCTIONAL CHARACTERISTICS OF NON-ALCOHOLIC FATTY LIVER DISEASE AND PANCREATIC STEATOSIS IN PATIENTS WITH METABOLIC SYNDROME

Abstract

Background: Metabolic syndrome (MS) affects 25-35% of the general population, with prevalence exceeding 40% among individuals over 60 years. The complex interplay between visceral adiposity, insulin resistance, and metabolic dysregulation creates a pathological cascade affecting multiple organ systems. Non-alcoholic fatty liver disease (NAFLD) and pancreatic steatosis (PS) frequently coexist in patients with MS, yet the functional consequences of this combination remain poorly characterized. Objective: To comprehensively evaluate pancreatic exocrine function in patients with NAFLD and concomitant pancreatic steatosis within the context of metabolic syndrome. Materials and Methods: A prospective observational study of 58 patients with confirmed NAFLD (36 females, 22 males; mean age 42.2±6.2 years). Patients were stratified into two groups: Group 1 (n=28) with NAFLD and pancreatic steatosis (NAFLD+PS), Group 2 (n=30) with NAFLD without PS. Control group comprised 14 healthy volunteers. All participants underwent clinical assessment, biochemical profiling, fecal elastase-1 (FE-1) determination, coprological examination, abdominal ultrasonography, and computed tomography. Results: Exocrine pancreatic insufficiency (EPI) was significantly more prevalent in the NAFLD+PS group compared to NAFLD patients without PS (87.5% vs. 40.1%, p<0.05). FE-1 levels demonstrated moderate EPI (150-200 μg/g) in 64.3% of NAFLD+PS patients versus 33.3% in NAFLD patients. Strong positive correlations were identified between EPI and age (r=+0.71 to +0.87, p<0.05) and disease duration (r=+0.75 to +0.94, p<0.05). CT densitometry demonstrated reduced attenuation values (<30 Hounsfield units) and lobulated pancreatic architecture in PS patients. Conclusion: Pancreatic steatosis significantly exacerbates exocrine pancreatic dysfunction in patients with NAFLD and metabolic syndrome. Age and disease duration serve as strong predictors of EPI development, while CT provides valuable diagnostic information for identifying PS.