Understanding the association of intrapancreatic fat deposition with adiposity and components of metabolic syndrome in children and adolescents: a systematic review and meta-analysis

Background: Intrapancreatic fat deposition is associated with increased cardiovascular risk in adults, but the association is less clear in children. Our goal in this work was therefore to conduct a systematic review and meta-analysis of the associations between intrapancreatic fat deposition with adiposity and components of metabolic syndrome in children and adolescents. Methods: Systematic searches were conducted in MEDLINE, Web of Science, and Scopus from database inception to January 11, 2025 (registration number: CRD42022374159). Random-effects meta-analysis was performed to obtain pooled correlations estimates of the association of intrapancreatic fat deposition with various adiposity related outcomes (i.e., overall/central adiposity and specific fat depots; primary outcome) and cardiometabolic risk factors (i.e., glycaemic traits, insulin resistance/sensitivity, insulin secretion surrogates, plasma lipids, and blood pressure; secondary outcomes). Risk of bias and the quality of evidence were evaluated. Findings: We identified a total of 252 studies, of which 15 unique studies (N = 1261 participants, mean age ranged 10.6–17.7 years, 44.4% females) were eligible for meta-analysis. Magnetic resonance imaging-measured intrapancreatic fat deposition showed a small to medium positive significant association with adiposity (n = 53 studies, r = 0.24 [95% CI:0.19; 0.29], I2 = 61.5%), impaired glycaemic traits and insulin sensitivity (n = 11 studies, r = 0.15 [95% CI:0.03; 0.26], I2 = 58.9%), and HDL levels (n = 7 studies, pooled r = 0.11 [95% CI: 0.01; 0.20], I2 = 0%), and increased blood pressure (n = 6 studies, pooled r = 0.15 [95% CI: 0.05; 0.25], I2 = 0%). Interpretation: Intrapancreatic fat deposition may increase the risk of cardiometabolic disturbances in children. Therefore, it requires more attention in clinical research as an early indicator of ectopic fat deposition, insulin resistance and metabolic syndrome. Longitudinal studies are necessary to understand the temporal dynamics of these associations and to determine the long-term impact of intrapancreatic fat deposition on the risk of developing type 2 diabetes and cardiovascular diseases.