The effect of long-term weight-loss intervention strategies on the dynamics of pancreatic-fat and morphology: An MRI RCT study

Lilac Tene, Ilan Shelef, Dan Schwarzfuchs, Yftach Gepner, Anat Yaskolka Meir, Gal Tsaban, Hila Zelicha, Avital Bilitzky, Oded Komy, Noa Cohen, Nitzan Bril, Michal Rein, Dana Serfaty, Shira Kenigsbuch, Yoash Chassidim, Benjamin Sarusy, Uta Ceglarek, Michael Stumvoll, Matthias Blüher, Joachim ThieryMeir J. Stampfer, Assaf Rudich, Iris Shai*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background & aims: The ability to mobilize pancreatic-fat and the meaning of decreased fat in the pancreas remain controversial. We followed the dynamics of pancreatic-fat and its morphology during various long weight-loss induced lifestyle-interventions. Methods: In isolated workplace with monitored/provided lunch, we randomly assigned healthy persons with abdominal obesity or dyslipidemia for one of two 18-month equal-caloric diets: low-fat (LF) or Mediterranean/low-carbohydrate (Med/LC, with provided 1oz walnuts/day), with or without added moderate exercise (supervised gym membership). We used magnetic-resonance-imaging to quantify pancreatic-fat and morphology. Results: At baseline, 277 eligible participants (mean age = 48 years; 88% men; pancreatic-fat = 17.4 ± 5.1%) had higher pancreatic-fat in men (17.7 ± 4.9% vs 14.9 ± 5.5% in women; p = 0.004). Following 18-month intervention (adherence = 86.3%) and moderate weight-loss (mean = −3.0 ± 5.5 kg), pancreatic-fat decreased moderately but significantly (−0.26 ± 2.18% units; p = 0.049). Med/LC diet induced a greater decrease in pancreatic-fat compared to LF (p = 0.043), and the combination of Med/LC diet + exercise exhibited the highest reduction (−0.69% units) as compared to LF diet without exercise (+0.12%units; p = 0.027 between groups). In multivariate regression models, after further adjusted for visceral adipose-tissue (ΔVAT), pancreatic-fat loss associated with both decreases in pancreatic-morphology ratio (perimeter divided by area; beta = 0.361; p < 0.001) and superficial-subcutaneous adipose-tissue loss (beta = 0.242; p = 0.001), but not with changes in intrahepatic-fat (beta = −0.034; p = 0.638). Pancreatic-fat loss associated with increased intake of polyunsaturated-fat (beta = −0.137; p = 0.032), as with improved high-density lipoprotein-cholesterol (HDL; beta = −0.156; p = 0.023) and triglycerides/HDL ratio (beta = 0.162; p = 0.015), independently of ΔVAT, but not with glycemic–control parameters (e.g. HbA1c, HOMA-IR and HOMA-beta; p > 0.2 for all). Conclusions: Pancreatic-fat loss is mainly associated with improved lipid, rather than glycemic profiles. Med/LC diet, mostly with exercise, may benefit pancreatic-fat loss. Pancreatic-morphology could serve as a biomarker of pancreatic-fat state. (

Original languageEnglish
Pages (from-to)82-89
Number of pages8
JournalClinical Nutrition ESPEN
StatePublished - Apr 2018
Externally publishedYes


FundersFunder number
Israel Ministry of Science and Technology3-13604
Dr. Robert C. and Veronica Atkins Foundation
Deutsche Forschungsgemeinschaft873151, SFB1052
Ministry of Science and Technology# 3-13604 to IS
Israel Science Foundation8755871


    • Cardio-metabolic risk
    • Diet
    • Pancreatic fat


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