Fatty Pancreas: Concept, Diagnosis, Clinical Implications, and Future Directions: A Comprehensive Review Centered on the 2026 International Consensus

Fatty pancreas, characterized by abnormal intrapancreatic fat accumulation, has gained increasing clinical attention alongside the global rise in obesity and metabolic disease. Historically regarded as an incidental imaging finding, it is now recognized as a potential pancreatic manifestation of systemic metabolic dysfunction. Its prevalence is estimated at approximately 21% in the general population, exceeding 50% in patients with metabolic dysfunction-associated steatotic liver disease or type 2 diabetes. The 2026 International Multidisciplinary Consensus Report adopted “fatty pancreas” as a unified umbrella term and identified magnetic resonance imaging (MRI)-based proton density fat fraction as the most accurate noninvasive quantification method, while acknowledging the absence of standardized diagnostic cutoffs. Key pathophysiological mechanisms include ectopic fat deposition, lipotoxicity, fibroinflammatory remodeling, and bidirectional exocrine-endocrine crosstalk. Among clinical associations, postoperative pancreatic fistula risk and acute pancreatitis severity escalation are supported by the strongest evidence. Associations with type 2 diabetes, exocrine dysfunction, and pancreatic ductal adenocarcinoma remain biologically plausible but are limited by shared etiology confounding and reverse causation. Fatty pancreas is currently best understood as an emerging metabolic-fibroinflammatory pancreatic phenotype rather than a definitively established disease entity. Diagnostic standardization, prospective cohort studies, and intervention trials are essential next steps.