Meta-analysis finds fatty pancreas disease in over half of adults with MASLD

BACKGROUND AND AIMS: Fatty pancreas disease (FPD), characterized by excessive intrapancreatic fat deposition (IPFD), is increasingly recognized as a manifestation of metabolic dysfunction. However, its epidemiology and clinical impact in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) remain unclear. We conducted a systematic review and meta-analysis to quantify the prevalence of FPD in MASLD and to compare clinical characteristics between patients with and without FPD. METHODS: A comprehensive search of the PubMed and Embase databases was conducted from inception to November 29, 2025, to identify observational studies reporting the prevalence and/or clinical impact of FPD in adults with MASLD. Pooled prevalence estimates were calculated using a generalized linear mixed model, and clinical features were compared using random-effects models. RESULTS: We identified 11 studies (n = 21 438 patients). The pooled prevalence of FPD in MASLD was 54.32% (95% CI 34.53 to 72.83), with high heterogeneity (I = 99.6%). FPD prevalence was significantly lower in Asian studies (35.59%) than in non-Asian studies (75.05%) (p = 0.01). No differences in FPD prevalence were found when stratified by sample size, MASLD diagnosis, or IPFD assessment method. Patients with MASLD and FPD were found to be older, had a higher body mass index, and were more likely to have diabetes, hypertension, and metabolic syndrome. CONCLUSIONS: Around half of patients with MASLD have concomitant FPD, which is associated with an adverse cardiometabolic phenotype. These findings support the need for integrated, longitudinal evidence to define the prognostic and therapeutic relevance of IPFD within a multiorgan ectopic fat framework of systemic metabolic dysfunction.