Excess Liver Fat in Type 2 Diabetes Stratified by Intrapancreatic Fat Deposition: A Meta-Analysis of Dual-Organ MRI Studies

Both liver fat content (LFC) and intrapancreatic fat deposition (IPFD) are frequently increased in Type 2 diabetes mellitus (T2DM). We meta-analysed dual-organ MRI studies comparing LFC between individuals with T2DM and non-diabetic controls and explored whether study-level differences in LFC varied according to IPFD burden. Seventeen studies (2142 participants) were included. Individuals with T2DM had significantly higher LFC than non-diabetic controls (standardised mean difference [SMD] 0.89, 95% CI 0.60-1.18). In exploratory subgroup analyses, liver fat excess was larger in studies with mean IPFD ≥ 10% than in those with IPFD < 10% (SMD 1.20 vs. 0.62; p = 0.04), though this finding was not consistently retained in leave-one-out analyses. Alternative IPFD cutoffs yielded directionally similar but non-significant subgroup differences. Study-level differences in IPFD were associated with differences in LFC (β = 0.383, p = 0.006) in univariable meta-regression, but not after BMI adjustment. These findings suggest that higher IPFD is associated with greater liver fat excess in T2DM at the study level. Individual-level analyses are now warranted to clarify this relationship.