Intra-Pancreatic Fat Deposition and Pancreatitis: Insights from the COSMOS Program

Juyeon Ko,1 Maxim S Petrov2 1College of Medicine, Yonsei University, Seoul, Republic of Korea; 2School of Medicine, University of Auckland, Auckland, New ZealandCorrespondence: Maxim S Petrov, University of Auckland, Grafton Campus, Room 507-2006, Auckland, New Zealand, Email [email protected]: The global burden of pancreatitis is substantial, bedevilled by the lack of pathogenesis-based treatments for acute pancreatitis and chronic pancreatitis. The integrated PANDORA (PANcreatic Diseases Originating from intRa-pancreatic fAt) hypothesis “moved the needle” on thinking why pancreatitis develops by bringing fat in the pancreas to the fore. A total of 20 original clinical studies exploring an uncharted territory of fat in the pancreas and pancreatitis were published between 2019 and 2024 as part of the COSMOS (Clinical and epidemiOlogical inveStigations in Metabolism, nutritiOn, and pancreatic diseaseS) program. This review concisely summarises the novel insights into the relationship of intra-pancreatic fat deposition with endocrine and exocrine pancreatic functions, behavioural and nutritional factors, as well as various biomarkers. Tapping into the wealth of knowledge derived from the COSMOS program can unlock new perspectives on the treatment of acute pancreatitis and chronic pancreatitis.Keywords: intra-pancreatic fat deposition, acute pancreatitis, chronic pancreatitis