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Elbanna Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt Nadia M. Hamdy Department of Biochemistry, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt Ahmed Morad Hashim Division of Gastroenterology and Hepatology, Department of Internal Medicine, Cairo University, Cairo, Egypt Marwa Matboli Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Ain Shams University, Cairo, Egypt Hussein Hassan Okasha Department of Internal Medicine and Gastroenterology, Hepatology Unit, Kasr Al-Aini Hospitals, Cairo University, Cairo, Egypt Sara A. Sedeek Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt Asia Mohamed Bilal Azam Department of Medical Gastroenterology, Saveetha Medical College and Hospitals, Chennai, India Feng Cao Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China Udit Chauhan Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, India Guozhong Chen Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi University of Chinese Medicine, Nanning, China Ning Chen Department of Gastroenterology, Peking University People's Hospital, Beijing, China Song Chen Translational Research Institute, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China Weigang Chen Department of Gastroenterology, The First Affiliated Hospital of Shihezi University, Shihezi University, Shihezi, China Weiwei Chen Medical College, Yangzhou University, Yangzhou, China Sudipta Dhar Chowdhury Department of Gastroenterology, Christian Medical College Vellore, Vellore, India Lihui Deng Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China Xiaowu Dong Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China ### Page 4 Vishal Gupta Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhopal, India Tsuyoshi Hamada Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Chaoqun Han Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Jianyu Hao Department of Gastroenterology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China Wenhua He Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China Guoyong Hu Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Lianghao Hu Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China Haojie Huang Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China Heguang Huang Department of General Surgery, Union Hospital, Fujian Medical University, Fuzhou, China Wei Huang West China Centre of Excellence for Pancreatitis, West China Hospital, Sichuan University, Chengdu, China Zhiyin Huang Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China Bei Ji Department of Gastroenterology, The Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi, China Meng Jin Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China Tawfik Khoury Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel Juyeon Ko Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea Xiangyu Kong Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China Junji Kozawa Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan Mohammad Shafi Kuchay Division of Endocrinology and Metabolism, Medanta - The Medicity Hospital, Gurugram, India Naotaka Kugiyama Department of Gastroenterology and Hepatology, Kumamoto University, Kumamoto, Japan Chengpeng Li Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital and Institute, Beijing, China ### Page 5 Guichen Li Department of Pancreatobiliary Surgery, The First Hospital of China Medical University, China Medical University, Shenyang, China Jing Li Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China Tuo Li Department of Endocrinology, Changzheng Hospital, Naval Medical University, Shanghai, China Weiqin Li Department of Critical Care Medicine, Center of Severe Acute Pancreatitis, Jinling Hospital, Nanjing University, Nanjing, China Xiaoyu Li Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China Hai Lin Department of Pancreatic Surgery, The First Teaching Hospital of Xinjiang Medical University, Xinjiang Medical University, Urumqi, China Xinjuan Liu Department of Gastroenterology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China Zhilan Liu Department of Gastroenterology, Qinghai Provincial People's Hospital, Xining, China Guotao Lu Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China Jiajie Lu Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China Zipeng Lu Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China Chao Luo School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China Ke Lv Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China Ying Lv Department of Gastroenterology, The Affiliated Drum Tower Hospital, Nanjing University, Nanjing, China Jiarong Miao Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China Anoop Misra Fortis CDOC Center for Excellence for Diabetes, Metabolic Disorders, and Endocrinology, New Delhi, India Yousuke Nakai Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan Hiroki Oyama Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Nonthalee Pausawasdi Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand ### Page 6 Jie Peng Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China Sunitha Priya Department of Physiology, Indira Medical College, Thiruvallur, India Tingyue Qi Department of Ultrasound, Medical Imaging Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China Weiguang Qiao Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China Yi Qin School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China Ramesh Rajan Department of Surgical Gastroenterology, Trivandrum Medical College, Trivandrum, India Hongbo Ren Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China Takahiko Sakaue Division of Gastroenterology, Department of Medicine, Kurume University, Kurume, Japan Dong Shang Laboratory of Integrative Medicine, First Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian, China Yan Shen School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China Qiao Shi Department of Pancreatic Surgery, Renmin Hospital, Wuhan University, Wuhan, China Xiaolei Shi Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China Shuhei Shinoda Department of Gastroenterology and Hepatology, Yamaguchi University, Ube, Japan Channabasappa Shivaprasad Diabetes and Endocrinology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, India Loren Skudder-Hill Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Raymond Shing Yan Tang Department of Medicine and Therapeutics, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Xiaowei Tang Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China Pengxian Tao Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China ### Page 7 Ahmed Tawheed Department of Gastroenterology, Al Emadi Hospital, Doha, Qatar Meihua Wan Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China Rong Wan Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Gang Wang Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China Shengfeng Wang Department of Epidemiology and Biostatistics, School of Public Health, Key Laboratory of Epidemiology of Major Diseases, Peking University, Beijing, China Wei Wang Department of Radiology, Medical Imaging Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China Zheng Wang Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China Wenping Wei Department of Pediatrics, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China Li Wen Center for Biomarker Discovery and Validation, National Infrastructures for Translational Medicine, Institute of Clinical Medicine, Peking Union Medical College Hospital, Beijing, China Dong Wu Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China Heshui Wu Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Wenbin Wu School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China Liang Xia Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China Hong Xiang Laboratory of Integrative Medicine, First Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian, China Hongwei Xu Department of Gastroenterology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China Kedong Xu Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China Qiang Xu Department of General Surgery, Peking Union Medical College Hospital, Beijing, China ### Page 8 Hajime Yamazaki Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan Yong Yang Department of Hepatobiliary Surgery, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China Tao Yin Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Ping Yu Department of Nursing, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China Xiao Yu Department of Hepatopancreatobiliary Surgery, Third Xiangya Hospital, Central South University, Changsha, China Xiaoping Yu Health Management Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China Chenchen Yuan Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China Yue Zeng Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Wenlong Zhai Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China Xiaofeng Zhang Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Westlake University, Hangzhou, China Yao Zhang Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Yun Zhang Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China Yi Zhao Department of Radiology, Medical Imaging Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China Chunhua Zhou Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Sisi Zhou Department of Gastroenterology, Qinghai Provincial People's Hospital, Xining, China Changju Zhu Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China Kexiang Zhu Department of General Surgery, The First Affiliated Hospital of Lanzhou University, Lanzhou University, Lanzhou, China Qingtian Zhu Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China ### Page 9 Xiaoliang Zhu Department of General Surgery, The First Affiliated Hospital of Lanzhou University, Lanzhou University, Lanzhou, China Yin Zhu Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China Duowu Zou Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Wenbin Zou Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China Europe Ahmad H. Al-Mrabeh Institute for Neuroscience and Cardiovascular Research, University of Edinburgh, Edinburgh, UK Laure Alexandre- Heymann Department of Diabetology and Endocrinology, Lariboisière Hospital AP-HP, Université Paris Cité, Paris, France Akif Bayyigit Department of Internal Medicine, Taksim Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye Michele Bevere ARC-Net Center for Applied Research on Cancer, University of Verona, Verona, Italy Roberto Bizzotto Institute of Neuroscience, National Research Council of Italy, Padua, Italy Danijela Budimir Mršić Department of Diagnostic and Interventional Radiology, University Hospital of Split, Split, Croatia Cristina Cadenas- Sanchez Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain Federico Caldart Gastroenterology B Unit, Pancreas Center, University of Verona, Verona, Italy James Cantley Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK Ethem Turgay Cerit Division of Endocrinology and Metabolism, Department of Internal Medicine, Gazi University Faculty of Medicine , Ankara, Türkiye Nicolò De Pretis Department of Medicine, University of Verona, Verona, Italy Giuseppe Della Pepa Unit of Endocrine Diseases and Diabetology, ASST Bergamo Ovest, Bergamo, Italy Gema Frühbeck Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain Louise M. Goff Diabetes Research Centre, University of Leicester, Leicester, UK Mehmet Kanbay School of Medicine, Koc University, Istanbul, Türkiye ### Page 10 Julia S. Kenkre Department of Clinical Biochemistry, Imperial College Healthcare NHS Trust, Charing Cross Hospital , London, UK Idoia Labayen Department of Health Sciences, Public University of Navarra, Pamplona, Spain Claudio Luchini Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy Eva Marín-Serrano Department of Gastroenterology, La Paz University Hospital, Madrid, Spain David Marti-Aguado Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain Paola Mattiolo Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy Shanta J. Persaud Department of Diabetes, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK Joanna M. Pienkowska Department of Radiology, Medical University of Gdansk, Gdansk, Poland Susanne Rospleszcz Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany Bedriye Koyuncu Sokmen Department of Radiology, Acıbadem Atakent Hospital, Istanbul, Türkiye Aysegul Oz Department of Radiology, Bakircay University, Izmir, Türkiye Osman Özdoğan Department of Gastroenterology, Mersin University, Mersin, Türkiye Tricia M-M. Tan Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK E. Louise Thomas Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK Fatih Türker Department of Internal Medicine, Haseki Training and Research Hospital, Istanbul, Türkiye Nicola Veronese Faculty of Medicine, Saint Camillus International University of Health Sciences, Rome, Italy Alexander von Kriegsheim Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK Hanieh Yaghootkar School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK North America Faraz Bishehsari Gastroenterology Research Center, Department of Internal Medicine, University of Texas Health Science CentFIer at Houston, McGovern Medical School, Houston, USA Saurabh Chawla Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, USA ### Page 11 Bara El Kurdi Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA Brian Z. Huang Department of Population and Public Health Sciences, University of Southern California, Los Angeles, USA Shanlin Ke Department of Internal Medicine, The Ohio State University, Columbus, USA Lauren Khanna Department of Medicine, New York University Langone Health, New York, USA Niwen Kong Department of Medicine, Stanford University, Palo Alto, USA Teresa L. Mastracci Department of Biology, Indiana University Indianapolis, Indianapolis, USA Gabriel Q. Shaibi Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, USA Samantha A. Streicher Cancer Epidemiology Division, University of Hawaii Cancer Center, Honolulu, USA Andrew T. Trout Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA John Virostko Department of Diagnostic Medicine, Dell Medical School, University of Texas at Austin, Austin, USA Cemal Yazici Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, Chicago, USA Oceania Viviane Delghingaro- Augusto John Curtin School of Medical Research, Australian National University, Canberra, Australia Sakina H. Bharmal School of Medicine, University of Auckland, Auckland, New Zealand Spiros Fourlanos Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Australia Tej Joshi School of Medicine, University of Auckland, Auckland, New Zealand Ryul Kang School of Medicine, University of Auckland, Auckland, New Zealand Sarah Kilian School of Medicine, University of Auckland, Auckland, New Zealand Chani-Brynn Leybourne School of Medicine, University of Auckland, Auckland, New Zealand Xinye Li School of Medicine, University of Auckland, Auckland, New Zealand Yutong Liu School of Medicine, University of Auckland, Auckland, New Zealand ### Page 12 Names are listed alphabetically.Maxim S. Petrov School of Medicine, University of Auckland, Auckland, New Zealand Xiatiguli Shamaitijiang School of Medicine, University of Auckland, Auckland, New Zealand Charlotte Stuart School of Medicine, University of Auckland, Auckland, New Zealand Yaochen Wang School of Medicine, University of Auckland, Auckland, New Zealand Katie Wynne School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia Jasmine Zhang School of Medicine, University of Auckland, Auckland, New Zealand Yingxin Zhang School of Medicine, University of Auckland, Auckland, New Zealand South America José Celso Ardengh Division of Digestive and Endoscopic Surgery, Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil Marcio Garrison Dytz School of Medicine, Faculty of Education and Health Sciences, University Center of Brasilia, Brasilia, Brazil Jorge Carvalho Guedes Faculty of Medicine, Federal University of Bahia, Salvador, Brazil Bruno Pereira Melo Centro Universitário ITOP (UNITOP) – Instituto Tocantinense de Ensino Superior e Pesquisa Ltda., Palmas, Brazil Claudia P. Oliveira Department of Gastroenterology, Ribeirão Preto School of Medicine , University of São Paulo, São Paulo, Brazil Matheus Souza Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Cristiane A. Villela- Nogueira Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil ### Page 13 Supplementary Table 2. | Search strings used in systematic reviewsStudy ID Citation Search stringSR#1 Souza, M. et al. Prevalence, clinical characteristics, and outcomes of fatty pancreas disease: an updated systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 37, 137-146 (2025).PubMed and Embase：1. ("pancrea*" OR “pancreas” OR “intrapancreatic” OR “IPFD”) 2. ("ectopic" OR "fatty" OR “fat” OR "steato*" OR "NAFPD" OR "lipomatosis" OR “hyperecho*”) 3. ("prevalence*" OR "epidemiol*" OR "incidence" “OR “cancer” OR “pancreatitis” OR “insufficiency”) 4. (#1 AND #2 AND #3) 5. ("randomised controlled trial" OR "controlled clinical trial" OR "RCT") 6. #4 NOT #5 7. Filter: Humans SR#2 Leybourne, C.B., Liu, Y. & Petrov, M.S. Excessive intrapancreatic fat deposition and risk of pancreatic diseases: longitudinal cohort evidence from a systematic review with population-attributable fraction analysis. Am J Gastroenterol. 121, 1071-1081 (2026).MEDLINE:1. pancrea*.mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier] 2. (fat or adipose or steatosis or lipid*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier] 3. 1 and 2 4. (longitudinal or cohort or prospective or "follow up" or followup or "follow-up").mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier] 5. exp Longitudinal Studies/ or exp Cohort Studies/ or exp Prospective Studies/ or exp Follow-Up Studies/ 6. 4 or 5 7. 3 and 6 8. exp Animals/ not (exp Animals/ and exp Humans/) 9. (non-human or animal or bariatric or diet).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier] 10. 8 or 9 11. 7 not 10 12. limit 11 to human 13. limit 12 to yr="2014 -Current”Scopus： ### Page 14 TITLE-ABS-KEY ( ( pancreas OR pancreatic ) AND ( fat OR adipose OR steatosis OR lipid* ) AND ( longitudinal OR cohort OR prospective OR "follow up" OR followup OR "follow-up" OR "longitudinal studies" OR "cohort studies" OR "prospective studies" OR "follow-up studies" ) AND humans ) AND NOT TITLE-ABS-KEY ( "non-human" OR animal OR bariatric OR diet ) AND PUBYEAR > 2014 AND PUBYEAR < 2026 AND ( LIMIT-TO ( DOCTYPE , "ar" ) ) AND ( LIMIT-TO ( EXACTKEYWORD , "Human" ) )Pubmed:(("Pancreas"[MeSH] OR pancreas[tiab] OR pancreatic[tiab]) AND (fat[tiab] OR adipose[tiab] OR steatosis[tiab] OR lipid*[tiab])) AND (longitudinal[tiab] OR cohort[tiab] OR prospective[tiab] OR "follow up"[tiab] OR followup[tiab] OR "follow-up"[tiab] OR "longitudinal studies"[MeSH Terms] OR "cohort studies"[MeSH Terms] OR "prospective studies"[MeSH Terms] OR "follow-up studies"[MeSH Terms]) AND (humans[MeSH Terms]) NOT (non-human[tiab] OR animal[tiab] OR bariatric[tiab] OR diet[tiab]) AND ("2014"[Date - Publication] : "2025"[Date - Publication]) SR#3 Zhang, Y., Liu, Y. & Petrov, M.S. Relationship of fat in the pancreas with cardiovascular disease: a systematic review and meta-analysis. Obes Rev. 26, e13914 (2025).MEDLINE and Embase：1. pancrea*.mp. 2. (heart or cardia* or cardio* or myocardi* or endocardi* or epicardi* or pericardi* or atherosclero*).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms, population supplementary concept word, anatomy supplementary concept word] 3. (fat* or steatos* or steatotic or adipo* or lip*).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms, population supplementary concept word, anatomy supplementary concept word] 4. 1 and 2 and 3 5. limit 4 to humans SR#4 Joshi, T., Virostko, J. & Petrov, M.S. Artificial intelligence-based models for quantification of intra-pancreatic fat deposition and their clinical relevance: a systematic review of imaging studies. Eur Radiol. 36, 627-641 (2026).Embase, Scopus, MEDLINE, and IEEE Xplore:(pancrea*) AND (artificial intelligence OR artificial OR reasoning OR deep learning OR machine learning OR supervised learning OR unsupervised learning OR neural network* OR automat* OR generation adversarial* OR convolution*) AND (fat* OR steatos* OR steatotic OR adipo* OR lip*) AND (imag* OR imaging OR scan* OR ultrasound OR sonograph* OR endoscopic ultrasound OR endoscopic sonograph* OR magnetic resonance imag* OR mri OR computed tomograph* OR ct OR tomograph*) AND (quant* OR quantif* OR volume OR fraction OR percent* OR ratio OR deposi*). ### Page 15 SR#5 Wang, Y., Liu, Y. & Petrov, M.S. The effects of metabolic bariatric surgery on intra-pancreatic fat deposition and total pancreas volume: a systematic review and meta-analysis. Obes Surg. 35, 1513-1524 (2025).Embase and MEDLINE:1. Bariatric surgery/ 2. (“bariatric surgery” or “sleeve gastrectomy” or “gastric bypass” or “Roux* BPD*” or billio* or SAD* or “sin- gle-anastamo*” or endoscop* or “bariatric endoscop*” or gastroplast* or balloon* or “metabolic surgery” or “weight loss surgery”).mp. [mp = title, abstract, heading word, drug trade name, original title, device manufac- turer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word]. 3. 1 or 2 4. Tomography, X-ray computed/ 5. Magnetic resonance imaging/ 6. (CT or MRI or “comp* tomography” or “Magnetic resonance imaging” or “MRS” or “MR spectroscopy” or “Magnetic resonance spectroscopy” or “nuclear res- onance imaging” or imaging).mp. [mp = title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word]. 7. 4 or 5 or 6 8. (“pancrea* adipose” or “pancrea* fat” or “pancrea* volume” or “pancrea* size” or “pancrea* steato*” or “Ecotopic fat*” or “ectopic adipose”).mp. [mp = title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word]. 9. 3 and 7 and 8 SR#6 Della Pepa, G., Salamone, D., Testa, R., Bozzetto, L. & Costabile, G. Intrapancreatic fat deposition and nutritional treatment: the role of various dietary approaches. Nutr Rev. 82, 1820-1834 (2024).PubMed, Scopus, and Embase:“pancreatic fat” OR “intra-pancreatic fat” OR “nonalcoholic fatty pancreas disease” OR “pancreatic steatosis” OR “pancreatic fat content” OR “pancreatic fat infiltration” OR “fatty pancreas disease” AND “diet” OR “nutritional interventions” OR “dietary intervention” OR “hypocaloric diet” OR “isocaloric diet” OR “low energy diet” OR “low calorie diet” SR#7 Agon, H.C., Shen, Y. & Petrov, M.S. Effects of glucose-lowering medications on intra- pancreatic fat deposition: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 27, e70087 (2026).Cochrane Central Register of Controlled Trials, Embase, and MEDLINE:((((pancreatic or pancreas) adj3 (fatt* or lip* or steato* or adipo* or lipomatosis or fat content or accumulation or morphology)) or intrapancreatic fat* or fat* pancrea*).mp.) AND ((pharmac* or drug* or Medic*) adj3 (effect* or treatment* or intervention* or therap*)).mp. or placebo. ti, ab, kw. Limits to humans and “Randomised Controlled Trial” [publication type] SR#8 Rodríguez, C.I. et al. Understanding the association of intrapancreatic fat deposition with adiposity and components of metabolic syndrome in children and adolescents: a systematic review and meta-analysis.EClinicalMedicine. 83, 103205 (2025).MEDLINE:(("Cardiometabolic risk*" OR "Cardiometabolic Risk Factors" OR "Metabolic disease" OR "Metabolic syndrome" OR "Metabolic syndrome" OR "Obesity" OR "Obesity" OR "Insulin resistance" OR "Insulin resistance" OR "Diabetes" OR "Diabetes mellitus" OR "Hepatic steatosis" OR "Fatty liver" OR "Fatty liver" OR "Hypercholesterolemia" OR "Hypercholesterolemia" OR "Cholesterol" OR "Cholesterol" OR "HDL" OR "Cholesterol, HDL"OR "high-density lipoprotein" OR "high density lipoprotein" OR "LDL" OR ### Page 16 "Cholesterol, LDL"OR "low-density lipoprotein" OR "low density lipoprotein" OR "Hypertriglyceridemia" OR "Hypertriglyceridemia" OR "Triglycerides" OR "Triglycerides" OR "Blood glucose" OR "Blood glucose" OR "Hyperglycemia" OR "Hyperglycemia" OR "Arterial pressure" OR "Arterial pressure" OR "Blood pressure" OR "Blood pressure" OR "Hypertension" OR " Atherosclerosis " OR "Hypertension") AND ("Pancreatic steatosis" OR "Pancreas steatosis" OR “Fatty infiltration of the pancreas" OR " Pancreatic fat infiltration" OR " pancreatic lipomatosis" OR " Fat replacement of pancreatic parenchyma" OR “intra- pancreatic fat deposition” OR "Pancreatic Fat" OR "Pancreas fat" OR "Fatty pancreas" OR "Pancreatic adipose tissue" OR "Non-alcoholic fatty pancreatic disease" OR "Nonalcoholic fatty pancreatic disease" OR “Pancreatic lipid”) AND ("child*"OR "adolescent*"OR "teenager*" OR "youth*"))Web of Science:(("Cardiometabolic risk*" OR "Cardiometabolic Risk Factors" OR "Metabolic disease" OR "Metabolic syndrome" OR "Obesity" OR "Insulin resistance" OR "Diabetes" OR "Diabetes mellitus" OR "Hepatic steatosis" OR "Fatty liver" OR "Hypercholesterolemia" OR "Cholesterol" OR "HDL" OR "Cholesterol, HDL"OR "high-density lipoprotein" OR "high density lipoprotein" OR "LDL" OR "Cholesterol, LDL"OR "low-density lipoprotein" OR "low density lipoprotein" OR "Hypertriglyceridemia" OR "Triglycerides" OR "Blood glucose" OR "Hyperglycemia" OR "Arterial pressure" OR "Blood pressure" OR " Atherosclerosis " OR "Hypertension") AND ("Pancreatic steatosis" OR "Pancreatic Fat" OR “Fatty infiltration of the pancreas" OR "Pancreatic fat infiltration" OR "pancreatic lipomatosis" OR "Fat replacement of pancreatic parenchyma" OR “intra-pancreatic fat deposition” OR "Pancreas fat" OR "Fatty pancreas" OR "Pancreatic adipose tissue" OR "Non-alcoholic fatty pancreatic disease" OR "Nonalcoholic fatty pancreatic disease" OR “Pancreatic lipid”) AND ("child*"OR "adolescent*"OR "teenager*" OR "youth*"))Scopus:( TITLE-ABS-KEY ( {Cardiometabolic risk} OR " Cardiometabolic Risk Factors *" OR {Metabolic disease} OR "Insulin Resistance*" OR {Dysmetabolic Syndrome} OR {Metabolic Cardiovascular Syndrome} OR {Cardiometabolic Syndrome} OR {obesity} OR {Diabetes mellitus} OR {Fatty liver} OR {Steatosis of Liver} OR {Visceral Steatosis} OR {Liver Steatosis} OR {Hypercholesterolemia} OR "Cholesterol*" OR {Hypercholesteremia} OR {Hypertriglyceridemia} OR "Triglyceride*" OR {Blood glucose} OR {Blood Sugar} OR {Hyperglycemia} OR {Arterial pressure} OR {Arterial Tension} OR {Arterial Blood Pressure} OR {Aortic Pressure} OR {Aortic Tension} OR {Aortic Blood Pressure} OR {Aortic Pulse Pressure} OR {Blood Pressure} OR {Diastolic Pressure} OR {Pulse Pressure} OR {Systolic Pressure} OR { Atherosclerosis} OR {Hypertension} ) ) AND ( TITLE-ABS-KEY ( {Pancreatic steatosis} OR {Pancreas steatosis} OR {Pancreatic fat infiltration } OR {Fat replacement of pancreatic parenchyma} OR {Fatty infiltration of the pancreas } OR {pancreatic lipomatosis} OR {intra-pancreatic fat deposition} OR {Pancreatic Fat} OR {Pancreas fat} OR {Fatty ### Page 17 pancreas} OR {Pancreatic adipose tissue} OR {Non-alcoholic fatty pancreatic disease} OR {Nonalcoholic fatty pancreatic disease} ) ) AND ( TITLE-ABS-KEY ( ( "child*" OR "adolescent*" OR "teenager*" OR "youth*" ) ) ) ### Page 18 Supplementary Table 3 | Summary of the studies included in systematic review #1 #Study ID Year Country/territory Study design Study population Baseline participants (n) Method of IPFD measurement Key findingXiao et al.1 2024 China Cross-sectional Individuals who underwent a health examination 1,774 TAUS ▲Weight-related parameters (weight, BMI, TyG-BMI); TG- related parameters (TyG, TG, TG/HDL) Dong et al.2 2024 China Longitudinal Individuals from general population 42,599 MRI ▲Diabetes and its complications Berger et al.3 2023 Chile Cross-sectional Individuals who underwent CT of the abdomen and pelvis 203 CT ▲Age and BMI Bi et al.4 2022 China Longitudinal Individuals who underwent a health examination 12,551 TAUS ▲T2DM and its complications; metabolic syndrome Oh et al.5 2022 South Korea Cross-sectional Individuals who underwent TAUS at a tertiary hospital 1,459 TAUS ▲Age, weight, BMI, waist circumference, systolic and diastolic blood pressures, FPG, HbA1c, BUN, Cr, TG, LDL, NAFLD Okada et al.6 2021 Japan Cross-sectional Individuals who underwent a health examination 919 TAUS ▲Age, waist circumference, TyG, LDL, hepatic steatosis index Chan et al.7 2022 Hong Kong Longitudinal Individuals selected from a randomly generated list derived from the government census database 631 MRI ▲T2DM and its complications Sahin & Karadeniz82022 Türkiye Cross-sectional Individuals diagnosed with NAFLD 183 TAUS ▲Carotid intima-media thickness Oh et al.9 2021 South Korea Cross-sectional Individuals who underwent TAUS at a tertiary hospital 1,386 TAUS ▲T2DM and its complications ### Page 19 Milovanovic et al.102019 Serbia Cross-sectional Individuals diagnosed with NAFLD 143 TAUS ▲Waist circumference, fasting plasma glucose, total cholesterol, serum amylase and lipase Hung et al.11 2018 Taiwan Longitudinal Individuals who underwent a health examination 32,346 TAUS ▲Diabetes and its complications Weng et al.12 2018 China Cross-sectional Individuals who underwent a health examination 4,418 TAUS ▲NAFLD, T2DM, insulin resistance, dyslipidaemia, and GLP-1 Wang et al.13 2018 China Cross-sectional Individuals from the hospital staff (including retirees) who underwent TAUS 2,093 TAUS ▲Age, central obesity, and NAFLD Rosenblatt et al.14 2019 USA Cross-sectional Individuals aged ≥18 years diagnosed with NAFLD who underwent TAUS within 1 year of liver biopsy 104 TAUS ▲Advanced liver fibrosis Zhou et al.15 2016 China Cross-sectional Individuals who underwent a health examination 1,190 TAUS ▲Age, sex, central obesity, hepatic steatosis, hypertriglyceridaemia and hyperglycaemia Lesmana et al.16 2015 Indonesia Cross-sectional Individuals who underwent a health examination 901 TAUS ▲Age, sex, systolic and diastolic blood pressures, BMI, FPG, TG, and TC Wong et al.17 2014 Hong Kong Cross-sectional Individuals selected from a randomly generated list derived from the government census database 685 MRI ▲Central obesity, TG, and hyperferritinaemia ### Page 20 Wang et al.18 2014 Taiwan Cross-sectional Individuals who underwent a health examination 8,097 TAUS ▲Age, general or central obesity, T2DM, and NAFLDAbbreviations: BMI, body mass index; BUN, blood urea nitrogen; Cr, creatinine; CT, computed tomography; FPG, fasting plasma glucose; GLP-1, glucagon- like peptide-1; HbA1c, glycated haemoglobin; IPFD, intrapancreatic fat deposition; LDL, low-density lipoprotein; MRI, magnetic resonance imaging; NAFLD, non-alcoholic fatty liver disease; T2DM, type 2 diabetes mellitus; TAUS, transabdominal ultrasound; TG, triglyceride; TyG, triglyceride-glucose index; TyG-BMI,triglyceride glucose-body mass index; TG/HDL, triglyceride to high-density lipoprotein ratio; TC, total cholesterol; USA, United States of America; UK, United Kingdom.Footnotes: Country/territory denotes the location of the corresponding author’s primary affiliation. The upward arrow (▲) denotes a significant negative health impact associated with excessive intrapancreatic fat deposition, or a significant negative effect of an intervention on intrapancreatic fat deposition. The downward arrow (▼) indicates a significant positive health impact associated with excessive intrapancreatic fat deposition, or a significant positive effect of an intervention on reducing intrapancreatic fat deposition. The sideways arrow (◄►) indicates no significant or mixed effects on health outcomes associated with excessive intrapancreatic fat deposition, or no significant effect of an intervention on intrapancreatic fat deposition. Statistical significance was defined as p < 0.05 in the most fully adjusted model.# This systematic review refers to Souza, M. et al. Prevalence, clinical characteristics, and outcomes of fatty pancreas disease: an updated systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 37, 137-146 (2025). ### Page 21 Supplementary Table 4 | Summary of the studies included in systematic review #2 #Study ID Year Country/territory Study design Study population Baseline participants (n) Method of IPFD measurement Key findingBi et al.4 2022 China Longitudinal Individuals from general population 12,551 TAUS ▲T2DM and its complications; ▲Metabolic syndrome Chan et al.7 2022 Hong Kong Longitudinal Individuals from general population 631 MRI ▲T2DM and its complications Diamond et al.19 2024 UK Longitudinal Individuals diagnosed with T2DM 134 MRI ◄►IPFD change Dong et al.2 2024 China Longitudinal Individuals from general population 42,599 MRI ▲Pancreatitis, pancreatic cancer ▲T2DM and its complications Espes et al.20 2021 Sweden Longitudinal Individuals diagnosed with T1DM 10 MRI ◄►IPFD change Fujii et al.21 2019 Japan Longitudinal Individuals from general population 9,933 TAUS ▲Pancreatitis Gyllenhammer et al.22 2016 USA Longitudinal Adolescents and young adults 76 MRI ▲IPFD change Hung et al.11 2018 Taiwan Longitudinal Individuals from general population 8,856 TAUS ▲T2DM and its complications Ishibashi et al.23 2020 Japan Longitudinal Individuals diagnosed with T2DM 56 CT ◄►Insulin traits Kashiwagi et al.24 2019 Japan Longitudinal Individuals diagnosed with low-risk BD- IPMN 75 CT ▲Imaging progression ### Page 22 Nadarajah et al.25 2020 USA Longitudinal Individuals who underwent MRI at a tertiary hospital 126 MRI ▲T2DM and its complications Oh et al.9 2021 South Korea Longitudinal Individuals from general population 1,386 TAUS ▲T2DM and its complications Patel et al.26 2015 USA Longitudinal Individuals diagnosed with NASH 43 MRI ◄►IPFD change Steinkohl et al.27 2020 Denmark Longitudinal Individuals diagnosed with chronic pancreatitis 25 MRI ▲Pancreatitis and IPFD change Sunouchi et al.28 2023 Japan Longitudinal Individuals from general population 37 CT ▲IPFD change Wang et al.29 2024 China Longitudinal Individuals diagnosed with T2DM 405 CT ▲T2DM and its complications Whitcher et al.30 2022 UK Longitudinal Individuals from general population 3,088 MRI ◄►IPFD change Yamazaki et al.31 2016 Japan Longitudinal Individuals from general population 813 CT ◄►T2DM and its complications Yamazaki et al. (a))32 2018 Japan Longitudinal Individuals from general population 198 CT ▲IPFD change Yamazaki et al. (b))33 2018 Japan Longitudinal Individuals from general population 320 CT ▲Metabolic syndrome Yamazaki et al.34 2020 Japan Longitudinal Lean individualsfrom general population 1,478 CT ▲T2DM and its complications Yamazaki et al.35 2022 Japan Longitudinal Individuals from general population 754 CT ▲T2DM and its complications ### Page 23 Yamazaki et al.36 2024 UK Longitudinal Individuals from general population 29,463 MRI ▲Pancreatic cancerAbbreviations: BD-IPMN, branch duct intraductal papillary mucinous neoplasm; CT, computed tomography; IPFD, intrapancreatic fat deposition; MRI, magnetic resonance imaging; NASH, non-alcoholic steatohepatitis; TAUS, transabdominal ultrasound; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus; USA, United States of America; UK, United Kingdom.Footnotes: Country/territory denotes the location of the corresponding author’s primary affiliation. The upward arrow (▲) denotes a significant negative health impact associated with excessive intrapancreatic fat deposition, or a significant negative effect of an intervention on intrapancreatic fat deposition. The downward arrow (▼) indicates a significant positive health impact associated with excessive intrapancreatic fat deposition, or a significant positive effect of an intervention on reducing intrapancreatic fat deposition. The sideways arrow (◄►) indicates no significant or mixed effects on health outcomes associated with excessive intrapancreatic fat deposition, or no significant effect of an intervention on intrapancreatic fat deposition. Statistical significance was defined as p < 0.05 in the most fully adjusted model.# This systematic review refers to Leybourne, C.B., Liu, Y. & Petrov, M.S. Excessive intrapancreatic fat deposition and risk of pancreatic diseases: longitudinal cohort evidence from a systematic review with population-attributable fraction analysis. Am J Gastroenterol. 121, 1071-1081 (2026). ### Page 24 Supplementary Table 5 | Summary of the studies included in systematic review #3 #Study ID Year Country/territory Study design Study population Baseline participants (n) Method of IPFD measurement Key findingChan et al.7 2022 China Longitudinal Individuals from general population 631 MRI ◄►Ischaemic heart disease Hannukainen et al.372016 Finland Cross-sectional Individuals referred to CAD screening 30 MRS ◄►Ischaemic heart disease Jeong et al.38 2018 South Korea Cross-sectional Individuals with T2DM 186 CT ▲Atherosclerotic retinopathy Kim et al.39 2014 South Korea Cross-sectional Individuals with T2DM 198 CT ▲Carotid intima- media thickness; ▲Carotid plaque; ▲Vascular stiffness Koo et al.40 2020 USA Cross-sectional Individuals from general population 3,951 CT ▲Calcification of vessels Kul et al.41 2019 Türkiye Cross-sectional Individuals from general population 103 TAUS ▲Aortic intima-media thickness Li et al.42 2024 China Cross-sectional Individuals referred to weight management programme 128 MRI ▲Vascular stiffness Meloni et al.43 2023 Italy Cross-sectional Individuals with thalassemia major 308 MRI ▲Cardiac complications Ordulj et al.44 2023 Croatia Cross-sectional Individuals who underwent urgent CT scan upon hospital admission 302 CT ◄►Calcification of vessels Ozturk et al.45 2018 Türkiye Cross-sectional Individuals with MASLD and healthy volunteers 138 TAUS ▲Carotid intima- media thickness; ▲Vascular stiffness Sahin et al.46 2022 Türkiye Cross-sectional Individuals with acute coronary syndrome 99 TAUS ▲Ischaemic heart disease Sahin & Karadeniz82022 Türkiye Cross-sectional Individuals with MASLD 183 TAUS ▲Carotid intima- media thickness Sotoudehman esh et al.472019 Iran Cross-sectional Individuals referred to EUS examination 228 EUS ▲Aortic intima-media thickness ### Page 25 ▲Ischaemic heart disease Stamm48 1984 Switzerland Cross-sectional Cadavers 112 Post-mortem examination ▲Atherosclerosis Sun et al.49 2021 China Cross-sectional Individuals with T2DM 337 CT ▲Carotid plaque Walters50 1966 Australia Cross-sectional Cadavers 200 Post-mortem examination ▲AtherosclerosisAbbreviations: CAD, coronary artery disease; CT, computed tomography; EUS, endoscopic ultrasound; IPFD, intrapancreatic fat deposition; MRI, magnetic resonance imaging; MRS, magnetic resonance spectroscopy; MASLD, metabolic dysfunction-associated steatotic liver disease; TAUS, transabdominal ultrasound; T2DM, type 2 diabetes mellitus; USA, United States of America.Footnotes: Country/territory denotes the location of the corresponding author’s primary affiliation. The upward arrow (▲) denotes a significant negative health impact associated with excessive intrapancreatic fat deposition, or a significant negative effect of an intervention on intrapancreatic fat deposition. The downward arrow (▼) indicates a significant positive health impact associated with excessive intrapancreatic fat deposition, or a significant positive effect of an intervention on reducing intrapancreatic fat deposition. The sideways arrow (◄►) indicates no significant or mixed effects on health outcomes associated with excessive intrapancreatic fat deposition, or no significant effect of an intervention on intrapancreatic fat deposition. Statistical significance was defined as p < 0.05 in the most fully adjusted model.# This systematic review refers to Zhang, Y., Liu, Y. & Petrov, M.S. Relationship of fat in the pancreas with cardiovascular disease: a systematic review and meta-analysis. Obes Rev. 26, e13914 (2025). ### Page 26 Supplementary Table 6 | Summary of the studies included in systematic review #4 #Study ID Year Country/territo ry Study design Study population Baseline participants (n) Method of IPFD measurement Key findingBagur et al.51 2021 UK Cross-sectional Individuals from general population1,170 MRI Clinical endpoints Basty et al.52 2020 UK Cross-sectional Individuals from general population98 MRI Technical aspects of artificial intelligence Dong et al.2 2024 China Longitudinal Individuals from general population42,599 MRI Clinical endpoints Gatidis et al.53 2023 Germany Cross-sectional Individuals from general population17,996 MRI Clinical endpoints Lin et al.54 2023 China Cross-sectional Not reported 176 MRI Technical aspects of artificial intelligence Liu et al.55 2021 UK Cross-sectional Individuals from general population25,617 MRI Technical aspects of artificial intelligence; Clinical endpoints Tallam et al.56 2022 USA Cross-sectional Individuals admitted to a hospital8,992 CT Clinical endpoints Tanabe et al.57 2022 Japan Cross-sectional Individuals admitted to a hospital128 CT Clinical endpoints Whitcher et al.30 2022 UK Longitudinal Individuals from general population3,088 MRI Clinical endpoints Yang et al.58 2022 New Zealand Cross-sectional Individuals admitted to a hospital394 MRI Technical aspects of artificial intelligence; Clinical endpoints ### Page 27 Yang et al.59 2024 South Korea Cross-sectional Individuals admitted to a hospital851 CT Technical aspects of artificial intelligenceZhang et al.60 2024 China Cross-sectional Individuals admitted to a hospital227 CT Technical aspects of artificial intelligenceAbbreviations: CT, computed tomography; IPFD, intrapancreatic fat deposition; MRI, magnetic resonance imaging; T2DM, type 2 diabetes mellitus; USA, United States of America; UK, United Kingdom.Footnotes: Country/territory denotes the location of the corresponding author’s primary affiliation. The upward arrow (▲) denotes a significant negative health impact associated with excessive intrapancreatic fat deposition, or a significant negative effect of an intervention on intrapancreatic fat deposition. The downward arrow (▼) indicates a significant positive health impact associated with excessive intrapancreatic fat deposition, or a significant positive effect of an intervention on reducing intrapancreatic fat deposition. The sideways arrow (◄►) indicates no significant or mixed effects on health outcomes associated with excessive intrapancreatic fat deposition, or no significant effect of an intervention on intrapancreatic fat deposition. Statistical significance was defined as p < 0.05 in the most fully adjusted model.# This systematic review refers to Joshi, T., Virostko, J. & Petrov, M.S. Artificial intelligence-based models for quantification of intra-pancreatic fat deposition and their clinical relevance: a systematic review of imaging studies. Eur Radiol. 36, 627-641 (2026). ### Page 28 Supplementary Table 7 | Summary of the studies included in systematic review #5 #Study ID Year Country/territory Study design Study population Baseline participants (n) Method of IPFD measurement Key findingGaborit et al.61 2015 France Longitudinal Lean, obese non- diabetic, and T2DM individuals 45 (20©) MRS ▲T2DM; ▼Bariatric surgery Honka et al.62 2015 Finland Longitudinal Morbidly obese and healthy control individuals 42 (23©) CT ▼Bariatric surgery Steven et al.63 2016 UK Longitudinal Individuals with T2DM or normal glucose tolerance 27 MRI ▼Bariatric surgery in people with T2DM; ◄►Bariatric surgery in people with normal glucose tolerance Umemura et al.642017 Japan Longitudinal Individuals with obesity 27 CT ▼Laparoscopic sleeve gastrectomy Lautenbach et al.652018 Germany Longitudinal Individuals with obesity 11 MRI ▼Roux-en-Y gastric bypass (Pancreas volume decreased after bariatric surgery. The decrease in total volume was associated with a significant decrease in fat volume.) Covarrubias et al.662019 USA Longitudinal Individuals with obesity 9 MRI ▼ Bariatric surgery Hui et al.67 2019 China Longitudinal Individuals with morbid obesity 12 MRI ▼Bariatric surgery (12 mo after surgery) Kulali et al.68 2019 Türkiye Longitudinal Individuals with obesity 44 MRI Not reported ### Page 29 Salman et al.69 2022 Egypt Longitudinal Individuals with morbid obesity 54 MRI ▼Laparoscopic sleeve gastrectomy Bai et al.70 2023 China Longitudinal Individuals with morbid obesity but normal blood glucose 21 MRI ▼Laparoscopic sleeve gastrectomy Cui et al.71 2023 China Longitudinal Individuals with obesity 49 MRI ▼Laparoscopic sleeve gastrectomy Yu et al.72 2023 China Longitudinal Individuals with obesity 151 (18©) MRI ▼Bariatric surgery Hong et al.73 2024 China Longitudinal Individuals with obesity 76 CT ◄►Laparoscopic sleeve gastrectomyAbbreviations: CT, computed tomography; IPFD, intrapancreatic fat deposition; MRI, magnetic resonance imaging; MRS, magnetic resonance spectroscopy; T2DM, type 2 diabetes mellitus; USA, United States of America; UK, United Kingdom.Footnotes: Country/territory denotes the location of the corresponding author’s primary affiliation. The upward arrow (▲) denotes a significant negative health impact associated with excessive intrapancreatic fat deposition, or a significant negative effect of an intervention on intrapancreatic fat deposition. The downward arrow (▼) indicates a significant positive health impact associated with excessive intrapancreatic fat deposition, or a significant positive effect of an intervention on reducing intrapancreatic fat deposition. The sideways arrow (◄►) indicates no significant or mixed effects on health outcomes associated with excessive intrapancreatic fat deposition, or no significant effect of an intervention on intrapancreatic fat deposition. Statistical significance was defined as p < 0.05 in the most fully adjusted model. © Number of patients who underwent surgery.# This systematic review refers to Wang, Y., Liu, Y. & Petrov, M.S. The effects of metabolic bariatric surgery on intra-pancreatic fat deposition and total pancreas volume: a systematic review and meta-analysis. Obes Surg. 35, 1513-1524 (2025). ### Page 30 Supplementary Table 8 | Summary of the studies included in systematic review #6 #Study ID Year Country/territory Study design Study population Baseline participants (n) Method of IPFD measurement Key findingLim et al.74 2011 UK Longitudinal Obese individuals with T2DM 11 MRI ▼Hypocaloric diet Al-Mrabeh et al.752020 UK Longitudinal Obese individuals with T2DM 55 MRI ▼Hypocaloric diets Vogt et al.76 2016 Germany Longitudinal Obese individuals with T2DM 29 MRI ◄►Hypocaloric diets Rossi et al.77 2012 Italy Longitudinal Obese individuals 24 MRI ▼Hypocaloric diets Tene et al.78 2018 Israel RCT Obese individuals with MetS 270 MRS ▼Mediterranean low-carbohydrate diet Thomsen et al.792022 Denmark RCT Obese individuals with T2DM 72 MRI ▼Conventional diabetes diet Schübel et al.802018 Germany RCT Obese individuals with MetS 150 MRI ◄►Intermittent and continuous calorie restriction Skytte et al.812019 Denmark RCT Obese individuals with T2DM 28 MRI ▼Carbohydrate-reduced high-protein diet; ▼Conventional diabetes diet Della Pepa et al.822022 Italy RCT Obese individuals with T2DM 39 MRI ▼Multifactorial diet; ◄►Monounsaturated fatty acid dietAbbreviations: IPFD, intrapancreatic fat deposition; MetS, metabolic syndrome; MRI, magnetic resonance imaging; MRS, magnetic resonance spectroscopy; RCT, randomised controlled trial; T2DM, type 2 diabetes mellitus; UK, United Kingdom.Footnotes: Country/territory denotes the location of the corresponding author’s primary affiliation. The upward arrow (▲) denotes a significant negative health impact associated with excessive intrapancreatic fat deposition, or a significant negative effect of an intervention on intrapancreatic fat deposition. The downward arrow (▼) indicates a significant positive health impact associated with excessive intrapancreatic fat deposition, or a significant positive effect of an intervention on reducing intrapancreatic fat deposition. The sideways arrow (◄►) indicates no significant or mixed effects on health outcomes associated with excessive intrapancreatic fat deposition, or no significant effect of an intervention on intrapancreatic fat deposition. Statistical significance was defined as p < 0.05 in the most fully adjusted model.# This systematic review refers to Della Pepa, G., Salamone, D., Testa, R., Bozzetto, L. & Costabile, G. Intrapancreatic fat deposition and nutritional treatment: the role of various dietary approaches. Nutr Rev. 82, 1820-1834 (2024). ### Page 31 Supplementary Table 9 | Summary of the studies included in systematic review #7 #Study ID Year Country/territory Study design Study population Baseline participants (n) Method of IPFD measurement Key findingDutour et al.83 2016 France RCT Individuals with T2DM 44 MRS ◄►Exenatide (GLP-1 receptor agonist) Gaborit et al.842021 France RCT Individuals with T2DM 56 MRS ◄►Empagliflozin (SGLT-2 inhibitor) Hummel et al.852022 Germany RCT Individuals with prediabetes 42 MRI ◄►Empagliflozin (SGLT-2 inhibitor) Kuchay et al.862020 India RCT Individuals with T2DM 64 MRI ▼Dulaglutide (GLP-1 receptor agonist) No significance compared to standard care in T2DM Pop et al.87 2017 USA RCT Individuals with metabolic syndrome 42 MRS ◄►Pioglitazone (Thiazolidinedione) Shi et al.88 2023 China RCT Individuals with T2DM and NAFLD 84 MRI ▼Dapagliflozin (SGLT-2 inhibitor) Smits et al.89 2017 Netherlands RCT Individuals with T2DM 56 MRI ▼Sitagliptin (DPP-4 inhibitor) ◄►Liraglutide (GLP-1 receptor agonist) Vanderheiden et al.902016 USA RCT Individuals with T2DM 71 MRI ◄►Liraglutide (GLP-1 receptor agonist)Abbreviations: DPP4, dipeptidyl peptidase 4; GLP-1, glucagon-like peptide 1; IPFD, intrapancreatic fat deposition; MRI, magnetic resonance imaging; MRS, magnetic resonance spectroscopy; NAFLD, non-alcoholic fatty liver disease; RCT, randomised controlled trial, SGLT-2, sodium-glucose cotransporter-2; T2DM, type 2 diabetes mellitus; USA, United States of America.Footnotes: Country/territory denotes the location of the corresponding author’s primary affiliation. The upward arrow (▲) denotes a significant negative health impact associated with excessive intrapancreatic fat deposition, or a significant negative effect of an intervention on intrapancreatic fat deposition. The downward arrow (▼) indicates a significant positive health impact associated with excessive intrapancreatic fat deposition, or a significant positive effect of an intervention on reducing intrapancreatic fat deposition. The sideways arrow (◄►) indicates no significant or mixed effects on health outcomes associated with excessive intrapancreatic fat deposition, or no significant effect of an intervention on intrapancreatic fat deposition. Statistical significance was defined as p < 0.05 in the most fully adjusted model.# This systematic review refers to Agon, H.C., Shen, Y. & Petrov, M.S. Effects of glucose-lowering medications on intra-pancreatic fat deposition: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 27, e70087 (2026). ### Page 32 Supplementary Table 10 | Summary of the studies included in systematic review #8 #Study ID Year Country/territory Study design Study population Baseline participants (n) Method of IPFD measurement Key findingCadenas- Sánchez et al.912023 Spain Cross- sectional Children and adolescents with overweight or obesity 114 MRI ▲Visceral adipose tissue Chiyanika et al.922020 China Cross- sectional Adolescents with obesity and MASLD 52 MRI ▲BMI Cohen et al.93 2014 Canada Cross- sectional Adolescents with and without overweight/obesity 50 MRS ▼ISSI-2 Kim et al.94 2021 South Korea Cross- sectional Adolescents with and without obesity 172 MRI ▲Obesity Kovalinkaya et al.952005 USA Cross- sectional Adolescents with and without obesity 15 MRI ▲BMI and fasting blood insulin Lee et al.96 2021 South Korea Cross- sectional Children and adolescents with obesity and MASLD 65 MRI ▲Fasting blood glucose and diastolic blood pressure Lee et al.97 2021 South Korea Cross- sectional Children and adolescents with and without obesity 64 MRI ▲BMIz; ▲Hepatic fat fraction in children and adolescents with obesity Lê et al.98 2011 USA Cross- sectional Adolescents with overweight 138 MRI ▲BMI, hepatic fat fraction, subcutaneous adipose tissue, and visceral adipose tissue Maggio et al.99 2012 Switzerland Cross- sectional Adolescents with and without obesity 50 MRI ▲Visceral adipose tissue ### Page 33 Pacifico et al.1002015 Italy Cross- sectional Children and adolescents with overweight/obesity 158 MRS ▲Hepatic fat fraction, Visceral adipose tissue, C-peptide, fasting blood insulin, HOMA-IR; ▼Insulin sensitivity Pimentel et al.1012022 USA Cross- sectional Adolescents with obesity 79 MRI ▲Visceral adipose tissue, waist circumference, and fasting blood glucose Regnell et al.1022016 Sweden Cross- sectional Children and adolescents 29 MRI Not associated with any variable Staaf et al.103 2017 Sweden Cross- sectional Children and adolescents with and without obesity 116 MRI In children without obesity: ▲BMI SD, hepatic fat fraction, visceral adipose tissue; ▼Fasting blood glucose. In children with obesity: ▲Visceral adipose tissue, C- peptide, fasting blood glucose, HOMA-IR; ▼ISSI-2. Story et al.104 2023 USA Cross- sectional Children and adolescents with and without overweight 34 MRI ▲BMI, BMIz, hepatic fat fraction, and waist circumference Trout et al.105 2019 USA Cross- sectional Children and adolescents with MASLD 86 MRI ▲BMIz and subcutaneous fat area Wicklow et al.1062015 Canada Cross- sectional Adolescents with overweight/obesity or T2DM 54 MRS ▲Hepatic fat fraction Gyllenhammer et al.222016 USA Longitudinal Adolescents with and without overweight/obesity 76 MRI Not associated with any variable Owolabi et al.1072025 USA Longitudinal Adolescents with obesity 55 MRI Not associated with any variableAbbreviations: BMI, body mass index, BMIz, body mass index Z score; BMI SD, body mass index standard deviation; HOMA-IR, homeostatic model assessment for insulin resistance; IPFD, intrapancreatic fat deposition; ISSI-2, insulin secretion-sensitivity index-2; MRI, magnetic resonance imaging; MRS, magnetic resonance spectroscopy; MASLD, metabolic dysfunction-associated steatotic liver disease; T2DM, type 2 diabetes mellitus; USA, United States of America. ### Page 34 Footnotes: Country/territory denotes the location of the corresponding author’s primary affiliation. The upward arrow (▲) denotes a significant negative health impact associated with excessive intrapancreatic fat deposition, or a significant negative effect of an intervention on intrapancreatic fat deposition. The downward arrow (▼) indicates a significant positive health impact associated with excessive intrapancreatic fat deposition, or a significant positive effect of an intervention on reducing intrapancreatic fat deposition. The sideways arrow (◄►) indicates no significant or mixed effects on health outcomes associated with excessive intrapancreatic fat deposition, or no significant effect of an intervention on intrapancreatic fat deposition. Statistical significance was defined as p < 0.05 in the most fully adjusted model.# This systematic review refers to Rodríguez, C.I. et al. Understanding the association of intrapancreatic fat deposition with adiposity and components of metabolic syndrome in children and adolescents: a systematic review and meta-analysis. EClinicalMedicine. 83, 103205 (2025). ### Page 35 Supplementary Table 11 | Expert agreement on domain 1 statements #Number Strongly agreen (%)Agreen (%)Moderately agreen (%)Othern (%)RatingMean ± SD 1.1 19 (76.0%) 5 (20.0%) 1 (4.0%) 0 8.72 ± 0.53 1.2 22 (88.0%) 3 (12.0%) 0 0 8.88 ± 0.32 1.3 11 (44.0%) 12 (48.0%) 1 (4.0%) 1 (4.0%) 8.2 ± 1.2 1.4 14 (56.0%) 6 (24.0%) 1 (4.0%) 4 (16.0%) 8.16 ± 1.19 16 (64.0%) 9 (36.0%) 0 0 8.64 ± 0.49* 1.5 17 (68.0%) 5 (20.0%) 2 (8.0%) 1 (4.0%) 8.52 ± 0.81 1.6 12 (48%) 4 (16.0%) 2 (8.0%) 7 (28.0%) 7.28 ± 2.27 12 (48%) 10 (40.0%) 3 (12.0%) 0 8.36 ± 0.7**1.7 18 (72%) 6 (24.0%) 1 (4.0%) 0 8.68 ± 0.55 1.8 16 (64%) 7 (28.0%) 0 2 (8.0%) 8.36 ± 1.29 ### Page 36 Footnotes: Data highlighted with an orange background represent responses from Round 1 of the survey whereas data with a blue background are from Round 2. Differences in statement-level ratings between Rounds 1 and 2 were analysed using either paired t-tests or Wilcoxon signed-rank tests, depending on the normality of the data distribution (as assessed by the Shapiro–Wilk test). Statistically significant differences are denoted as follows: *p < 0.05, ** p < 0.01, *** p < 0.001.# Domain 1 refers to conceptual framework. ### Page 37 Supplementary Table 12 | Expert agreement on domain 2 statements #Number Strongly agreen (%)Agreen (%)Moderately agreen (%)Othern (%)RatingMean ± SD2.1 16 (64.0%) 7 (28.0%) 1 (4.0%) 1 (4.0%) 8.32 ± 1.59 2.2 3 (12.0%) 12 (48.0%) 4 (16.0%) 6 (24.0%) 7.36 ± 1.23 12 (48.0%) 8 (32.0%) 4 (16.0%) 1 (4.0%) 8.24 ± 0.88*** 2.3 19 (76.0%) 5 (20.0%) 1 (4.0%) 0 8.72 ± 0.53 2.4 9 (36.0%) 9 (36.0%) 4 (16.0%) 3 (12.0%) 7.88 ± 1.18 11 (44.0%) 14 (56.0%) 0 0 8.44 ± 0.51** 2.5 21 (84.0%) 3 (12.0%) 1 (4.0%) 0 8.8 ± 0.49 2.6 12 (48.0%) 8 (32.0%) 2 (8.0%) 3 (12.0%) 7.84 ± 1.83 21 (84.0%) 4 (16.0%) 0 0 8.84 ± 0.37*** 2.7 8 (32.0%) 10 (40.0%) 3 (12.0%) 4 (16.0%) 7.52 ± 1.9 19 (76.0%) 5 (20.0%) 0 1 (4.0%) 8.68 ± 0.69*** ### Page 38 2.8 8 (32.0%) 10 (40.0%) 4 (16.0%) 3 (12.0%) 7.6 ± 1.77 18 (72.0%) 7 (28.0%) 0 0 8.72 ± 0.46***2.9 12 (48.0%) 8 (32.0%) 2 (8.0%) 3 (12.0%) 8.12 ± 1.11 13 (52.0%) 10 (40.0%) 2 (8.0%) 0 8.44 ± 0.65* 2.10 2 (8.0%) 11 (44.0%) 4 (16.0%) 8 (32.0%) 6.72 ± 1.95 6 (24.0%) 14 (56.0%) 4 (16.0%) 1 (4.0%) 8 ± 0.76***Footnotes: Data highlighted with an orange background represent responses from Round 1 of the survey whereas data with a blue background are from Round 2. Differences in statement-level ratings between Rounds 1 and 2 were analysed using either paired t-tests or Wilcoxon signed-rank tests, depending on the normality of the data distribution (as assessed by the Shapiro–Wilk test). Statistically significant differences are denoted as follows: *p < 0.05, ** p < 0.01, *** p < 0.001.# Domain 2 refers to characteristics. ### Page 39 Supplementary Table 13 | Expert agreement on domain 3 statements #Number Strongly agreen (%)Agreen (%)Moderately agreen (%)Othern (%)RatingMean ± SD3.1 15 (60.0%) 3 (12.0%) 3 (12.0%) 4 (16.0%) 7.92 ± 1.83 14 (56.0%) 11 (44.0%) 0 0 8.56 ± 0.51* 3.2 18 (72.0%) 4 (16.0%) 1 (4.0%) 2 (8.0%) 8.48 ± 1.02 3.3 11 (44.0%) 7 (28.0%) 2 (8.0%) 5 (20.0%) 7.88 ± 1.31 12 (48.0%) 10 (40.0%) 3 (12.0%) 0 8.36 ± 0.7** 3.4 10 (40.0%) 9 (36.0%) 3 (12.0%) 3 (12.0%) 8.04 ± 1 9 (36.0%) 14 (56.0%) 2 (8.0%) 0 8.28 ± 0.61 3.5 17 (68.0%) 7 (28.0%) 1 (4.0%) 0 8.64 ± 0.56 3.6 12 (48.0%) 9 (36.0%) 2 (8.0%) 2 (8.0%) 8.04 ± 1.48Footnotes: Data highlighted with an orange background represent responses from Round 1 of the survey whereas data with a blue background are from Round 2. Differences in statement-level ratings between Rounds 1 and 2 were analysed using either paired t-tests or Wilcoxon signed-rank tests, depending on the normality of the data distribution (as assessed by the Shapiro–Wilk test). Statistically significant differences are denoted as follows: *p < 0.05, ** p < 0.01, *** p < 0.001.# Domain 3 refers to pathophysiology. ### Page 40 Supplementary Table 14 | Expert agreement on domain 4 statements #Number Strongly agreen (%)Agreen (%)Moderately agreen (%)Othern (%)RatingMean ± SD4.1 22 (88.0%) 2 (8.0%) 0 1 (4.0%) 8.8 ± 0.63 4.2 14 (56.0%) 6 (24.0%) 4 (16.0%) 1 (4.0%) 8.32 ± 0.9 4.3 20 (80.0%) 5 (20.0%) 0 0 8.8 ± 0.4 4.4 15 (60.0%) 9 (36.0%) 0 1 (4.0%) 8.48 ± 0.85 4.5 16 (64.0%) 6 (24.0%) 1 (4.0%) 2 (8.0%) 8.4 ± 1.02 4.6 16 (64.0%) 4 (16.0%) 4 (16.0%) 1 (4.0%) 8.36 ± 1.02 4.7 19 (76.0%) 4 (16.0%) 1 (4.0%) 1 (4.0%) 8.6 ± 0.89 4.8 10 (40.0%) 8 (32.0%) 3 (12.0%) 4 (16.0%) 7.88 ± 1.24 13 (52.0%) 10 (40.0%) 2 (8.0%) 0 8.44 ± 0.65** 4.9 13 (52.0%) 10 (40.0%) 2 (8.0%) 0 8.44 ± 0.64 4.10 9 (36.0%) 11 (44.0%) 4 (16.0%) 1 (4.0%) 8.12 ± 0.82 ### Page 41 Footnotes: Data highlighted with an orange background represent responses from Round 1 of the survey whereas data with a blue background are from Round 2. Differences in statement-level ratings between Rounds 1 and 2 were analysed using either paired t-tests or Wilcoxon signed-rank tests, depending on the normality of the data distribution (as assessed by the Shapiro–Wilk test). Statistically significant differences are denoted as follows: *p < 0.05, ** p < 0.01, *** p < 0.001.# Domain 4 refers to principles of assessment.4.11 18 (72.0%) 2 (8.0%) 4 (16.0%) 1 (4.0%) 8.4 ± 1.17 4.12 22 (88.0%) 2 (8.0%) 0 1 (4.0%) 8.8 ± 0.63 4.13 17 (68.0%) 7 (28.0%) 1 (4.0%) 0 8.64 ± 0.56 4.14 12 (48.0%) 7 (28.0%) 5 (20.0%) 1 (4.0%) 8.12 ± 1.14 4.15 7 (28.0%) 13 (52.0%) 1 (4.0%) 4 (16.0%) 7.64 ± 1.67 13 (52.0%) 9 (36.0%) 3 (12.0%) 0 8.4 ± 0.71** 4.16 9 (36.0%) 5 (20.0%) 7 (28.0%) 4 (16.0%) 7.44 ± 1.77 10 (40.0%) 13 (52.0%) 2 (8.0%) 0 8.32 ± 0.63** ### Page 42 Supplementary Table 15 | Expert agreement on domain 5 statements #Number Strongly agreen (%)Agreen (%)Moderately agreen (%)Othern (%)RatingMean ± SD5.1 16 (64.0%) 6 (24.0%) 3 (12.0%) 0 8.52 ± 0.7 5.2 13 (52.0%) 7 (28.0%) 1 (4.0%) 4 (16.0%) 8.12 ± 1.18 14 (56.0%) 8 (32.0%) 3 (12.0%) 0 8.44 ± 0.71* 5.3 11 (44.0%) 8 (32.0%) 5 (20.0%) 1 (4.0%) 8.12 ± 0.99 5.4 13 (52.0%) 8 (32.0%) 3 (12.0%) 1 (4.0%) 8.32 ± 0.84 5.5 10 (40.0%) 8 (32.0%) 5 (20.0%) 2 (8.0%) 8 ± 1.06 5.6 15 (60.0%) 6 (24.0%) 4 (16.0%) 0 8.44 ± 0.75 5.7 9 (36.0%) 11 (44.0%) 1 (4.0%) 4 (16.0%) 7.96 ± 1.11 12 (48.0%) 9 (36.0%) 4 (16.0%) 0 8.32 ± 0.75** 5.8 4 (16.0%) 5 (20.0%) 8 (32.0%) 8 (32.0%) 6.72 ± 1.78 7 (28.0%) 10 (40.0%) 7 (28.0%) 1 (4.0%) 7.88 ± 0.97*** ### Page 43 Footnotes: Data highlighted with an orange background represent responses from Round 1 of the survey whereas data with a blue background are from Round 2. Differences in statement-level ratings between Rounds 1 and 2 were analysed using either paired t-tests or Wilcoxon signed-rank tests, depending on the normality of the data distribution (as assessed by the Shapiro–Wilk test). Statistically significant differences are denoted as follows: *p < 0.05, ** p < 0.01, *** p < 0.001.# Domain 5 refers to health risks. ### Page 44 Supplementary Table 16 | Expert agreement on domain 6 statements #Number Strongly agreen (%)Agreen (%)Moderately agreen (%)Othern (%)RatingMean ± SD6.1 10 (40.0%) 11 (44.0%) 3 (12.0%) 1 (4.0%) 8.08 ± 1.23 6.2 14 (56.0%) 7 (28.0%) 4 (16.0%) 0 8.4 ± 0.75 6.3 16 (64.0%) 6 (24.0%) 3 (12.0%) 0 8.52 ± 0.7 6.4 12 (48.0%) 7 (28.0%) 5 (20.0%) 1 (4.0%) 8.2 ± 0.89 6.5 10 (40.0%) 6 (24.0%) 6 (24.0%) 3 (12.0%) 7.76 ± 1.45 9 (36.0%) 11 (44.0%) 4 (16.0%) 1 (4.0%) 8 ± 1.26 6.6 11 (44.0%) 10 (40.0%) 2 (8.0%) 2 (8.0%) 8.16 ± 1.01 6.7 3 (12.0%) 11 (44.0%) 4 (16.0%) 7 (28.0%) 7.04 ± 1.71 9 (36.0%) 13 (52.0%) 3 (12.0%) 0 8.24 ± 0.66***6.8 12 (48.0%) 6 (24.0%) 6 (24.0%) 1 (4.0%) 8.16 ± 0.92 6.9 9 (36.0%) 8 (32.0%) 3 (12.0%) 5 (20.0%) 7.48 ± 1.84 ### Page 45 11 (44.0%) 10 (40.0%) 4 (16.0%) 0 8.28 ± 0.74** 6.10 12 (48.0%) 9 (36.0%) 1 (4.0%) 3 (12.0%) 8.12 ± 1.18 17 (68.0%) 6 (24.0%) 2 (8.0%) 0 8.6 ± 0.65**Footnotes: Data highlighted with an orange background represent responses from Round 1 of the survey whereas data with a blue background are from Round 2. Differences in statement-level ratings between Rounds 1 and 2 were analysed using either paired t-tests or Wilcoxon signed-rank tests, depending on the normality of the data distribution (as assessed by the Shapiro–Wilk test). Statistically significant differences are denoted as follows: *p < 0.05, ** p < 0.01, *** p < 0.001.# Domain 6 refers to modifiability. ### Page 46 Supplementary Figure 1 | Recommended approach for establishing 95% reference intervals #Abbreviations: IQR, interquartile range; LRL, lower reference limit; MAD, median absolute deviation; Q1, 25th percentile; Q3, 75th percentile; SD, standard deviation; URL, upper reference limit.# According to Clinical and Laboratory Standards Institute. Defining, establishing, and verifying reference intervals in the clinical laboratory; approved guideline— third edition (CLSI document C28-A3). Wayne, PA. (2008). ### Page 47 Supplementary references1. Xiao, Y. et al. 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