| Summary: | Background Chronic diseases may injure the pancreas and result in a reduction in pancreas volume (PV), which may adversely impact its critical role in endocrine and exocrine function. Less is known about whether individuals with smaller PV face higher risks of adverse clinical outcomes. Methods We estimated baseline age‐adjusted predicted PV (pPV) from abdominal magnetic resonance imaging in 36 592 UK Biobank participants. Since the initial magnetic resonance imaging occurred 9.0 (interquartile range, 7.5–10.1) years after baseline, we fit a linear regression equation that included age for the outcome of PV slope in 451 participants with repeat magnetic resonance imaging 2.8 (interquartile range, 2.2–4.8) years after the initial scan. Using these data, we calculated baseline age‐adjusted pPV slope by adding or subtracting the annual change to the initial PV measurement assuming linear change in PV over time. Multivariable‐adjusted proportional hazards models tested associations of pPV with incident chronic kidney disease, cardiovascular disease (CVD; myocardial infarction, heart failure, or stroke), and death. Results Participants (52.2% women) were 55±8 years old and had a pPV of 63.3±15.3 mL. During median follow‐up of 13.9 years, there were 757 incident chronic kidney disease, 1392 CVD, and 702 death events. In final adjusted models, participants in the first pPV quartile had a 1.67‐fold (95% CI, 1.34–2.07) and 1.28‐fold (95% CI, 1.10–1.49) increased risk of incident CVD and death compared with the fourth quartile, respectively. pPV had nonlinear associations with incident CVD and death (each P<0.001). pPV was not associated with incident chronic kidney disease. Conclusions Lower pPV is associated with increased risk of incident CVD and death but not incident chronic kidney disease. Future studies should investigate the pathophysiologic mechanisms driving these associations.
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