IGF1 and metabolic syndrome: Insulin resistance, stimulation of insulin-like growth factor (IGF), changes in the microbiome and intestinal permeability, hormonal and inflammatory changes produced by abdominal fat tissue, mediated by the secretion of adipokines and pro-inflammatory mediators, and stimulation of the hedgehog pathways are all potentially interconnected mechanisms in pancreatic carcinogenesis, and are associated with obesity, metabolic syndrome, and NAFLD.18