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 This evidence concerns the gene IGF1 and obesity due to melanocortin 4 receptor deficiency.