国内外非酒精性脂肪性肝病诊疗指南的异同及解读

为规范非酒精性脂肪性肝病(NAFLD)的诊治与疗效评估,中华医学会肝病学分会脂肪肝和酒精性肝病学组按照循证医学的原则,于2006年5月制定了<非酒精性脂肪性肝病诊疗指南>.与国际上发表的指南或共识相比较为全面和广泛地反映了目前NAFLD的临床诊疗现状,尽管彼此类似,但在诊治规范上也存在差异,本文就国内外NAFLD诊疗指南的异同进行解读.     

中外非酒精性脂肪性肝病诊疗指南解读

随着肥胖和代谢综合征(MetS) 的流行，非酒精性脂肪性肝病(NAFLD) 已取代慢性乙型肝炎成为中国第一大 慢性肝病。为了规范NAFLD 的诊断和治疗，中华医学会脂肪肝和酒精性肝病学组于2018 年3 月发布了《非酒精性 脂肪性肝病防治指南》，与近2 年发布的最新版美国、欧洲、亚太NAFLD 诊疗指南相比，有相似之处，但各国国情不 同诊疗规范有细节差异。本文旨在通过对中外NAFLD 诊疗指南的解读，帮助临床工作者更全面深刻地理解指南并 用于指导临床工作。     

《代谢相关(非酒精性)脂肪性肝病防治指南(2024年版)》解读

随着肥胖和代谢综合征的流行,非酒精性脂肪性肝病(NAFLD)已取代慢性乙型肝炎成为中国第一大慢性肝病。随着对该疾病流行病学和自然史的深入研究、更名、诊断技术的飞速进步以及治疗手段的不断更新,NAFLD的诊疗领域经历了显著发展。最近,中华医学会肝病学分会组织相关专家对《非酒精性脂肪性肝病防治指南(2018更新版)》进行了全面修订,发布了《代谢相关(非酒精性)脂肪性肝病防治指南(2024年版)》。2024年版指南对代谢相关脂肪性肝病的疾病更名与分类、筛查和监测、诊断和评估、治疗和随访等重要临床问题提出了指导性建议。该文旨在通过对该诊疗指南的重要更新点进行解读,以帮助临床工作者更全面深刻地理解指南,并将其应用于指导临床实践。     

酒精性与非酒精性脂肪性肝病

脂肪性肝病(FLD)根据有无过量饮酒史,分为酒精性肝病(ALD)和非酒精性脂肪性肝病(NAFLD)两大类。两者享有FLD的许多共性特征,但又各有其独特之处。 1.酒精性与非酒精性FLD的异同:NAFLD的肝组织学改变与ALD相似,包括单纯性脂肪肝、脂肪性肝炎及肝硬化。我国及日本学者认为ALD还应包括轻症ALD、酒精性重型肝炎及酒精性肝纤维化,事实上NAFLD均有其相对应的临床病理类     

瘦素与脂肪性肝病

脂肪性肝病(fatty liver disease，FLD)是遗传一环境一代谢应激相关因素所致的以肝细胞脂肪变性为主的临床病理综合征。FLD包括由酒精所致的酒精性肝病(alcoholic liver disease，ALD)和肥胖、高脂等代谢紊乱所致的非酒精性脂肪性肝病(non-alcoholic fatty liver disease，NAFLD)。在病理上分为单纯性脂肪肝、脂肪性肝炎、脂肪性肝纤维化和脂肪性肝硬化。在FLD的发生发展过程中，瘦素的作用日益受到重视。     

脂肪性肝病非创伤性诊断的研究进展

脂肪性肝病 (fatty liver disease,FLD)依病因可分为酒精性脂肪性肝病 (A L D) 和非酒精性脂肪性肝病(NAFLD).我国学者对FLD病因分析的流行病学调查发现,ALD占7.56%,NAFLD则高达92.43%~([1]),提示后者是我国FLD的主要类型.     

饮食疗法在非酒精性脂肪性肝病治疗中的作用

非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)是一组肝组织学改变与酒精性肝病相似,但无过量饮酒史的临床综合征,包括单纯性脂肪肝(NAFL)、脂肪性肝炎(NASH)和肝硬化。随着肥胖、糖尿病、高脂血症的高发,NAFLD的患病率逐渐增加。目前这种与肥胖有关的脂肪性肝病已成为重要的公共健康问题。然而,迄今为止尚无治疗     

非酒精性脂肪性肝病更名带来的新思考

非酒精性脂肪性肝病(NAFLD)是一种代谢紊乱相关的多系统疾病,在肥胖和2型糖尿病(T2DM)患者中更为常见,而且与这两个共患疾病有着相似的不良结局。长期以来,NAFLD的重点强调肝脏病变和肝病相关结局,内分泌科医生按照目前糖尿病临床指南处理T2DM的同时往往忽视了对肝脏病变的筛查、诊断与处理。因此,在实际工作中,将NAFLD更名为代谢相关脂肪性肝病有着重要的现实意义。以降低肝脂肪含量为目标的防治T2DM的策略需要多学科临床与基础合作,以共同理念防治肥胖、脂肪肝、糖尿病,才能将最常见的慢性病防治落到实处。     

脂肪性肝病研究新进展

<正>脂肪性肝病包括酒精性脂肪性肝病(ALD)和非酒精性脂肪性肝病(NAFLD)两大类。ALD包括单纯性脂肪肝、酒精性肝炎、酒精性肝纤维化及肝硬化;NAFLD包括单纯性脂肪肝(NAFL)、非酒精性脂肪肝性肝炎(NASH)、非酒精性脂肪性肝纤维化及肝硬化等。目前,全球脂肪性肝病的发病率逐年增多,尤其以发达国家和地区为甚。NAFLD还与2型糖尿病、心血管疾病、代谢综合征等疾病密切相     

脂肪性肝病的流行现状与自然转归

脂肪性肝病(FLD)是遗传-环境-代谢应激相关性疾病,包括酒精性肝病(ALD)和非酒精性脂肪性肝病(NAFLD)两大类.当前ALD的患病率居高不下,而NAFLD的发病率不断攀高且起病渐趋低龄化,已成为发达国家和地区慢性肝病第一大病因,并且,ALD与NAFLD、FLD与病毒性肝炎可以合并存在.     

非酒精性脂肪性肝病的自然史和危险因素

非酒精性脂肪性肝病(NAFLD)是一种肝组织病理学改变,与酒精性肝病相类似,但无过量饮酒史的临床病理综合征.现有的研究提示大多数NAFLD是一个良性病变,但一些患者仍可导致肝硬化、肝癌和肝功能衰竭.肥胖、胰岛素抵抗、C-反应蛋白及糖尿病、高血脂、高血压、HCV等在NAFLD的发病过程中都是重要的危险因素,因此预防和治疗相关的危险因素对于NAFLD的发生和发展至关重要.     

非酒精性脂肪性肝病的相关危险因素研究进展

非酒精性脂肪性肝病(NAFLD)是指一群组织病理异常,其发病以胰岛素抵抗为基础,并与肥胖、高脂血症、Ⅱ型糖尿病、原发性高血压等密切相关。疾病早期症状隐匿,如不及时控制可诱发肝硬化及慢性肝病。NAFLD治疗策略有限,因此探讨脂肪肝相关危险因素对降低NAFLD发病及延缓其病程进展具有重要意义。     

Coronavirus disease 2019 and non-alcoholic fatty liver disease

The coronavirus disease 2019(COVID-19) pandemic may present with a broad range of clinical manifestations, from no or mild symptoms to severe disease. Patients with specific pre-existing comorbidities, such as obesity and type 2 diabetes, are at high risk of coming out with a critical form of COVID-19. Nonalcoholic fatty liver disease(NAFLD) is the most common chronic liver disease, and, because of its frequent association with metabolic alterations including obesity and type 2 diabetes, it has recently been re-named as metabolic-associated fatty liver disease(MAFLD). Several studies and systematic reviews pointed out the increased risk of severe COVID-19 in NAFLD/MAFLD patients. Even though dedicated mechanistic studies are missing, this higher probability may be justified by systemic low-grade chronic inflammation associated with immune dysregulation in NAFLD/MAFLD, which could trigger cytokine storm and hypercoagulable state after severe acute respiratory syndrome coronavirus 2 infection. This review focuses on the predisposing role of NAFLD/MAFLD in favoring severe COVID-19, discussing the available information on specific risk factors, clinical features, outcomes, and pathogenetic mechanisms.     

Fatty liver with metabolic disorder,such as metabolic dysfunction‐associated fatty liver disease,indicates high risk for developing diabetes mellitus

IntroductionNonalcoholic fatty liver disease (NAFLD) is diagnosed after excluding other liver diseases. The pathogenesis of NAFLD when complicated by other liver diseases has not been established completely. Metabolic dysfunction‐associated fatty liver disease (MAFLD) involves more metabolic factors than NAFLD, regardless of complications with other diseases. This study aimed to clarify the effects of fatty liver occurring with metabolic disorders, such as MAFLD without diabetes mellitus (DM), on the development of DM.Materials and MethodsWe retrospectively assessed 9,459 participants who underwent two or more annual health check‐ups. The participants were divided into the MAFLD group (fatty liver disease with overweight/obesity or non‐overweight/obesity complicated by metabolic disorders), simple fatty liver group (fatty liver disease other than MAFLD group), metabolic disorder group (metabolic disorder without fatty liver disease), and normal group (all other participants).ResultsThe DM onset rates in the normal, simple fatty liver, metabolic disorder, and MAFLD groups were 0.51, 1.85, 2.52, and 7.36%, respectively. In the multivariate analysis, the MAFLD group showed a significantly higher risk of DM onset compared with other three groups (P < 0.01). Additionally, the risk of DM onset was significantly increased in fatty liver disease with overweight/obesity or pre‐diabetes (P < 0.01).ConclusionsFatty liver with metabolic disorders, such as MAFLD, can be used to identify patients with fatty liver disease who are at high risk of developing DM. Additionally, patients with fatty liver disease complicated with overweight/obesity or prediabetes are at an increased risk of DM onset and should receive more attention.     

Overview of screening methods for fatty liver disease in children

The prevalence of obesity and obesity related comorbidities including diabetes and nonalcoholic fatty liver disease (NAFLD) has been rising globally. Nonalcoholic fatty liver disease is emerging as a common liver disease among adults which can lead to the eventua development of complications including cirrhosis and hepatocellular carcinoma. With the rise of obesity in children, the development of detection methods for the presence of NAFLD is becoming imperative. Although the gold standard for diagnosis is liver biopsy, practica issues limit pediatric use and warrant development of noninvasive or minimally invasive screening tools for the detection and staging of NAFLD. A variety of diagnostic methods have been studied including use aminotransferases, imaging studies and serologic markers which have some population-based limitations. Additional factors such as gender and ethnicity may also play a role in the screening of NAFLD in pediatric population studies.     

Non-alcoholic fatty liver disease: The diagnosis and management

Non-alcoholic fatty liver disease(NAFLD) is now the most frequent chronic liver disease that occurs across all age groups and is recognized to occur in 14%-30% of the general population, representing a serious and growing clinical problem due to the growing prevalence of obesity and overweight. Histologically, it resembles alcoholic liver injury but occurs in patients who deny significant alcohol consumption. NAFLD encompasses a spectrum of conditions, ranging from benign hepatocellular steatosisto inflammatory nonalcoholic steatohepatitis, fibrosis, and cirrhosis. The majority of hepatocellular lipids are stored as triglycerides, but other lipid metabolites, such as free fatty acids, cholesterol, and phospholipids, may also be present and play a role in disease progression. NAFLD is associated with obesity and insulin resistance and is considered the hepatic manifestation of the metabolic syndrome, a combination of medical conditions including type 2 diabetes mellitus, hypertension, hyperlipidemia, and visceral adiposity. Confirmation of the diagnosis of NAFLD can usually be achieved by imaging studies; however, staging the disease requires a liver biopsy. Current treatment relies on weight loss and exercise, although various insulin-sensitizing agents, antioxidants and medications appear promising. The aim of this review is to highlight the current information regarding epidemiology, diagnosis, and management of NAFLD as well as new information about pathogenesis, diagnosis and management of this disease.     

Nonalcoholic fatty liver disease as a multi-systemic disease

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease. NAFLD includes a wide spectrum of liver conditions ranging from simple steatosis to nonalcoholic steatohepatitis and advanced hepatic fibrosis. NAFLD has been recognized as a hepatic manifestation of metabolic syndrome linked with insulin resistance. NAFLD should be considered not only a liver specific disease but also an early mediator of systemic diseases. Therefore, NAFLD is usually associated with cardiovascular disease, chronic kidney disease, type 2 diabetes, obesity, and dyslipidemia. NAFLD is highly prevalent in the general population and is associated with increased cardiovascular morbidity and mortality. The underlying mechanisms and pathogenesis of NAFLD with regard to other medical disorders are not yet fully understood. This review focuses on pathogenesis of NAFLD and its relation with other systemic diseases.     

Non-alcohol fatty liver disease in Asia: Prevention and planning

AIM: To review all of epidemiological aspects of non-alcoholic fatty liver disease (NAFLD) and also prevent this disease is examined.METHODS: We conducted a systematic review according to the PRISMA guidelines. All searches for writing this review is based on the papers was found in PubMed (MEDLINE), Cochrane database and Scopus in August and September 2014 for topic of NAFLD in Asia and the way of prevention of this disease, with no language limitations. All relevant articles were accessed in full text and all relevant materials was evaluated and reviewed.RESULTS: NAFLD is the most common liver disorder in worldwide, with an estimated with 20%-30% prevalence in Western countries and 2%-4% worldwide. The prevalence of NAFLD in Asia, depending on location (urban vs rural), gender, ethnicity, and age is variable between 15%-20%. According to the many studies in the world, the relationship between NAFLD, obesity, diabetes mellitus, and metabolic syndrome (MS) is quiet obvious. Prevalence of NAFLD in Asian countries seems to be lower than the Western countries but, it has increased recently due to the rise of obesity, type 2 diabetes and MS in this region. One of the main reasons for the increase in obesity, diabetes and MS in Asia is a lifestyle change and industrialization. Today, NAFLD is recognized as a major chronic liver disease in Asia. Therefore, prevention of this disease in Asian countries is very important and the best strategy for prevention and control of NAFLD is lifestyle modifications. Lifestyle modification programs are typically designed to change bad eating habits and increase physical activity that is associated with clinically significant improvements in obesity, type 2 diabetes and MS.CONCLUSION: Prevention of NAFLD is very important in Asian countries particularly in Arab countries because of high prevalence of obesity, diabetes and MS.     

Comparison between metabolic-associated fatty liver disease and nonalcoholic fatty liver disease: From nomenclature to clinical outcomes

As a result of the obesity epidemic, Nonalcoholic fatty liver disease(NAFLD) and its complications have increased among millions of people. Consequently, a group of experts recommended changing the term NAFLD to an inclusive terminology more reflective of the underlying pathogenesis; metabolic-associated fatty liver disease(MAFLD). This new term of MAFLD has its own disease epidemiology and clinical outcomes prompting efforts in studying its differences from NAFLD.This article discusses the rati...     

Is there any link between dietary pattern and development of nonalcoholic fatty liver disease in adolescence? An expert review

Evaluation of: Oddy WH, Herbison CE, Jacoby P et al. The western dietary pattern is prospectively associated with nonalcoholic fatty liver disease in adolescence. Am. J. Gastroenterol. 108, 778–785 (2013).

The prevalence of overweight and obesity in childhood is a major public health concern. According to the obesity trend, the prevalence of pediatric nonalcoholic fatty liver disease (NAFLD) is also increasing. Nonalcoholic fatty liver disease is characterized by a spectrum of hepatic lesions (i.e., steatosis, ballooning, necroinflammation and fibrosis) that can progress to cirrhosis, hepatocellular carcinoma and liver failure with the consequent need for liver transplantation. Pediatric NAFLD is typically of primary origin and it is strongly associated with several features of the metabolic syndrome such as obesity, insulin resistance, dyslipidemia and Type 2 diabetes. The evaluated article reports the prospective relationship between dietary patterns at age 14 years and the presence of NAFLD at age 17 years. A total of 995 adolescents completed a food frequency questionnaire at 14 years and had liver ultrasound at 17 years. Prospective associations between the dietary pattern scores and the risk of NAFLD were analyzed using multiple logistic regression analyses. Nonalcoholic fatty liver disease was present in 15.2% of adolescents. A healthy dietary pattern at 14 years appeared protective against NAFLD at 17 years in centrally obese adolescents. On the contrary, a western dietary pattern at 14 years in this cohort was associated with an increased risk of NAFLD at 17 years, particularly in obese adolescents.