饮食行为与非酒精性脂肪性肝病的关系

非酒精性脂肪性肝病(NAFLD)的患病率逐年攀升，对全球公共卫生造成重大负担。NAFLD发病与肥胖、胰岛素抵抗、饮食等因素息息相关，其中饮食是NAFLD防治的核心与基石。鉴于既往研究侧重于不同饮食成分、结构、方案与NAFLD的关系，而较少探讨整体饮食行为对NAFLD的影响。故本文将饮食行为对NAFLD的影响进行综述，旨在为NAFLD的防治及指导患者合理饮食行为习惯提供参考依据。     

非酒精性脂肪性肝病的运动治疗

非酒精性脂肪性肝病（nonalcoholic fatty liver disease,NAFLD）是一种以肝小叶、以肝细胞脂肪变性储积为病理特征，但无过量饮酒史的临床综合征，包括单纯性脂肪肝、脂肪性肝炎和肝硬化3个阶段。NAFLD的发病率近年来呈不断上升趋势,对人们的健康造成严重危害。专家们预测,由于NAFLD系一种系统性疾病，且有资料表明，NAFLD患者的死亡率明显高于同龄正常人群,因而将是今后重要的疾病负担之一。而NAFLD的综合治疗方案中，如何科学、合理地进行规范的运动疗法是十分重要的。合理的运动有助于促进脂肪代谢，     

非酒精性脂肪性肝病的治疗进展

非酒精性脂肪性肝病(NAFLD)的病因和发病机制较复杂,迄今尚未完全明了,因此,目前临床上缺乏针对NAFLD治疗的有效药物。NAFLD的治疗,多数学者认为重点在于去除病因,治疗原发疾病;调整饮食,修正不良行为,合理运动,辅以一定的药物治疗。根据NAFLD发生的临床表现和异常的实验室结果酌情进行药物选择。本文就目前非酒精性脂肪性肝病的治疗进展作一简要概述。     

低碳水化合物饮食与非酒精性脂肪性肝病

低碳水化合物饮食是指限制每日碳水化合物摄入,而适当增加脂肪及蛋白质摄入的饮食模式,目前越来越多的研究指出低碳水化合物饮食对于延缓及治疗非酒精性脂肪性肝病(NAFLD)有一定的作用。此文综述了低碳水化合物饮食在治疗NAFLD中的可能机制及实际应用,以期为NAFLD患者提供有效的饮食疗法,为预防及治疗NAFLD提供新的方向。     

运动类型对代谢相关脂肪性肝病的影响

非酒精性脂肪性肝病(NAFLD)是从单纯的肝脏脂肪变性,到以脂肪变性加炎性反应为特征的非酒精性脂肪性肝炎(NASH),可以依次进展为肝脏纤维化、肝硬化和肝细胞癌的肝脏疾病谱。病理生理学机制包括脂肪酸、亚临床炎症、氧化应激和各种脂肪细胞因子。目前的治疗推荐包括饮食、运动、药物或手术治疗等各种减少体重的措施。着重于体重下降和身体活动的生活方式干预依然是NAFLD管理的基础,在NAFLD中有特殊的治疗作用。虽然运动的益处是显而易见的,但运动类型不同对NAFLD的作用也有所不同。此文针对NAFLD的发病机制,讨论在治疗和预防NAFLD中不同运动类型的可能作用。规律的运动可以改善胰岛素抵抗,减少脂肪沉积,抑制氧化应激,并减弱与NAFLD有关的炎性标志物。多模式运动作为NAFLD治疗的方法仍需要进一步的调查研究。     

非酒精性脂肪性肝病治疗进展与现状

正目前对非酒精性脂肪性肝病(NAFLD)尚无特效治疗方法,仍在不断探索研究中。基因治疗近年也许会有新的突破。当前的治疗包括改变生活方式、饮食治疗、运动与锻炼、药物治疗和减重手术等几个方面。上述治疗方法经实践证实对NAFLD患者都有不同程度的改善和治疗作用。2015年日本胃肠病学会NAFLD/非酒精性脂肪性肝炎(NASH)循证医学治疗指南[1]提出NAFLD/NASH     

二甲双胍联合苯扎贝特治疗非酒精性脂肪肝50例疗效观察

目前，非酒精性脂肪性肝病（NAFLD）的治疗为去除病因、积极治疗原发病和坚持合理饮食，并根据NAFLD的病因和发病机制合理选用药物。近年来，我们采用二甲双胍联合苯扎贝特治疗NAFLD患者50例，疗效满意。现报告如下。     

非酒精性脂肪性肝病的治疗进展

非酒精性脂肪性肝病(NAFLD)的病因和发病机制较复杂，迄今尚未完全明了，因此，目前临床上缺乏针对NAFLD治疗的有效药物。NAFLD的治疗，多数学认为重点在于去除病因，治疗原发疾病；调整饮食，修正不良行为，合理运动，辅以一定的药物治疗。根据NAFLD发生的临床表现和异常的实验室结果酌情进行药物选择。本就目前非酒精性脂肪性肝病的治疗进展作一简要概述。     

非酒精性脂肪性肝病治疗方法的评估

非酒精性脂肪性肝病(NAFLD)是遗传环境一代谢应激相关性肝脏疾病，病理上包括单纯性脂肪肝(nonalcoholicfatty liver,NAFL)及由其演变的脂肪性肝炎(NASH)和脂肪性肝硬化等类型。NAFLD治疗方法很多，但其临床疗效的评估标准尚在探讨过程中。目前，一般认为NAFLD的治疗重点在于去除病因，治疗原发疾病；调整饮食，纠正不良生活习惯，合理运动以及辅以一定的药物治疗。     

非酒精性脂肪性肝病国内外诊疗指南的区别及治疗展望

非酒精性脂肪性肝病(NAFLD)是一种与胰岛素抵抗和遗传易感性密切相关的、肝脏脂肪过度堆积的代谢应激性肝脏损伤。据估计,目前世界上25%的人口被诊断患有NAFLD,对社会经济发展和人们的健康水平造成巨大影响。基于不同地区的生活习俗和人群基因差异,NAFLD在各国/地区的流行率不同,并且在NAFLD诊断标准和治疗方案上各国/地区诊疗指南给出的推荐也存在一定差异。该综述旨在对比国内外最新指南在NAFLD诊断与治疗方面的异同点,汇总最新诊疗手段研究进展,以期对NAFLD的临床诊疗提供借鉴。     

Non-alcoholic fatty liver disease and liver transplantation:Outcomes and advances

Non-alcoholic fatty liver disease(NAFLD)is one of the most prevalent causes of chronic liver disease worldwide.In the last decade it has become the third most common indication for liver transplantation in the United States.Increasing prevalence of NAFLD in the general population also poses a risk to organ donation,as allograft steatosis can be associated with non-function of the graft.Post-transplant survival is comparable between NAFLD and non-NAFLD causes of liver disease,although long term outcomes beyond 10 year are lacking.NAFLD can recur in the allograft frequently although thus far post transplant survival has not been impacted.De novo NAFLD can also occur in the allograft of patients transplanted for non-NAFLD liver disease.Predictors for NAFLD post-transplant recurrence include obesity,hyperlipidemia and diabetes as well as steroid dose after liver transplantation.A polymorphism in PNPLA3 that mediates triglyceride hydrolysis and is linked to pre-transplant risk of obesity and NAFLD has also been linked to post transplant NAFLD risk.Although immunosuppression side effects potentiate obesity and the metabolic syndrome,studies of immunosuppression modulation and trials of specific immunosuppression regimens post-transplant are lacking in this patient population.Based on pre-transplant data,sustained weight loss through diet and exercise is the most effective therapy for NAFLD.Other agents occasionally utilized in NAFLD prior to transplantation include vitamin E and insulin-sensitizing agents.Studies of these therapies are lacking in the post-transplant population.A multimodality and multidisciplinary approach to treatment should be utilized in management of post-transplant NAFLD.     

Clinical practice advice on lifestyle modification in the management of nonalcoholic fatty liver disease in Japan: an expert review

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver diseases worldwide, including in Japan. The Japanese Society of Gastroenterology (JSGE) and the Japanese Society of Hepatology (JSH) have established the Japanese NAFLD/NASH guidelines in 2014 and revised these guidelines in 2020. As described in these guidelines, weight reduction by diet and/or exercise therapy is important for the treatment of NAFLD patients. The I148M single nucleotide polymorphism (rs738409 C > G) of PNPLA3 (patatin-like phospholipase domain-containing 3 protein) is widely known to be associated with the occurrence and progression of NAFLD. In the Japanese, the ratio of PNPLA3 gene polymorphisms found is approximately 20%, which is higher than that found in Westerners. In addition, the ratio of lean NAFLD patients is also higher in Japan than in Western countries. Therefore, the method for lifestyle guidance for the NAFLD patients in Japan would be different from that for the people in Western countries. The problems in the treatment of NAFLD patients include alcohol consumption and sarcopenia. Therefore, guidelines that can help clinicians treat Japanese patients with NAFLD are needed. In this expert review, we summarize evidence-based interventions for lifestyle modification (diet, exercise, alcohol, and sarcopenia) for the treatment of patients with NAFLD, especially from Japan and Asian countries.

     

Current pharmacological therapies for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

Nonalcoholic fatty liver disease(NAFLD)/nonalcoholic steatohepatitis(NASH) is considered to be a hepatic manifestation of metabolic syndrome, and its incidence is rapidly increasing worldwide. It is currently the most common chronic liver disease. NASH can progress to liver cirrhosis and hepatocellular carcinoma, and may result in liver-related death. Currently, the principal treatment for NAFLD/NASH is lifestyle modification by diet and exercise. However, pharmacological therapy is indispensable because obese patients with NAFLD often have difficulty maintaining improved lifestyles. The pathogenesis of NAFLD/NASH has not been completely elucidated. However, insulin resistance, inflammatory cytokines, and oxidative stress are thought to be important in the development and/or progression of the disease. Currently, insulin sensitizers(thiazolidinediones) and antioxidants(vitamin E) seem to be the most promising therapeutic agents for NAFLD/NASH, and lipid-lowering drugs, pentoxifylline, angiotensin receptor blockers, and n-3 polyunsaturated fatty acids also have promise. However, there is a lack of consensus regarding the most effective and appropriate pharmacotherapy for NAFLD/NASH. Animal experiments suggest that herbal medicines and natural products may be promising therapeutic agents for NAFLD/NASH, but their efficacy and safety are yet to be investigated in human studies. In this paper, we review the existing and potential pharmacological therapies for NAFLD/NASH.     

Non-alcoholic fatty liver disease and associated dietary and lifestyle risk factors

Nonalcoholic fatty liver disease (NAFLD) has emerged as the most common chronic liver disease worldwide with a reported prevalence ranging 20–30% depending on the studied populations. The high prevalence of NAFLD is probably due to the contemporary epidemics of obesity, unhealthy dietary pattern, and sedentary lifestyle. NAFLD patients are at increased risk of cardiovascular and liver related mortality. The cornerstone of any treatment regimen for patients with NAFLD is lifestyle modification focused on weight loss, exercise, and improving insulin sensitivity. The purpose of this review is to outline the effect of diet and lifestyle factors on developing NAFLD.     

Current therapeutic strategies in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of disease ranging from simple steatosis through steatohepatitis (NASH) to increasing fibrosis and eventual cirrhosis. NAFLD is the hepatic manifestation of the metabolic syndrome and has now become the most common cause of liver disease in Western countries, with the more advanced stages of disease being associated with an increased risk of liver-related morbidity and mortality. The optimal management of patients with NAFLD remains a clinical challenge. The aim of this study is to describe established and emerging strategies for the treatment of NAFLD. Relevant research and review articles were identified by searching PubMed. Selected articles referenced in these publications were also examined. Good quality randomized controlled studies have demonstrated the need for multifaceted lifestyle interventions in patients with NAFLD including the need for diet, exercise and behavioural counselling. Despite several trials of pharmacological agents, no highly effective treatment yet exists, with surgery representing the mainstay for advanced disease. A multidisciplinary approach, with a major focus on lifestyle change, represents best treatment pending the development of new therapeutic options.     

MicroRNAs as controlled systems and controllers in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is a multi-faceted condition including simple steatosis alone or associated with inflammation and ballooning (non-alcoholic steatohepatitis) and eventually fibrosis. The NAFLD incidence has increased over the last twenty years becoming the most frequent chronic liver disease in industrialized countries. Obesity, visceral adiposity, insulin resistance, and many other disorders that characterize metabolic syndrome are the major predisposing risk factors for NAFLD. Furthermore, different factors, including genetic background, epigenetic mechanisms and environmental factors, such as diet and physical exercise, contribute to NAFLD development and progression. Several lines of evidence demonstrate that specific microRNAs expression profiles are strongly associated with several pathological conditions including NAFLD. In NAFLD, microRNA deregulation in response to intrinsic genetic or epigenetic factors or environmental factors contributes to metabolic dysfunction. In this review we focused on microRNAs role both as controlled and controllers molecules in NAFLD development and/or their eventual value as non-invasive biomarkers of disease.     

Nonalcoholic fatty liver disease and polycystic ovary syndrome

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the Western world comprising a spectrum of liver damage from fatty liver infiltration to end-stage liver disease, in patients without significant alcohol consumption. Increased prevalence of NAFLD has been reported in patients with polycystic ovary syndrome (PCOS), one of the most common endocrinopathies in premenopausal women, which has been redefined as a reproductive and metabolic disorder after the recognition of the important role of insulin resistance in the pathophysiology of the syndrome. Obesity, in particular central adiposity and insulin resistance are considered as the main factors related to NAFLD in PCOS. Moreover, existing data support that androgen excess, which is the main feature of PCOS and is interrelated to insulin resistance, may be an additional contributing factor to the development of NAFLD. Although the natural history of NAFLD remains unclear and hepatic steatosis seems to be a relatively benign condition in most patients, limited data imply that advanced stage of liver disease is possibly more frequent in obese PCOS patients with NAFLD. PCOS patients, particularly obese patients with features of the metabolic syndrome, should be submitted to screening for NAFLD comprising assessment of serum aminotransferase levels and of hepatic steatosis by abdominal ultrasound. Lifestyle modifications including diet, weight loss and exercise are the most appropriate initial therapeutic interventions for PCOS patients with NAFLD. When pharmacologic therapy is considered, metformin may be used, although currently there is no medical therapy of proven benefit for NAFLD. Long-term follow up studies are needed to clarify clinical implications and guide appropriate diagnostic evaluation, follow-up protocol and optimal treatment for PCOS patients with NAFLD.     

Nonalcoholic fatty liver disease: a nutritional approach

Nonalcoholic fatty liver disease (NAFLD) is among the most common causes of chronic liver disease in many countries, and its prevalence is increasing. NAFLD is often considered to be a hepatic component of metabolic syndrome, and studies have established that insulin resistance plays a major role in the pathogenesis of NAFLD. Treatments for NAFLD primarily target insulin resistance. Interestingly, the most common environmental cause of insulin resistance is diet. This article examines the correlations between NAFLD and diet and provides some diet recommendations based on the most current data available.     

Physical activity as a treatment of non-alcoholic fatty liver disease: A systematic review

AIM: To review the effectiveness of exercise as a therapy for nonalcoholic fatty liver disease (NAFLD) and potential benefits in treating insulin resistance and atherosclerosis.METHODS: Medline (EBSCOhost) and PubMed were searched for English-language randomized controlled trials and prospective cohort studies in human adults aged ≥ 18 which investigated the various effects of exercise alone, a combination of exercise and diet, or exercise and diet coupled with behavioral modification on NAFLD from 2010 to Feburary 2015.RESULTS: Eighteen of 2298 available studies were chosen for critical review, which included 6925 patients. Nine (50%) studies were randomized controlled trials. Five (27.8%) studies utilized biopsy to examine the effects of physical activity on hepatic histology. The most commonly employed imaging modality to determine change in hepatic steatosis was hydrogen-magnetic resonance spectroscopy. Only two studies examined the effects of low impact physical activity for patients with significant mobility limitations and one compared the efficacy of aerobic and resistance exercise. No studies examined the exact duration of exercise required for hepatic and metabolic improvement in NAFLD.CONCLUSION: While exercise improved hepatic steatosis and underlying metabolic abnormalities in NAFLD, more studies are needed to define the most beneficial form and duration of exercise treatment.     

Weight loss interventions and nonalcoholic fatty liver disease: Optimizing liver outcomes

The growth in prevalence of obesity, type 2 diabetes and nonalcoholic fatty liver disease (NAFLD) has become one of the most important global health challenges. The three chronic diseases are closely linked in their epidemiology and pathophysiology. Currently, weight loss is the most effective treatment for NAFLD (even in the minority of patients with NAFLD who do not have obesity) and is recommended in all national and international guidelines. Accumulating evidence has shown that weight loss, whether achieved by diet and lifestyle interventions, bariatric surgery or pharmacotherapy, can improve biomarkers of NAFLD, as well as prevent progression and, in some cases, reverse fibrosis. There is a dose dependency of weight loss with NAFLD improvement. Pharmacotherapy with antiobesity medications, alone or in combination with intensive lifestyle interventions or other weight-loss drugs, is closing the efficacy gap between diet and exercise and weight-loss surgery in efficacy at reversing obesity. Given the importance of providing effective weight-loss treatment to patients with NAFLD, weight management services need to be made increasingly available and embedded within hepatology services. This narrative review addresses the evidence that weight loss optimizes liver outcomes in people with NAFLD.