Benefits of lifestyle modification in NAFLD
Benefits of lifestyle modification in NAFLD
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DOI：
10.1136/gut.2006.112094
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发表时间：
2007-12-01
期刊：
影响因子：
24.5
通讯作者：
Day, Christopher Paul
中科院分区：
文献类型：
--
作者：
Harrison, Stephen A.;Day, Christopher Paul
与我们的祖先相比，西方社会今天的生活方式更久坐不动，这可能是现代社会经济道德引发的文化变化的结果。考虑到体型的差异，我们每公斤体重的能量消耗估计是史前祖先的40%。1目前的估计表明，10个成年人中有7个不运动或缺乏适当的调节，2而缺乏适当的运动，加上饮食不慎重，导致了全球范围内肥胖和非酒精性脂肪性肝病（NAFLD）的流行。在美国，数据显示64.5%的成年人超重或肥胖，全球患病率为40-60%。3-5肥胖，再加上饮食、久坐不动的生活方式和遗传易感性等宿主因素，与胰岛素抵抗、糖尿病和代谢综合征患病率的增加直接相关。代谢综合征的肝脏表现，NAFLD，患病率也有所增加，目前在西方国家约为20-30%。在接受减肥手术的病态肥胖患者中，大约90%患有NAFLD， 36-37%患有更具侵袭性的脂肪肝，非酒精性脂肪性肝炎（NASH）。在NAFLD患者中，年龄增长、体重增加、代谢综合征特征数量和胰岛素抵抗程度均与NASH严重程度独立相关。目前缺乏基于证据的NAFLD治疗方案。最近的数据表明，噻唑烷二酮类胰岛素增敏剂可能是有效的，但这些药物的广泛使用有待进一步的研究。有证据也支持通过饮食和锻炼来减肥的作用。本综述的目的是描述目前公认的NAFLD病理生理学，强调NAFLD患者已知的饮食和运动习惯，并详细说明通过饮食和/或运动改变生活方式对代谢综合征参数的益处，包括胰岛素抵抗和NAFLD。对肝脏组织病理学的影响，如有的话，也将被详细说明。
Compared with our ancestors, Western societies today lead a lifestyle that is much more sedentary, probably as a result of cultural changes stemming from modern socio-economic morays. Taking into account differences in body size, our energy expenditure per kilogram of body weight has been estimated to be, 40% of that of our prehistoric ancestors. 1 Current estimates suggest that 7 out of 10 adults are inactive or lack adequate conditioning, 2 and this lack of adequate exercise, combined with dietary indiscretion, has contributed to the worldwide epidemic of obesity and non-alcoholic fatty liver disease (NAFLD). Within the USA, data suggest that 64.5% of the adult population is now overweight or obese, with a worldwide prevalence of 40–60%. 3–5 Obesity, combined with host factors such as diet, sedentary lifestyle and genetic predisposition, has been directly associated with increases in the prevalence of insulin resistance, diabetes mellitus and the metabolic syndrome. The hepatic manifestation of the metabolic syndrome, NAFLD, has also increased in prevalence, now considered to be around 20–30% in Western countries. Among morbidly obese patients undergoing bariatric surgery, approximately 90% have NAFLD and 36–37% have the more aggressive form of fatty liver, non-alcoholic steatohepatitis (NASH). 6 7 In patients with NAFLD, advancing age, increasing weight, the number of features of the metabolic syndrome and the degree of insulin resistance have all been independently associated with NASH severity. 8 Evidence-based treatment options for NAFLD are currently lacking. Recent data suggest that the thiazolidinedione class of insulin sensitisers may be efficacious, but widespread utilisation of these agents awaits further investigation. 9 Evidence also supports a role for weight loss, achieved through diet and exercise.The purpose of this review is to describe the currently accepted pathophysiology of NAFLD, t o highlight the known dietary and exercise habits of patients with NAFLD, and to detail the benefits o f lifestyle modification with diet and/or exercise on parameters of metabolic syndrome, includin g insulin resistance and NAFLD. The effects on liver histopathology, where available, will also b e detailed.