Kang Hellan, Greenson Joel K, Omo Jason T, Chao Cewin, Peterman Debra, Anderson Lilian, Foess-Wood Laura, Sherbondy Mary A, Conjeevaram Hari S
Division of Gastroenterology, Department of Medicine, The University of Michigan, Ann Arbor, Michigan 48109-0362, USA.
Am J Gastroenterol. 2006 Oct;101(10):2247-53. doi: 10.1111/j.1572-0241.2006.00719.x.
Nonalcoholic fatty liver disease (NAFLD) is considered as the hepatic manifestation of metabolic syndrome. Insulin resistance (IR) is a key component of metabolic syndrome. The aim was to determine the dietary composition, physical activity, and histologic severity between NAFLD patients with and without metabolic syndrome.
Ninety-one patients with NAFLD completed the Block Food Frequency Questionnaire and the Paffenbarger Physical Activity Questionnaire. IR was assessed by the homeostasis model assessment (HOMA) index. Metabolic syndrome was defined by the ATP III clinical definition. Nonalcoholic steatohepatitis (NASH) Clinical Network Scoring System was used to determine the histologic severity of NAFLD.
Thirty-one patients (34%) had metabolic syndrome. Patients with metabolic syndrome had a higher HOMA index (7.66 vs 4.45, p = 0.04), and consumed more carbohydrates (51%vs 45%, p = 0.03) and less fat (34%vs 40%, p = 0.01) compared with those without metabolic syndrome; total daily calorie, protein consumption, and physical activity were similar between the two groups. Patients with metabolic syndrome had higher scores for steatosis (2.0 +/- 0.8 vs 1.37 +/- 1, p = 0.02), NASH activity (4.13 +/- 1.4 vs 3.13 +/- 1.7, p = 0.004), and global NASH score (5.9 +/- 1.7 vs 4.4 +/- 2.3, p = 0.0006) compared with those without metabolic syndrome. When controlled for other factors including dietary composition and physical activity, the presence of metabolic syndrome was a significant risk factor for global NASH severity in addition to HOMA index and female gender.
Metabolic syndrome in patients with NAFLD is associated with a diet containing more carbohydrate and less fat and greater histologic severity. The role of a carbohydrate-restricted diet in decreasing the risk for metabolic syndrome and histologic severity should be assessed in patients with NAFLD.
非酒精性脂肪性肝病（NAFLD）被认为是代谢综合征的肝脏表现。胰岛素抵抗（IR）是代谢综合征的关键组成部分。本研究旨在确定合并和不合并代谢综合征的NAFLD患者的饮食构成、身体活动情况以及组织学严重程度。
91例NAFLD患者完成了Block食物频率问卷和Paffenbarger身体活动问卷。通过稳态模型评估（HOMA）指数评估胰岛素抵抗。采用ATP III临床定义来定义代谢综合征。使用非酒精性脂肪性肝炎（NASH）临床网络评分系统来确定NAFLD的组织学严重程度。
31例患者（34%）患有代谢综合征。与不合并代谢综合征的患者相比，合并代谢综合征的患者HOMA指数更高（7.66对4.45，p = 0.04），碳水化合物摄入量更多（51%对45%，p = 0.03），脂肪摄入量更少（34%对40%，p = 0.01）；两组的每日总热量、蛋白质摄入量和身体活动情况相似。与不合并代谢综合征的患者相比，合并代谢综合征的患者在脂肪变性（2.0±0.8对1.37±1，p = 0.02）、NASH活动度（4.13±1.4对3.13±1.7，p = 0.004）和整体NASH评分（5.9±1.7对4.4±2.3，p = 0.0006）方面得分更高。在控制包括饮食构成和身体活动等其他因素后，除了HOMA指数和女性性别外，代谢综合征的存在是整体NASH严重程度的一个重要危险因素。
NAFLD患者的代谢综合征与碳水化合物含量更高、脂肪含量更低的饮食以及更高的组织学严重程度相关。对于NAFLD患者，应评估限制碳水化合物饮食在降低代谢综合征风险和组织学严重程度方面的作用。
