Chitturi Shivakumar, Farrell Geoffrey C, Hashimoto Etsuko, Saibara Toshiji, Lau George K K, Sollano José D
Gastroenterology and Hepatology Unit, The Canberra Hospital, Canberra, Australian Capital Territory, Garran, Australia.
J Gastroenterol Hepatol. 2007 Jun;22(6):778-87. doi: 10.1111/j.1440-1746.2007.05001.x.
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder in Western industrialized countries, affecting 20-40% of the general population. Large population-based surveys in China, Japan, and Korea indicate that the prevalence of NAFLD is now 12% to 24% in population subgroups, depending on age, gender, ethnicity, and location (urban versus rural). There is strong evidence that the prevalence of NAFLD has increased recently in parallel with regional trends in obesity, type 2 diabetes, and metabolic syndrome; and that further increases are likely. The relationship between NAFLD, central obesity, diabetes, and metabolic syndrome is clearly evident in retrospective and prospective Asian studies, but the strength of association with these metabolic risk factors is only appreciated when regional definitions of anthropometry are used. Pathological definition of NAFLD, particularly its activity and the extent of liver fibrosis, requires histological examination, but liver biopsy is often not appropriate in this disorder for logistic reasons. An alternative set of operational definitions is proposed here. Clinicians need guidelines as how best to diagnose and manage NAFLD and its associated metabolic disorders in countries with scant healthcare resources. The Asia-Pacific Working Party (APWP) for NAFLD was convened to collate evidence and deliberate these issues. Draft proposals were presented and discussed at Asia-Pacific Digestive Week at Cebu, Philippines, in late November 2006, and are published separately in this issue of the Journal as an Executive Summary. The present document reviews the reasoning and evidence behind the APWP-NAFLD proposals for definition, assessment, and management of NAFLD in the Asia-Pacific region.
非酒精性脂肪性肝病（NAFLD）是西方工业化国家最常见的肝脏疾病，影响着20%至40%的普通人群。在中国、日本和韩国进行的基于大规模人群的调查表明，根据年龄、性别、种族和地理位置（城市与农村）的不同，NAFLD在人群亚组中的患病率目前为12%至24%。有充分证据表明，NAFLD的患病率最近随着肥胖、2型糖尿病和代谢综合征的区域趋势而上升；而且可能还会进一步增加。在回顾性和前瞻性亚洲研究中，NAFLD、中心性肥胖、糖尿病和代谢综合征之间的关系明显可见，但只有在使用人体测量学的区域定义时，才能认识到与这些代谢危险因素的关联强度。NAFLD的病理定义，特别是其活动程度和肝纤维化程度，需要进行组织学检查，但由于后勤原因，肝活检在这种疾病中往往不合适。本文提出了另一套操作定义。在医疗资源匮乏的国家，临床医生需要有关如何最好地诊断和管理NAFLD及其相关代谢紊乱的指南。亚太非酒精性脂肪性肝病工作组（APWP）召开会议，整理证据并审议这些问题。2006年11月下旬在菲律宾宿务举行的亚太消化周上提出并讨论了提案草案，并作为执行摘要单独发表在本期杂志上。本文件回顾了亚太非酒精性脂肪性肝病工作组关于亚太地区NAFLD定义、评估和管理提案背后的推理和证据。
