Marchesini Giulio, Moscatiello Simona, Di Domizio Silvia, Forlani Gabriele
University of Bologna, Via Massarenti, 9, I-40138 Bologna, Italy.
J Clin Endocrinol Metab. 2008 Nov;93(11 Suppl 1):S74-80. doi: 10.1210/jc.2008-1399.
In the last few years, several data have accumulated suggesting that obesity may be associated with liver disease and disease progression. Accordingly, the worldwide epidemic of obesity is likely to become a relevant source of morbidity and mortality in the general population.
We reviewed the literature on two main issues: 1) the evidence that obesity carries out an increased risk of liver disease, both in the general population and in selected cohorts; and 2) the evidence that obesity is a risk factor for nonalcoholic fatty liver disease and its progression in a series observed in liver units.
The presence of obesity increases the risk of elevated liver enzymes by a factor of two to three, whereas the risk of steatosis at ultrasonography is increased by a factor of 3 in the presence of overweight and peaks at a factor of approximately 15 in the presence of obesity. Both cirrhosis (cryptogenic cirrhosis) and hepatocellular carcinoma are also associated with obesity in the general population. In patients with nonalcoholic fatty liver disease observed in liver units, obesity and weight gain are systematically associated with advanced fibrosis and fibrosis progression.
Liver disease of metabolic origin, associated with obesity, is now recognized as the most prevalent liver disease in Western countries. Strategies are needed to approach obesity-associated liver disease by behavior programs, motivating people to adopt a healthier lifestyle. Such programs should be coupled with public policies at a societal level to obtain the maximum effects in lifestyle changes.
在过去几年中，积累了多项数据表明肥胖可能与肝脏疾病及疾病进展相关。因此，全球肥胖流行很可能成为普通人群发病和死亡的一个重要原因。
我们回顾了关于两个主要问题的文献：1）肥胖在普通人群和特定队列中增加肝脏疾病风险的证据；2）肥胖是非酒精性脂肪性肝病及其在肝病单元观察的一系列病例中进展的危险因素的证据。
肥胖的存在使肝酶升高的风险增加两到三倍，而超重时超声检查发现脂肪变性的风险增加三倍，肥胖时达到约十五倍的峰值。在普通人群中，肝硬化（隐源性肝硬化）和肝细胞癌也都与肥胖有关。在肝病单元观察的非酒精性脂肪性肝病患者中，肥胖和体重增加与肝纤维化进展及纤维化程度加重系统性相关。
与肥胖相关的代谢性肝病目前被认为是西方国家最普遍的肝脏疾病。需要通过行为计划来应对肥胖相关肝病，激励人们采用更健康的生活方式。此类计划应与社会层面的公共政策相结合，以在生活方式改变方面取得最大效果。
