Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St Louis, MO 63110-1093, USA.
Hepatology. 2010 Feb;51(2):679-89. doi: 10.1002/hep.23280.
Obesity is associated with an increased risk of nonalcoholic fatty liver disease (NAFLD). Steatosis, the hallmark feature of NAFLD, occurs when the rate of hepatic fatty acid uptake from plasma and de novo fatty acid synthesis is greater than the rate of fatty acid oxidation and export (as triglyceride within very low-density lipoprotein). Therefore, an excessive amount of intrahepatic triglyceride (IHTG) represents an imbalance between complex interactions of metabolic events. The presence of steatosis is associated with a constellation of adverse alterations in glucose, fatty acid, and lipoprotein metabolism. It is likely that abnormalities in fatty acid metabolism, in conjunction with adipose tissue, hepatic, and systemic inflammation, are key factors involved in the development of insulin resistance, dyslipidemia, and other cardiometabolic risk factors associated with NAFLD. However, it is not clear whether NAFLD causes metabolic dysfunction or whether metabolic dysfunction is responsible for IHTG accumulation, or possibly both. Understanding the precise factors involved in the pathogenesis and pathophysiology of NAFLD will provide important insights into the mechanisms responsible for the cardiometabolic complications of obesity.
肥胖与非酒精性脂肪性肝病（NAFLD）的风险增加有关。当肝脏从血浆中摄取脂肪酸和从头合成脂肪酸的速度大于脂肪酸氧化和输出（作为极低密度脂蛋白中的甘油三酯）的速度时，就会发生 NAFLD 的标志性特征——脂肪变性。因此，肝内甘油三酯（IHTG）过多代表代谢事件复杂相互作用之间的失衡。脂肪变性的存在与葡萄糖、脂肪酸和脂蛋白代谢的一系列不良改变有关。脂肪代谢异常与脂肪组织、肝和全身炎症一起，很可能是与 NAFLD 相关的胰岛素抵抗、血脂异常和其他心血管代谢危险因素发展的关键因素。然而，尚不清楚是 NAFLD 导致代谢功能障碍，还是代谢功能障碍导致 IHTG 积聚，或者可能两者兼而有之。了解 NAFLD 的发病机制和病理生理学中涉及的确切因素，将为肥胖相关的心血管代谢并发症的机制提供重要的见解。
