Dipartimento di Medicina Interna, Centro Studi Malattie Metaboliche del Fegato, Università degli Studi di Milano, Ospedale Maggiore Policlinico, IRCCS, Fondazione Ca' Granda, Milano, Italy.
J Hepatol. 2011 Jun;54(6):1244-9. doi: 10.1016/j.jhep.2010.09.037. Epub 2010 Nov 11.
BACKGROUND & AIMS: Increased visceral adiposity is considered the hallmark of the metabolic syndrome, whose hepatic manifestation is nonalcoholic fatty liver disease (NAFLD), although a subset of patients does not have visceral obesity. Our study aimed to compare metabolic alterations and liver damage in patients with NAFLD with and without visceral obesity.
Four hundred and thirty one consecutive patients with liver biopsy-confirmed NAFLD were divided in three groups according to waist circumference, the simplest surrogate marker of visceral obesity. One hundred and thirty three patients (31%) had a waist circumference ≤94 (males) and ≤80 cm (females) (group A), 157 (36%) between 94 and 102, and 80 and 88 (B), and the remaining 141 (33%) had values higher than 102 and 88 cm (C).
Significant trends for older age, higher prevalence of female gender, lower HDL, higher triglycerides, altered glucose metabolism, hypertension, and metabolic syndrome were observed with increasing visceral adiposity. In contrast, non-alcoholic steatohepatitis (NASH) detected in 55% and 72% of patients with normal and increased waist circumference, respectively, and the presence of fibrosis ≥2 were not associated with visceral adiposity. Alanine aminotransferase (ALT), ferritin, HOMA-IR >4, and severe steatosis were independently associated with NASH, whereas ferritin and impaired glucose tolerance were associated with fibrosis ≥2.
Patients with normal waist circumference, despite milder metabolic alterations, may have NASH and are at risk of developing fibrosis, suggesting that once NAFLD is present, visceral obesity is not a major determinant of liver damage severity.
内脏肥胖增加被认为是代谢综合征的标志，其肝脏表现为非酒精性脂肪性肝病（NAFLD），尽管有一部分患者没有内脏肥胖。我们的研究旨在比较有和没有内脏肥胖的 NAFLD 患者的代谢改变和肝损伤。
根据腰围将 431 例经肝活检证实的 NAFLD 患者分为三组，腰围是内脏肥胖的最简单替代标志物。133 例（31%）患者的腰围≤94（男性）和≤80cm（女性）（A 组），157 例（36%）患者的腰围在 94-102 之间，80-88 之间（B 组），其余 141 例（33%）患者的腰围大于 102 和 88cm（C 组）。
随着内脏脂肪的增加，观察到年龄较大、女性比例较高、高密度脂蛋白（HDL）较低、甘油三酯较高、葡萄糖代谢改变、高血压和代谢综合征的患病率呈显著趋势。相反，在腰围正常和增加的患者中，分别有 55%和 72%检测到非酒精性脂肪性肝炎（NASH），且纤维化程度≥2 与内脏肥胖无关。丙氨酸氨基转移酶（ALT）、铁蛋白、HOMA-IR>4 和严重脂肪变性与 NASH 独立相关，而铁蛋白和葡萄糖耐量受损与纤维化程度≥2 相关。
尽管腰围正常的患者代谢改变较轻，但可能患有 NASH，并有发生纤维化的风险，这表明一旦存在 NAFLD，内脏肥胖并不是肝损伤严重程度的主要决定因素。
