Souza Mônica Rodrigues de Araújo, Diniz Margareth de Fátima Formiga de Melo, Medeiros-Filho José Eymard Moraes de, Araújo Maria Salete Trigueiro de
Universidade Federal da Paraíba, PB, Brasil.
Arq Gastroenterol. 2012 Jan-Mar;49(1):89-96. doi: 10.1590/s0004-28032012000100015.
Non-alcoholic fatty liver disease (NAFLD), hepatic manifestation of metabolic syndrome, has been considered the most common liver disease nowadays, which is also the most frequent cause of elevated transaminases and cryptogenic cirrhosis. The greatest input of fatty acids into the liver and consequent increased beta-oxidation contribute to the formation of free radicals, release of inflammatory cytokines and varying degrees of hepatocytic aggression, whose histological expression may vary from steatosis (HS) to non-alcoholic steatohepatitis (NASH). The differentiation of these forms is required by the potential risk of progression to cirrhosis and development of hepatocellular carcinoma.
To review the literature about the major risk factors for NAFLD in the context of metabolic syndrome, focusing on underlying mechanisms and prevention.
PubMed, MEDLINE and SciELO data basis analysis was performed to identify studies describing the link between risk factors for metabolic syndrome and NAFLD. A combination of descriptors was used, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, metabolic syndrome and risk factors. At the end, 96 clinical and experimental studies, cohorts, meta-analysis and systematic reviews of great impact and scientific relevance to the topic, were selected.
The final analysis of all these data, pointed out the central obesity, type 2 diabetes, dyslipidemia and hypertension as the best risk factors related to NAFLD. However, other factors were highlighted, such as gender differences, ethnicity, genetic factors and the role of innate immunity system. How these additional factors may be involved in the installation, progression and disease prognosis is discussed.
Risk factors for NAFLD in the context of metabolic syndrome expands the prospects to 1) recognize patients with metabolic syndrome at high risk for NAFLD, 2) elucidate pathways common to other co-morbidities, 3) determine risk factors associated with a worse prognosis, 4) develop therapeutic strategies with goal of reducing risk factors, 5) apply acquired knowledge in public health policies focusing on preventive strategies.
非酒精性脂肪性肝病（NAFLD）是代谢综合征的肝脏表现，被认为是当今最常见的肝脏疾病，也是转氨酶升高和隐源性肝硬化的最常见原因。脂肪酸大量进入肝脏并导致β-氧化增加，促使自由基形成、炎性细胞因子释放以及不同程度的肝细胞损伤，其组织学表现可能从肝脂肪变性（HS）到非酒精性脂肪性肝炎（NASH）不等。由于存在进展为肝硬化和肝细胞癌的潜在风险，需要对这些形式进行区分。
在代谢综合征背景下综述有关NAFLD主要危险因素的文献，重点关注潜在机制和预防措施。
对PubMed、MEDLINE和SciELO数据库进行分析，以识别描述代谢综合征危险因素与NAFLD之间关联的研究。使用了“非酒精性脂肪性肝病”“非酒精性脂肪性肝炎”“代谢综合征”和“危险因素”等描述词的组合。最后，选择了96项对该主题具有重大影响和科学相关性的临床和实验研究、队列研究、荟萃分析和系统评价。
对所有这些数据的最终分析指出，中心性肥胖、2型糖尿病、血脂异常和高血压是与NAFLD相关的最佳危险因素。然而，其他因素也受到关注，如性别差异、种族、遗传因素以及先天免疫系统的作用。本文讨论了这些额外因素如何参与疾病的发生、发展和预后。
代谢综合征背景下NAFLD的危险因素拓展了以下前景：1）识别代谢综合征中发生NAFLD的高危患者；2）阐明与其他合并症共有的途径；3）确定与预后较差相关的危险因素；4）制定以降低危险因素为目标的治疗策略；5）将所获得的知识应用于以预防策略为重点的公共卫生政策中。
