Nutrition and Metabolism and NIHR Southampton Biomedical Research Centre, University Hospital Southampton and Faculty of Medicine, University of Southampton, Southampton, UK.
Diabet Med. 2012 Sep;29(9):1098-107. doi: 10.1111/j.1464-5491.2012.03732.x.
Non-alcoholic fatty liver disease is now recognized as the hepatic component of the metabolic syndrome. Non-alcoholic fatty liver disease is a spectrum of fat-associated liver conditions that can result in end-stage liver disease and the need for liver transplantation. Simple steatosis, or fatty liver, occurs early in non-alcoholic fatty liver disease and may progress to non-alcoholic steatohepatitis, fibrosis and cirrhosis with increased risk of hepatocellular carcinoma. Prevalence estimates for non-alcoholic fatty liver disease range from 17 to 33% in the general populations and it has been estimated that non-alcoholic fatty liver disease exists in up to 70% of people with Type 2 diabetes. Non-alcoholic fatty liver disease increases risk of Type 2 diabetes and cardiovascular disease. In people with Type 2 diabetes, non-alcoholic fatty liver disease is the most frequent cause (∼80%) of fatty liver diagnosed by ultrasound. As non-alcoholic fatty liver disease is strongly associated with insulin resistance, the presence of non-alcoholic fatty liver disease with diabetes often contributes to poor glycaemic control. Consequently, strategies that decrease liver fat and improve whole-body insulin sensitivity may both contribute to prevention of Type 2 diabetes and to better glycaemic control in people who already have developed diabetes. This review summarizes the Dorothy Hodgkin lecture given by the author at the 2012 Diabetes UK annual scientific conference, proposing that fatty acid fluxes through the liver are crucial for the pathogenesis of non-alcoholic fatty liver disease and for increasing insulin resistance.
非酒精性脂肪性肝病现在被认为是代谢综合征的肝脏组成部分。非酒精性脂肪性肝病是一系列与脂肪相关的肝脏疾病，可导致终末期肝病和需要进行肝移植。单纯性脂肪变性，即脂肪肝，是非酒精性脂肪性肝病的早期表现，可能进展为非酒精性脂肪性肝炎、纤维化和肝硬化，增加肝细胞癌的风险。一般人群中非酒精性脂肪性肝病的患病率估计为 17%至 33%，据估计，高达 70%的 2 型糖尿病患者存在非酒精性脂肪性肝病。非酒精性脂肪性肝病增加了 2 型糖尿病和心血管疾病的风险。在 2 型糖尿病患者中，非酒精性脂肪性肝病是通过超声诊断的脂肪肝最常见的原因（约 80%）。由于非酒精性脂肪性肝病与胰岛素抵抗密切相关，因此糖尿病患者存在非酒精性脂肪性肝病通常会导致血糖控制不佳。因此，减少肝脏脂肪和改善全身胰岛素敏感性的策略可能有助于预防 2 型糖尿病，并改善已经患有糖尿病的患者的血糖控制。本文综述了作者在 2012 年英国糖尿病协会年度科学会议上所做的 Dorothy Hodgkin 演讲，提出脂肪酸在肝脏中的流动对于非酒精性脂肪性肝病的发病机制和胰岛素抵抗的增加至关重要。
