Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
J Gastroenterol Hepatol. 2012 Oct;27(10):1555-60. doi: 10.1111/j.1440-1746.2012.07222.x.
Fatty liver (hepatic steatosis) is prevalent in industrialized countries. It is typically linked to obesity, central obesity and the presence of metabolic syndrome. With the introduction of a Westernized lifestyle and the increasing frequency of obesity in the Asia-Pacific region, the prevalence of non-alcoholic fatty liver disease (NAFLD) has been increasing over the past two decades. The risk factors are similar to those in other ethnic populations; but it is important to adopt the regional (ethnic-specific) anthropometric criteria to define overweight, obesity (including central obesity) and metabolic syndrome. To be noted, even using strict ethnic-specific criteria, a high percentage (15-21%) of Asia-Pacific NAFLD subjects in some series have been found to be non-obese, i.e. to have a normal body mass index (BMI) (17.5-22.4 kg/m(2)) or to be overweight (BMI 22.5-24.9 kg/m(2)). Differential distribution of visceral adipose tissue, recent increase in body weight, intake of high cholesterol diet and genetic background are factors likely associated with the development of NAFLD in these non-obese (but often overweight) Asia-Pacific subjects. Furthermore, insulin resistance may be the underlying key mechanism. In addition, since NAFLD may be the hepatic manifestation of metabolic syndrome, the presence of NAFLD is a predictor of future type 2 diabetes, metabolic syndrome and cardiovascular disease. Therefore, interventions at the public health level are indicated to halt the trend of overweight as well as obesity in Asia-Pacific region, particularly among those with relevant family history. Since the pathophysiology of NAFLD is closely related to metabolic derangement, lifestyle modification remains the cornerstone of management.
脂肪肝（肝脂肪变性）在工业化国家很普遍。它通常与肥胖、中心性肥胖和代谢综合征有关。随着西方化生活方式的引入以及亚太地区肥胖症的日益增多，过去二十年来，非酒精性脂肪性肝病（NAFLD）的患病率一直在上升。危险因素与其他种族人群相似；但是，采用区域性（种族特异性）人体测量标准来定义超重、肥胖（包括中心性肥胖）和代谢综合征非常重要。需要注意的是，即使使用严格的种族特异性标准，在一些系列研究中，亚太地区 NAFLD 患者中有很高的比例（15-21%）被发现是非肥胖者，即体质量指数（BMI）正常（17.5-22.4 kg/m²）或超重（BMI 22.5-24.9 kg/m²）。内脏脂肪组织的差异分布、体重的近期增加、高胆固醇饮食的摄入和遗传背景是与这些非肥胖（但通常超重）亚太人群中 NAFLD 发展相关的可能因素。此外，胰岛素抵抗可能是潜在的关键机制。此外，由于 NAFLD 可能是代谢综合征的肝脏表现，因此存在 NAFLD 是未来发生 2 型糖尿病、代谢综合征和心血管疾病的预测指标。因此，需要在公共卫生层面进行干预，以阻止亚太地区超重和肥胖的趋势，特别是在有相关家族史的人群中。由于 NAFLD 的病理生理学与代谢紊乱密切相关，因此生活方式的改变仍然是管理的基石。
