Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan.
Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Gut Liver. 2020 Sep 15;14(5):537-545. doi: 10.5009/gnl19236.
This review provides an update on the characteristics of nonalcoholic fatty liver disease (NAFLD), with a focus on the effects of age, sex, and body mass index. Age is a risk factor for NAFLD progression; however, extremely old patients have unique features, namely, the associations between metabolic comorbidities and NAFLD are weaker and NAFLD is not a risk factor for mortality. The prevalence of NAFLD is higher in men than in premenopausal women, whereas the reverse is true after menopause. Thus, before menopause, estrogen may have protective effects against NAFLD. Our hospital data showed that over 25% of male patients with NAFLD and almost 40% of female patients with NAFLD, especially elderly patients, were nonobese. Although histological steatosis and activity were associated with body mass index, the prevalence of nonalcoholic steatohepatitis was not. The prevalence of advanced fibrosis showed a significant sex difference. Advanced fibrosis was significantly more frequent among severely obese men but the prevalence was lower among severely obese women. This difference could be because a substantial proportion of severely obese women were premenopausal; thus, estrogen may have much stronger effects on the development of fibrosis than on obesity. Further studies are required to develop tailored management strategies.
这篇综述介绍了非酒精性脂肪性肝病（NAFLD）的特征，重点介绍了年龄、性别和体重指数的影响。年龄是 NAFLD 进展的一个危险因素；然而，非常高龄的患者具有独特的特征，即代谢合并症与 NAFLD 的相关性较弱，并且 NAFLD 不是死亡的危险因素。男性的 NAFLD 患病率高于绝经前女性，而绝经后则相反。因此，绝经前，雌激素可能对 NAFLD 具有保护作用。我们医院的数据显示，超过 25%的男性 NAFLD 患者和约 40%的女性 NAFLD 患者，尤其是老年患者，是非肥胖者。虽然组织学脂肪变性和活动与体重指数有关，但非酒精性脂肪性肝炎的患病率与体重指数无关。晚期纤维化的患病率存在显著的性别差异。严重肥胖的男性中晚期纤维化明显更为常见，但严重肥胖的女性中晚期纤维化的患病率较低。这种差异可能是因为大量严重肥胖的女性处于绝经前；因此，雌激素对纤维化的发展可能比对肥胖的影响更强。需要进一步的研究来制定有针对性的管理策略。
