Department of Gastroenterology and Hepatology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Metabolism. 2020 Oct;111S:154183. doi: 10.1016/j.metabol.2020.154183. Epub 2020 Feb 14.
Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease affecting approximately 25% of the global population. Although a majority of NAFLD patients will never experience liver-related symptoms it is estimated that 5-10% will develop cirrhosis-related complications with risk of death or need for liver transplantation. NAFLD is closely associated with cardiovascular disease and components of the metabolic syndrome. However, NAFLD is not uncommon in lean individuals and may in these subjects represent a different entity with separate pathophysiological mechanisms involved implying a higher risk for development of end-stage liver disease. There is considerable fluctuation in the histopathological course of NAFLD that may partly be attributed to lifestyle factors and dietary composition. Nutrients such as fructose, monounsaturated fatty acids, and trans-fatty acids may aggravate NAFLD. Presence of type 2 diabetes mellitus seems to be the most important clinical predictor of liver-related morbidity and mortality in NAFLD. Apart from severity of the metabolic syndrome, genetic polymorphisms and environmental factors, such as moderate alcohol consumption, may explain the variation in histopathological and clinical outcome among NAFLD patients.
非酒精性脂肪性肝病（NAFLD）已成为最常见的慢性肝病，影响着约全球 25%的人口。尽管大多数 NAFLD 患者从未出现过与肝脏相关的症状，但据估计，有 5-10%的患者会发展为与肝硬化相关的并发症，从而面临死亡或需要进行肝移植的风险。NAFLD 与心血管疾病和代谢综合征的组成部分密切相关。然而，在瘦人群体中，NAFLD 也并不罕见，在这些人群中，它可能代表着一种不同的实体，涉及不同的病理生理机制，这意味着发展为终末期肝病的风险更高。NAFLD 的组织病理学病程存在相当大的波动，这可能部分归因于生活方式因素和饮食成分。果糖、单不饱和脂肪酸和反式脂肪酸等营养素可能会加重 NAFLD。2 型糖尿病的存在似乎是 NAFLD 患者肝脏相关发病率和死亡率的最重要临床预测因素。除了代谢综合征的严重程度、遗传多态性和环境因素（如适量饮酒）外，这些因素可能解释了 NAFLD 患者在组织病理学和临床结局方面的差异。
