Division of Endocrinology, Diabetes and Metabolism, University of Alabama in Birmingham, Birmingham, AL 35233, United States.
Curr Hypertens Rev. 2021;17(2):94-111. doi: 10.2174/1573402116999201209203534.
Nonalcoholic fatty liver disease (NAFLD) has consolidated as a major public health problem, affecting ~25% of the global population. This percentage is significantly higher in the setting of obesity and/or type 2 diabetes. The presence of NAFLD is associated with severe liver complications, such as nonalcoholic steatohepatitis (NASH; i.e., presence of inflammation and necrosis), cirrhosis and hepatocellular carcinoma. However, the majority of these patients die of cardiovascular disease. For this reason, management of this condition requires a multidisciplinary team, where primary care providers are at center stage. However, important misconceptions remain among primary care providers, preventing them from appropriately approach these patients. Nonalcoholic fatty liver disease should be understood as part of a systemic disease characterized for abnormal accumulation of fat in tissues other than the adipose tissue. This, in turn, produces dysfunction of those organs or tissues (process sometimes referred to as lipotoxicity). Therefore, due to the systemic nature of this condition, it should not surprise that NAFLD is closely related to other metabolic conditions. This review will focus on the extrahepatic manifestations of NAFLD and its metabolic and cardiovascular implications. We believe these are the most important issues primary care providers should understand in order to effectively manage these complicated patients. In addition, we have provided a simple and straightforward approach to the diagnosis and treatment of patients with NAFLD and/or NASH. We hope this review will serve as a guide for primary care providers to approach their patients with NAFLD.
非酒精性脂肪性肝病（NAFLD）已成为一个主要的公共卫生问题，影响了全球约 25%的人口。在肥胖和/或 2 型糖尿病的情况下，这一比例显著更高。NAFLD 的存在与严重的肝脏并发症相关，如非酒精性脂肪性肝炎（NASH；即炎症和坏死的存在）、肝硬化和肝细胞癌。然而，这些患者中的大多数死于心血管疾病。因此，这种疾病的管理需要一个多学科团队，初级保健提供者处于中心地位。然而，初级保健提供者中仍然存在重要的误解，阻止他们适当地为这些患者提供治疗。非酒精性脂肪性肝病应被理解为一种系统性疾病的一部分，其特征是脂肪在脂肪组织以外的组织中异常积聚。这反过来又导致这些器官或组织的功能障碍（这一过程有时被称为脂肪毒性）。因此，由于这种疾病的系统性，NAFLD 与其他代谢状况密切相关，这并不奇怪。本综述将重点介绍 NAFLD 的肝外表现及其代谢和心血管影响。我们认为，这些是初级保健提供者为了有效地管理这些复杂的患者，应该理解的最重要的问题。此外，我们还为 NAFLD 和/或 NASH 患者的诊断和治疗提供了一种简单直接的方法。我们希望本综述能为初级保健提供者提供一个指导，帮助他们处理 NAFLD 患者。
