Diabetes, Endocrinology, and Obesity Branch, National Institutes of Health, Bethesda, Maryland, USA.
Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Clin Invest. 2021 Dec 15;131(24). doi: 10.1172/JCI154645.
Nonalcoholic fatty liver disease (NAFLD) in children resulting from the obesity epidemic is widespread and increasing. Although the complexities of pediatric NAFLD are recognized, screening and therapies in children remain limited. Moreover, pediatric NAFLD diagnosis fails to consider insulin resistance and metabolic dysfunction as important determinants. In this issue of the JCI, Cohen et al. explored the contribution of dietary factors to the pathogenesis of NAFLD in adolescent boys with biopsy-proven NAFLD and control participants. Notably, dietary sugar restriction over 8 weeks decreased de novo lipogenesis (DNL) and hepatic fat. The change in DNL correlated with changes in insulin and weight, but not with changes in hepatic fat, supporting the relevance of metabolic dysfunction to NAFLD. These results confirm the pathological link between excessive dietary sugar intake and NAFLD in children and support recent recommendations to change the nomenclature of NAFLD to metabolic associated fatty liver disease (MAFLD).
非酒精性脂肪性肝病（NAFLD）在儿童中因肥胖症的流行而广泛存在且呈上升趋势。尽管儿科 NAFLD 的复杂性已被认识到，但儿童的筛查和治疗仍然有限。此外，儿科 NAFLD 的诊断并未将胰岛素抵抗和代谢功能障碍视为重要决定因素。在本期 JCI 中，Cohen 等人研究了饮食因素对经活检证实患有 NAFLD 的青少年男孩和对照组参与者 NAFLD 发病机制的影响。值得注意的是，8 周的饮食糖分限制减少了从头脂肪生成（DNL）和肝脏脂肪。DNL 的变化与胰岛素和体重的变化相关，但与肝脏脂肪的变化无关，这支持代谢功能障碍与 NAFLD 的相关性。这些结果证实了儿童中过量饮食糖摄入与 NAFLD 之间的病理联系，并支持最近将 NAFLD 的命名更改为代谢相关脂肪性肝病（MAFLD）的建议。
