The review contains updated information on the epidemiology, etiology, pathogenesis, diagnosis, treatment and prevention of non-alcoholic fatty liver disease (NAFLD). We searched for terms including NAFLD, non-alcoholic steatohepatitis (NASH), metabolic syndrome and type 2 diabetes mellitus in literature published over the past 5 years using the Scopus, Web of Science, CyberLeninka, PubMed databases. The concept of NAFLD includes two morphological forms of the disease with different prognosis: non-alcoholic fatty hepatosis and NASH. The severity of NASH is quite variable, including fibrosis, cirrhosis and hepatocellular carcinoma. NAFLD, a spectrum of fatty liver disorders of viral, autoimmune, drug-induced, and genetic origin, which are not caused by alcohol abuse, has recently been renamed as metabolic (dysfunction) associated fatty liver disease (MAFLD). The average prevalence of NAFLD is approximately 25 % among the adult population worldwide, and in some regions exceeds 30 %. An increase in the prevalence of this pathology is in parallel with the global epidemic of obesity and type 2 diabetes mellitus in the world. It is time to reach a general consensus in the scientific community on changing the nomenclature and moving from a negative to a positive definition of NAFLD/NASH. The new nomenclature points to the “positive” determinants of the disease, namely the close relationship with metabolic disorders, instead of defining it as what it is not (ie. non-alcoholic). The MAFLD abbreviation more accurately discloses existing knowledge about fatty liver diseases associated with metabolic dysfunction and should replace NAFLD/NASH, as this will stimulate the research community’s efforts to update the disease nomenclature and subphenotype and accelerate the transition to new treatments. It is important that primary care physicians, endocrinologists, and other specialists are aware of the extent and long-term consequences of NAFLD. Early identification of patients with NASH can help improve treatment outcomes, avoid liver transplantation in patients with decompensated cirrhosis. There are currently no effective treatments for NAFLD, so it is important to follow a multidisciplinary approach, which means using measures to improve prognosis, reduce the risk of death associated with NAFLD, the development of cirrhosis or hepatocellular carcinoma. Epidemiological data suggest a close relationship between unhealthy lifestyles and NAFLD, so lifestyle adjustments are needed to all patients. Insulin sensitizers, statins, ezetimibe, a cholesterol absorption inhibitor, hepatoprotectors, antioxidants, incretin analogues, dipeptidyl peptidase 4 inhibitors, pentoxifylline, probiotics, angiotensin-converting enzyme inhibitors, and endocannabinoid antagonists are used in the treatment of NAFLD.
Сьогодні проблема ожиріння (ОЖ) є однією з найактуальніших у медичній науці. Її значущість обумовлена завеликою поширеністю цієї патології та значним ризиком розвитку коморбідних патологічних станів. Саме вони обумовлюють інвалідизацію та смертність пацієнтів із надлишком ваги. Одним із захворювань, для якого провідним фактором ризику є надлишкове накопичення жирової тканини, вважається артеріальна гіпертензія (АГ): за даними літератури, у пацієнтів із ОЖ ризик її розвитку є втричі більшим, ніж у осіб, які мають нормальну масу тіла [1,2].
Background. The relevance of the study is due to the need to optimize the prevention of arterial hypertension (AH) among the urban population of Ukraine, primarily those with obesity. The purpose was to detail the features of AH development in obese urban residents, and to develop a method for predicting AH in this category of the population. Materials and methods. A total of 1,094 residents of the city of Kharkiv who had not been treated for obesity and AH were examined. Body mass index, waist circumference, blood pressure were evaluated. Bioimpedance analysis was used to study body composition, immunoassay — serum levels of insulin, leptin, renin, aldosterone and clusterin. Features of central hemodynamics were assessed by the method of integral body rheography: stroke volume (ml), cardiac output (L/min), stroke volume index (ml/m2), cardiac index (L/min/m2) were determined. Results. It was found that middle-aged urban residents with obesity require intensification of preventive work in terms of AH development. In men, it should be started even before the age of 40. Development of concomitant pathology of AH and obesity in middle-aged people is due to the presence of insulin resistance, which is accompanied by changes in the circulating levels of insulin, leptin, aldosterone, in the stroke volume index and total peripheral vascular resistance, the occurrence of low-grade systemic inflammation in the body. Patients with obesity and AH differ from those with AH without obesity in terms of the level of volemia, the severity of changes in hemodynamics caused by the functioning of the heart, total peripheral vascular resistance, the degree of changes in the renin-aldosterone system, and the intensity of low-grade systemic inflammation. The results of the work made it possible to assert that one of the factors that primarily determine the development and progression of obesity in this category of the population is insulin resistance. Integral body rheography, a method for detecting changes in the stroke volume index, is an informative marker for the development and progression of AH. The presence of concomitant pathology of AH and obesity is characterized by changes in the levels of leptin and clusterin compared to the patients with obesity without hypertension, which should also be taken into account when developing therapeutic approaches. Conclusions. The approaches to the prognostic classification (created using the discriminant analysis program) of middle-aged urban residents — representatives of the Ukrainian population, identified in the process of work, can become the basis for optimizing the algorithms for the formation of risk groups for the development of obesity and AH.
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