Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya3237610.17116/terarkh20178912226-232Editorial articleПередовая статьяReview ArticleNonalcoholic fatty liver disease without obesity: the problem to be solvedНеалкогольная жировая болезнь печени без ожирения: проблема, ожидающая решенияBueverovA OБуеверовА ОBogomolovP OБогомоловП ОФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава РоссииГБУЗ МО «МОНИКИ им. М.Ф. Владимирского»ГБУЗ МО «МОНИКИ им. М.Ф. Владимирского»201220178912-2VOL 89, NO12 (2017)ТОМ 89, №12-2 (2017)22623210042020Copyright ©; 2017, Consilium MedicumCopyright ©; 2017, ООО "Консилиум Медикум"2017Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/32376

It is generally agreed that nonalcoholic fatty liver disease (NAFLD) is a component of metabolic syndrome and is frequently associated with obesity, type 2 diabetes mellitus, atherogenic dyslipidemia, and other components of the syndrome. However, there is no doubt that not all overweight people develop NAFLD and, conversely, the latter may be present in normal weight individuals. The prevalence of NAFLD without obesity in different countries is very variable from 3 to 30%. Its risk factors are considered to be both exogenous (for example, excess intakes of cholesterol and rapidly assimilable fructose) and genetically determined (allelic variants of the genes encoding adiponutrin, the cholesteryl ester transport protein, sterol-regulatory element-binding protein 2). The methods for the diagnosis of NAFLD without obesity do not differ in essence from those for classic NAFLD. Analysis of the conducted investigations gives grounds to claim that lifestyle modification as exercises and dietary restrictions improves biochemical parameters and histological pattern. The efficiency of drug treatments needs further investigation.

Принято считать, что неалкогольная жировая болезнь печени (НАЖБП) представляет собой компонент метаболического синдрома и часто сочетается с ожирением, сахарным диабетом 2-го типа, атерогенной дислипидемией и другими его компонентами. Однако не вызывает сомнений, что не у всех людей с избыточной массой тела развивается НАЖБП и, напротив, наличие НАЖБП возможно у лиц с нормальной массой тела. Данные о распространенности НАЖБП без ожирения в разных странах весьма вариабельны — от 3 до 30%. В качестве факторов риска развития рассматриваются как экзогенные (например, избыточное поступление в организм холестерина — ХС и быстро усваиваемой фруктозы), так и генетически детерминированные (аллельные варианты генов, кодирующих адипонутрин, белок — переносчик эфиров ХС, стеролрегулирующий элементсвязывающий фактор-2). Методы диагностики принципиально не отличаются от таковых при «классической» НАЖБП. Анализ проведенных исследований дает основание утверждать, что изменение образа жизни в виде физических нагрузок и пищевых ограничений способствует улучшению биохимических показателей и гистологической картины. Эффективность медикаментозных методов нуждается в дальнейшем изучении.

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