非酒精性脂肪性肝病的运动处方制定
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摘要
非酒精性脂肪性肝病(NAFLD)是世界范围内最常见的慢性肝病病因,且发病率逐渐上升,是多种心血管疾病、糖尿病和慢性肾病的危险因素,因此,非酒精性脂肪性肝病的防治非常重要。虽然运动疗法作为一种治疗手段已被证实对非酒精性脂肪性肝病的相关危险因素有改善作用,但不同的运动疗法对非酒精性脂肪性肝病的作用还需更多证据。进一步的研究和实践应基于运动处方的制定,探索不同运动处方治疗非酒精性脂肪性肝病的安全性和疗效。
Non-alcoholic fatty liver disease(NAFLD), which is a risk factor for multiple cardiovascular diseases, diabetes mellitus and chronic kidney disease, is the most common cause of chronic liver disease worldwide. The morbidity of NAFLD is increasing gradually.Therefore,it becomes more and more important to prevent and treat nonalcoholic fatty liver disease. Exercise therapy, as a therapeutic method, has been proven to improve nonalcoholic fatty liver disease by a large number of studies. This article reviews the effect of exercise therapy on non-alcoholic fatty liver, the formulation principle of exercise prescription and the therapeutic effect of exercise therapy on non-alcoholic fatty liver related risk factors,which may provide reference for exercise intervention in the treatment of nonalcoholic fatty liver disease.
Non-alcoholic fatty liver disease(NAFLD), which is a risk factor for multiple cardiovascular diseases, diabetes mellitus and chronic kidney disease, is the most common cause of chronic liver disease worldwide. The morbidity of NAFLD is increasing gradually.Therefore,it becomes more and more important to prevent and treat nonalcoholic fatty liver disease. Exercise therapy, as a therapeutic method, has been proven to improve nonalcoholic fatty liver disease by a large number of studies. This article reviews the effect of exercise therapy on non-alcoholic fatty liver, the formulation principle of exercise prescription and the therapeutic effect of exercise therapy on non-alcoholic fatty liver related risk factors,which may provide reference for exercise intervention in the treatment of nonalcoholic fatty liver disease.
引文
[1]Sayiner M,Koenig A,Henry L,et al.Epidemiology of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis in the United States and the Rest of the World[J].Clin Liver Dis,2016,20(2):205-214.
[2]Younossi ZM,Stepanova M,Afendy M,et al.Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008[J].Clin Gastroenterol Hepatol,2011,9(6):524-530.
[3]Satapathy SK,Sanyal AJ.Epidemiology and Natural History of Nonalcoholic Fatty Liver Disease[J].Semin Liver Dis,2015,35(3):221-235.
[4]Golabi P,Paik J.Prevalence and Outcomes of Non-alcoholic Fatty Liver Disease(NAFLD)among Asian American Adults in the United States[J].Liver Int,2018 Dec 29.doi:10.1111/liv.14038.[Epub ahead of print]
[5]Whitsett M,VanWagner LB.Physical activity as a treatment of nonalcoholic fatty liver disease:A systematic review.World J Hepatol,2015,7(16):2041-2052.
[6]Kwon H,Kim D,Kim JS.Body Fat Distribution and the Risk of Incident Metabolic Syndrome:A Longitudinal Cohort Study[J].Sci Rep,2017,7(1):10955.
[7]Grundy SM,Hansen B,Smith SC Jr,et al.Clinical management of metabolic syndrome:report of the American Heart Association/National Heart,Lung,and Blood Institute/American Diabetes Association conference on scientific issues related to management[J].Arterioscler Thromb Vasc Biol,2004,24(2):e19-e24.
[8]Kim D,Chung GE,Kwak MS,et al.Body fat distribution and risk of incident and regressed nonalcoholic fatty liver disease[J].Clin Gastroenterol Hepatol,2016,14(2):132-138.
[9]Chalasani N,Younossi Z,Lavine J E,et al.The diagnosis and management of non-alcoholic fatty liver disease:Practice Guideline by the American Association for the Study of Liver Diseases,American College of Gastroenterology,and the American Gastroenterological Association[J].Hepatology,2012,55(6):2005-2023.
[10]Yanai H,Adachi H,Masui Y,et al.Exercise therapy for patients with type 2 diabetes:a narrative review[J].J Clin Med Res,2018,0(5):365-369.
[11]Delevatti R S,Pinho C D,Kanitz A C,et al.Glycemic reductions following water-and land-based exercise in patients with type 2diabetes mellitus[J].Complement Ther Clin Pract,2016,24(1):73-77.
[12]Kim D,Kim WR,Kim HJ,et al.Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States[J].Hepatology,2013,57(4):1357-1365.
[13]Bacchi E,Negri C,Targher G,et al.Both resistance training and aerobic training reduce hepatic fat content in type 2 diabetic subjects with nonalcoholic fatty liver disease(the RAED2 Randomized Trial)[J].Hepatology,2013,58(4):1287-1295.
[14]Houghton D,Thoma C,Hallsworth K,et al.Exercise reduces liver lipids and visceral adiposity in patients with nonalcoholic steatohepatitis in a randomized controlled trial[J].Clin Gastroenterol Hepatol,2017,15(1):96-102.
[15]Shamsoddini A,Sobhani V,Ghamar Chehreh ME,et al.Effect of aerobic and resistance exercise training on liver enzymes and hepatic fat in iranian men with nonalcoholic fatty liver disease[J].Hepat Mon,2015,15(10):e31434.
[16]Slentz CA,Bateman LA,Willis LH,et al.Effects of aerobic vs.resistance training on visceral and liver fat stores,liver enzymes,and insulin resistance by HOMA in overweight adults from STRRIDE AT/RT[J].2011,301(5):E1033-1039.
[17]Kim D,Kim WR.Nonobese fatty liver disease[J].Clin Gastroenterol Hepatol,2017,15(4):474-485.
[18]Chen J,Talwalkar J A,Yin M,et al.Early Detection of Nonalcoholic Steatohepatitis in Patients with Nonalcoholic Fatty Liver Disease by Using MR Elastography[J].Radiology,2011,259(3):749-756.
[19]Chalasani N,Younossi Z,Lavine JE,et al.The diagnosis and management of nonalcoholic fatty liver disease:practice guidance from the American Association for the Study of Liver Diseases[J].Hepatology,2018,67(1):328-357.
[20]Armstrong MJ,Adams LA,Canbay A,et al.Extrahepatic complications of nonalcoholic fatty liver disease[J].Hepatology,2014,59(3):1174-1197.
[21]Tsunoda K,Kai Y,Kitano N,et al.Impact of physical activity on nonalcoholic steatohepatitis in people with nonalcoholic simple fatty liver:a prospective cohort study[J].Prev Med,2016,88:237-40.doi:10.1016/j.ypmed.2016.04.020.
[22]Pate RR,Pratt M,Blair SN,et al.Physical activity and public health.Arecommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine[J].JAMA,2017,273(4):402-407.
[23]Huai P,Xun H,Reilly KH,et al.Physical activity and risk of hypertension:a meta-analysis of prospective cohort studies[J].Hypertension,2013,62(2):1021-1026.
[24]Fagard RH.Exercise characteristics and the blood pressure response to dynamic physical training[J].Med Sci Sports Exerc,2001,33(6Suppl):S484-S492.
[25]Pedralli ML,Eibel B.Effects of exercise training on endothelial function in individuals with hypertension:a systematic review with meta-analysis[J].J Am Soc Hypertens,2018,12(12):e65-e75
[26]Baptista LC,Amorim AP.Nonalcoholic fatty liver disease is associated with coronary artery calcification[J].Hepatology,2012,56(5):605-613.
[27]Cotrim HP,Parise ER.Nonalcoholic fatty liver disease in Brazil.Clinical and histological profile[J].Ann Hepatol,2011,10(1):33-37
[28]Park HE,Kwak MS,Kim D,et al.Nonalcoholic fatty liver disease is associated with coronary artery calcification development:a longitudinal study[J].J Clin Endocrinol Metab,2016,101(8):3134-3143
[29]Brain MW,Wallace M.Acute effects of resistance exercise on parameters of lipoprotein metabol ism[J].Med Sci.Sport Exe,1991,23(4):505-511.
[30]Leite NC,Salles GF,Araujo AL,et al.Prevalence and associated factors of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus[J].Liver Int,2009,29(2):113-119.
[31]Valenti L,Bugianesi E,Pajvani U,et al.Nonalcoholic fatty liver disease:cause or consequence of type 2 diabetes?[J].Liver Int,2016,36(11):1563-1579.
[32]Dalle Grave R,Calugi S,Centis E,et al.Lifestyle modification in the management of the metabolic syndrome:achievements and challenges[J].Diabetes Metab Syndr Obes,2010,3:373-85.doi:10.2147/DMSOTT.S13860.
[33]Botton CE,Um pierre D.Effects of resistan cetraining on neuromuscular parameters in elderly with type 2 diabetes mellitus:Arandomized clinical trial[J].Exp Gerontol,2018,113(2):141-149.
[34]Helal HA,Khan TM.Prevalence of poor glycemic and blood pressure control and pattern of drug use among primary health-care outpatients in Al Ahsa Saudi Arabia[J].Int J Health Sci(Qassim),2017,11(3):38-44.
[35]European Association for the Study of the Liver(EASL),European Association for the Study of Diabetes(EASD),European Association for the Study of Obesity(EASO).EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease[J].JHepatol,2016,64(6):1388-1402.
[36]朱峰,季春鹏,王来明,等.非酒精性脂肪肝对新发糖尿病的影响[J].解放军医学杂志,2015,40(9):745-749.
[2]Younossi ZM,Stepanova M,Afendy M,et al.Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008[J].Clin Gastroenterol Hepatol,2011,9(6):524-530.
[3]Satapathy SK,Sanyal AJ.Epidemiology and Natural History of Nonalcoholic Fatty Liver Disease[J].Semin Liver Dis,2015,35(3):221-235.
[4]Golabi P,Paik J.Prevalence and Outcomes of Non-alcoholic Fatty Liver Disease(NAFLD)among Asian American Adults in the United States[J].Liver Int,2018 Dec 29.doi:10.1111/liv.14038.[Epub ahead of print]
[5]Whitsett M,VanWagner LB.Physical activity as a treatment of nonalcoholic fatty liver disease:A systematic review.World J Hepatol,2015,7(16):2041-2052.
[6]Kwon H,Kim D,Kim JS.Body Fat Distribution and the Risk of Incident Metabolic Syndrome:A Longitudinal Cohort Study[J].Sci Rep,2017,7(1):10955.
[7]Grundy SM,Hansen B,Smith SC Jr,et al.Clinical management of metabolic syndrome:report of the American Heart Association/National Heart,Lung,and Blood Institute/American Diabetes Association conference on scientific issues related to management[J].Arterioscler Thromb Vasc Biol,2004,24(2):e19-e24.
[8]Kim D,Chung GE,Kwak MS,et al.Body fat distribution and risk of incident and regressed nonalcoholic fatty liver disease[J].Clin Gastroenterol Hepatol,2016,14(2):132-138.
[9]Chalasani N,Younossi Z,Lavine J E,et al.The diagnosis and management of non-alcoholic fatty liver disease:Practice Guideline by the American Association for the Study of Liver Diseases,American College of Gastroenterology,and the American Gastroenterological Association[J].Hepatology,2012,55(6):2005-2023.
[10]Yanai H,Adachi H,Masui Y,et al.Exercise therapy for patients with type 2 diabetes:a narrative review[J].J Clin Med Res,2018,0(5):365-369.
[11]Delevatti R S,Pinho C D,Kanitz A C,et al.Glycemic reductions following water-and land-based exercise in patients with type 2diabetes mellitus[J].Complement Ther Clin Pract,2016,24(1):73-77.
[12]Kim D,Kim WR,Kim HJ,et al.Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States[J].Hepatology,2013,57(4):1357-1365.
[13]Bacchi E,Negri C,Targher G,et al.Both resistance training and aerobic training reduce hepatic fat content in type 2 diabetic subjects with nonalcoholic fatty liver disease(the RAED2 Randomized Trial)[J].Hepatology,2013,58(4):1287-1295.
[14]Houghton D,Thoma C,Hallsworth K,et al.Exercise reduces liver lipids and visceral adiposity in patients with nonalcoholic steatohepatitis in a randomized controlled trial[J].Clin Gastroenterol Hepatol,2017,15(1):96-102.
[15]Shamsoddini A,Sobhani V,Ghamar Chehreh ME,et al.Effect of aerobic and resistance exercise training on liver enzymes and hepatic fat in iranian men with nonalcoholic fatty liver disease[J].Hepat Mon,2015,15(10):e31434.
[16]Slentz CA,Bateman LA,Willis LH,et al.Effects of aerobic vs.resistance training on visceral and liver fat stores,liver enzymes,and insulin resistance by HOMA in overweight adults from STRRIDE AT/RT[J].2011,301(5):E1033-1039.
[17]Kim D,Kim WR.Nonobese fatty liver disease[J].Clin Gastroenterol Hepatol,2017,15(4):474-485.
[18]Chen J,Talwalkar J A,Yin M,et al.Early Detection of Nonalcoholic Steatohepatitis in Patients with Nonalcoholic Fatty Liver Disease by Using MR Elastography[J].Radiology,2011,259(3):749-756.
[19]Chalasani N,Younossi Z,Lavine JE,et al.The diagnosis and management of nonalcoholic fatty liver disease:practice guidance from the American Association for the Study of Liver Diseases[J].Hepatology,2018,67(1):328-357.
[20]Armstrong MJ,Adams LA,Canbay A,et al.Extrahepatic complications of nonalcoholic fatty liver disease[J].Hepatology,2014,59(3):1174-1197.
[21]Tsunoda K,Kai Y,Kitano N,et al.Impact of physical activity on nonalcoholic steatohepatitis in people with nonalcoholic simple fatty liver:a prospective cohort study[J].Prev Med,2016,88:237-40.doi:10.1016/j.ypmed.2016.04.020.
[22]Pate RR,Pratt M,Blair SN,et al.Physical activity and public health.Arecommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine[J].JAMA,2017,273(4):402-407.
[23]Huai P,Xun H,Reilly KH,et al.Physical activity and risk of hypertension:a meta-analysis of prospective cohort studies[J].Hypertension,2013,62(2):1021-1026.
[24]Fagard RH.Exercise characteristics and the blood pressure response to dynamic physical training[J].Med Sci Sports Exerc,2001,33(6Suppl):S484-S492.
[25]Pedralli ML,Eibel B.Effects of exercise training on endothelial function in individuals with hypertension:a systematic review with meta-analysis[J].J Am Soc Hypertens,2018,12(12):e65-e75
[26]Baptista LC,Amorim AP.Nonalcoholic fatty liver disease is associated with coronary artery calcification[J].Hepatology,2012,56(5):605-613.
[27]Cotrim HP,Parise ER.Nonalcoholic fatty liver disease in Brazil.Clinical and histological profile[J].Ann Hepatol,2011,10(1):33-37
[28]Park HE,Kwak MS,Kim D,et al.Nonalcoholic fatty liver disease is associated with coronary artery calcification development:a longitudinal study[J].J Clin Endocrinol Metab,2016,101(8):3134-3143
[29]Brain MW,Wallace M.Acute effects of resistance exercise on parameters of lipoprotein metabol ism[J].Med Sci.Sport Exe,1991,23(4):505-511.
[30]Leite NC,Salles GF,Araujo AL,et al.Prevalence and associated factors of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus[J].Liver Int,2009,29(2):113-119.
[31]Valenti L,Bugianesi E,Pajvani U,et al.Nonalcoholic fatty liver disease:cause or consequence of type 2 diabetes?[J].Liver Int,2016,36(11):1563-1579.
[32]Dalle Grave R,Calugi S,Centis E,et al.Lifestyle modification in the management of the metabolic syndrome:achievements and challenges[J].Diabetes Metab Syndr Obes,2010,3:373-85.doi:10.2147/DMSOTT.S13860.
[33]Botton CE,Um pierre D.Effects of resistan cetraining on neuromuscular parameters in elderly with type 2 diabetes mellitus:Arandomized clinical trial[J].Exp Gerontol,2018,113(2):141-149.
[34]Helal HA,Khan TM.Prevalence of poor glycemic and blood pressure control and pattern of drug use among primary health-care outpatients in Al Ahsa Saudi Arabia[J].Int J Health Sci(Qassim),2017,11(3):38-44.
[35]European Association for the Study of the Liver(EASL),European Association for the Study of Diabetes(EASD),European Association for the Study of Obesity(EASO).EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease[J].JHepatol,2016,64(6):1388-1402.
[36]朱峰,季春鹏,王来明,等.非酒精性脂肪肝对新发糖尿病的影响[J].解放军医学杂志,2015,40(9):745-749.