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摘要: 基于中国人群的临床试验及队列研究数据，本文系统总结了体质量/体质量指数(body mass index, BMI)水平及其变化在非酒精性脂肪性肝病(non-alcoholic fatty liver disease, NAFLD)预防及其不良结局发生风险中的意义。结果显示，BMI与NAFLD发生风险呈显著正相关；对于已发生NAFLD的人群，其基线BMI水平与NAFLD缓解率呈负相关，与死亡或肿瘤等不良结局发生风险呈非线性相关；BMI正常的瘦型NAFLD人群全因死亡、肝脏相关死亡、消化系统肿瘤与肥胖相关肿瘤的发生风险较超重或肥胖型NAFLD、瘦型非NAFLD人群升高。NAFLD人群基线BMI水平与其不良结局的关联性可能受其他代谢指标的影响。控制基线BMI后，虽然多数研究提示体质量减轻可降低NAFLD发生风险，但由于不同研究对BMI变化的评估方法与评估时间窗不同，目前对于如何控制体质量进行NAFLD预防尚未达成一致结论。对于已发生NAFLD的人群，有限的证据显示减重对不同不良结局发生风险产生不同的影响。未来需开展多中心队列研究和试验性研究，充分考虑NAFLD的异质性，针对不同特征人群制订个体化体质量控制策略。Abstract: Based on the clinical trials and cohort studies in the Chinese population, this paper systematically summarized the association between weight/ body mass index (BMI) and their changes in preventing non-alcoholic fatty liver disease (NAFLD) and its adverse outcomes. The results showed that BMI was positively correlated with NAFLD risk, but for those with NAFLD, BMI was negatively related to the remission of NAFLD and there was a non-linear dose-response relationship between BMI and adverse outcomes. The lean NAFLD group had a higher risk of all-cause death, liver-related death, digestive system tumors, and obesity-related tumors than the overweight or obese NAFLD and lean non-NAFLD group. Additionally, the association between baseline BMI levels and adverse outcomes in NAFLD populations may be affected by other metabolic indicators. After controlling for baseline BMI, most studies suggested that weight loss could reduce the NAFLD risk. However, there is no consistent conclusion on how to control weight to prevent NAFLD because the methods and the time windows to assess BMI changes vary in different studies. Moreover, for those with NAFLD, limited evidence suggested the different relationship between weight loss and different outcomes. Therefore, we call for conducting multi-center cohort and experimental studies to verify the effect of weight control on NAFLD and its related adverse outcomes after considering the heterogeneity of NAFLD, so as to propose precision weight control recommendations.
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Key words:
- non-alcoholic fatty liver disease /
- weight control /
- adverse outcome /
- prevention
作者贡献：杨晨露负责论文撰写；王丽负责选题设计、论文修订；赵欣宇、胡诗琪、蓝彦琦、冯宝玉负责文献分析。利益冲突：所有作者均声明不存在利益冲突 -
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