Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 466

Approximately 30% of the US population has fatty liver disease. Fatty liver disease can be divided into benign steatosis and steatohepatitis. Benign steatosis occurs in 25–30% of the US population, steatohepatitis occurs in about 5–6%,¹³ and cirrhosis due to fatty liver disease occurs in 1%. Nonalcoholic benign steatosis is liver fat encompassing >5% of a biopsy but with no inflammation or fibrosis. It usually has a benign course. Nonalcoholic steatohepatitis (NASH) is fatty infiltration of the liver >5% with lobular inflammation or fibrosis.^14,15

Fatty liver disease is the hepatic manifestation of metabolic syndrome, which is the condition produced when genetically susceptible individuals overconsume carbohydrates and do not exercise sufficiently. A recent study has shown that 80% of patients with nonalcoholic steatohepatitis are overweight or obese, 72% have dyslipidemia, and 44% have received a diagnosis of type 2 diabetes mellitus.¹⁶ Patients with fatty liver disease can have normal transaminases, though, when elevated ALT is usually greater than AST; they often have elevated serum ferritin, and fat can usually be detected on ultrasound of the liver, which has a sensitivity of 85–94%.¹⁷ Transient elastography can grade the degree of liver fat. Treatment of fatty liver disease consists of weight loss, decreased carbohydrates (particularly the elimination of sweetened beverages), exercise, and control of coexisting risk factors of type 2 diabetes and hyperlipidaemia with appropriate medication. Many medications for this disease are now in development.