سندرم متابولیک و کبد چرب غیر الکلی: رویکرد تغذیه‌ای در پیشگیری

نوع مقاله : مقاله مروری

نویسندگان

1 دانشیار، گروه تغذیه‌ی بالینی، دانشکده‌ی تغذیه و علوم غذایی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 کارشناس، گروه تغذیه، دانشکده‌ی تغذیه و علوم غذایی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: سندرم متابولیک مجموعه‌ای از عوامل خطرزای متابولیک است که در یک فرد وجود دارند. این عوامل خطرزا شامل مقاومت به انسولین، فشار خون، اختلالات چربی خون و افزایش خطر انعقاد می‌باشند. اغلب بیماران دچار اضافه وزن یا چاقی می‌باشند و برخی از آن‌ها از کبد چرب رنج می‌برند. این نکته ارتباط قوی کبد چرب را با سندرم متابولیک نشان می‌دهد. هدف مطالعه‌ی حاضر، خلاصه کردن شواهد موجود در زمینه‌ی اپیدمیولوژی، پاتوفیزیولوژی کبد چرب غیر الکلی و سندرم متابولیک و یافته‌های مبنی بر اثرات مقدار ماده‌ی مغذی یا اجزای خاص غذایی (مانند اسید چرب امگا 3) بود.روش‌ها: به این منظور واژگان کلیدی “Metabolic syndrome”، “Nonalcoholic Fatty Liver”،  “Metabolic syndrome and diet”، “Metabolic syndrome and Nonalcoholic Fatty Liver”، “Nonalcoholic Fatty Liver and diet”، “Nonalcoholic Fatty Liver and nutrition” و “Metabolic syndrome and nutrition” در PubMed و EMBASE بین سال‌های 1998 تا 2013 جستجو کردیم.یافته‌ها: افزایش جهانی شیوع چاقی با افزایش شیوع کبد چرب غیر الکلی و همچنین افزایش خطر دیابت نوع 2 همراه است. اگر چه راهکار خاصی برای درمان کبد چرب غیر الکلی وجود ندارد، ولی اصلاح رژیم غذایی نقش خاصی در درمان آن دارد. الگوهای غذایی سرشار از میوه و سبزیجات همراه با شیوع کمتری از سندرم متابولیک بودند. دریافت زیاد گوشت با اجزای سندرم متابولیک به ویژه اختلال در تحمل گلوکز همراه بود. دریافت اسیدهای چرب ترانس از روغن‌های هیدروژنه با افزایش مارکرهای التهابی همراه بوده است. به نظر می‌رسد یک رژیم غذایی حاوی مقادیر کم کربوهیدرات و اسید چرب اشباع و مقدار بیشتر فیبر و اسیدهای چرب امگا 3 برای کنترل سندرم متابولیک مفید باشد. پیشنهاد می‌شود در مبتلایان کبد چرب غیر الکلی، دریافت غذاها و نوشیدنی‌های سرشار از فروکتوز محدود شود. یافته‌ها ارتباط معکوس بین مصرف قهوه و سندرم متابولیک را به دلیل شیوع کمتر هیپر تری‌گلیسریدمی نشان داد و پیشنهاد شده است که دریافت قهوه می‌تواند خطر کبد چرب غیر الکلی را کاهش دهد.نتیجه‌گیری: برنامه‌ای مبنی بر کاهش وزن تدریجی و فعالیت فیزیکی، هنوز یک استاندارد طلایی درمان کبد چرب غیر الکلی می‌شود. مصرف منظم میوه و سیبزیجات برای کاهش خطر ایجاد سندرم متابولیک پیشنهاد می‌شود.

کلیدواژه‌ها

عنوان مقاله [English]

Metabolic Syndrome and Nonalcoholic Fatty Liver Disease: Nutritional Approach for Prevention

نویسندگان [English]

  • Zamzam Paknahad 1
  • Hadi Zeraei-Bidgoli 2
1 Associate Professor, Department of Clinical Nutrition, School of Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Nutrition School of Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Metabolic syndrome is a cluster of metabolic risk factors that come together in a single individual. These metabolic factors include insulin resistance, hypertension (high blood pressure), dyslipidemia, and an increased risk for clotting. Patients are most often overweight or obese. The development of nonalcoholic fatty liver disease (NAFLD) is strongly associated with the metabolic syndrome as reflected by the fact that most of the patients with NAFLD have more than one feature of metabolic syndrome. The aim of this review was to summarize the current knowledge on the epidemiology and pathophysiology of both NAFLD and metabolic syndrome and the findings about the effects nutrient content or specific food components (such as ω3 fatty acids).Methods: We searched Pubmed, ISI web of science, and EMBASE databases by using “Metabolic syndrome’, ‘Nonalcoholic fatty liver” , “Metabolic syndrome & diet”, “Metabolic syndrome & nonalcoholic fatty liver”, ‘Nonalcoholic fatty liver & diet” , “Nonalcoholic fatty liver & nutrition”, and “Metabolic syndrome & nutrition” from 2008 until 2013.Findings: The global increase in the prevalence of obesity is associated with NAFLD. NAFLD is also commonly associated with an increased risk of Type 2 diabetes mellitus development. Although there are no ideal options available for NAFLD treatment, dietary modification has a major role. Dietary patterns highly in fruit and vegetable content were generally found to be associated with lower prevalence of metabolic syndrome. High meat intake was associated with components of metabolic syndrome, especially impaired glucose tolerance. Intake of trans fatty acids from hydrogenated oils found to increase inflammatory markers. A low carbohydrate and saturated fat and high fiber and ω3 fatty acid diet is likely to be beneficial. The higher intake of soft drinks is associated with an increased risk of NAFLD. It is recommended to limit the intake of high-fructose foods and beverages in the NAFLD population. Findings showed negative correlation between coffee consumption and metabolic syndrome, because of the lower prevalence of hypertriglyceridemia, and data suggested coffee intake can reduce the risk of NAFLD.Conclusion: A gradual weight reduction and physical activity program is still the gold standard of NAFLD treatment. Regular consumption of fruit and vegetables is recommended to reduce the risk of developing metabolic syndrome.

کلیدواژه‌ها [English]

  • Metabolic Syndrome
  • Nonalcoholic fatty liver disease (NAFLD)
  • Diet
  • Nutrition

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مجله دانشکده پزشکی اصفهان
دوره 31، شماره 252 - شماره پیاپی 252
مهر و آبان 1392
صفحه 1461-1480

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  • تاریخ دریافت: 24 بهمن 1391
  • تاریخ بازنگری: 05 اردیبهشت 1403
  • تاریخ پذیرش: 17 فروردین 1401

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