運動對於改善非酒精性脂肪肝之探討

非酒精性脂肪肝病包含單純性脂肪肝與脂肪肝炎，嚴重時可能會發生肝硬化及肝癌。近年來流行病學的調查顯示，非酒精性脂肪肝的盛行率有上升的情形，尤其是在肥胖及糖尿病等代謝症候群的病人，可見非酒精性脂肪肝已是重要的健康議題。非酒精性脂肪肝的致病機轉主要為二次傷害假說，第一次傷害主要為脂肪大量蓄積於肝臟中，原因包括：肥胖及胰島素阻抗；第二次傷害則是會導致脂肪肝炎或肝纖維化，主要原因為氧化壓力上升、促發炎細胞激素與脂肪素的增加與釋出。近年來，許多研究已證實運動可以增加能量消耗、減少體內脂肪堆積、增加胰島素敏感性，並會影響細胞激素的調控及維持抗氧化狀態平衡。因此，對於非酒精性脂肪肝病患給予有氧運動介入是有助益的，而且維持運動與正確的飲食習慣也有助於預防非酒精性脂肪肝的發生。

關鍵字

非酒精性脂肪肝；有氧運動；氧化壓力；代謝症候群

並列摘要

Non-alcoholic fatty liver disease (NAFLD) encompasses simple steatosis and non-alcoholic steatohepatitis (NASH) that can progress to cirrhosis and hepatocellular carcinoma. In recent years, NAFLD has emerged as a global public health problem, particularly among patients who are obese, diabetic, or have the metabolic syndrome. The development and progression of NAFLD to NASH represents a complex pathophysiological process. The traditional model for the development of steatohepatitis comprises of a 'two hit' scenario. The first hit is the development of a fatty liver in the context of obesity and consequent insulin resistance. The second hit is initiated by oxidative stress and subsequent lipid peroxidation, together with the production of inflammatory cytokines which lead to inflammation and ultimately fibrosis. However, ample evidence indicates that exercise increases energy expenditure, reduces the accumulation of body fat, increases insulin sensitivity, regulates cytokine secretion and maintains oxidative balance. In conclusion, an aerobic exercise intervention is beneficial among patients with NAFLD. Regular exercise and proper dietary habits can prevent the occurrence of NAFLD.

並列關鍵字

non-alcoholic fatty liver disease ； aerobic exercise ； oxidative stress ； metabolic syndrome

參考文獻

Albu, J. B., Heilbronn, L. K., Kelley, D. E., Smith, S. R., Azuma, K., Berk, E. S., et al. (2010). Metabolic changes following a 1-year diet and exercise intervention in patients with type 2 diabetes. Diabetes, 59 (3), 627-633.

Bhat, G., Baba, C. S., Pandey, A., Kumari, N., & Choudhuri, G. (2012). Life style modification improves insulin resistance and liver histology in patients with non-alcoholic fatty liver disease. World J Hepatol, 4 (7), 209-217.

Bradley, R. L., Jeon, J. Y., Liu, F. F., & Maratos-Flier, E. (2008). Voluntary exercise improves insulin sensitivity and adipose tissue inflammation in diet-induced obese mice. Am J Physiol Endocrinol Metab, 295 (3), E586-594.

Cai, D., Yuan, M., Frantz, D. F., Melendez, P. A., Hansen, L., Lee, J., et al. (2005). Local and systemic insulin resistance resulting from hepatic activation of IKK-beta and NF-kappaB. Nat Med, 11 (2), 183-190.

Day, C. P., & James, O. F. (1998). Steatohepatitis: a tale of two “hits”? Gastroenterology, 114 (4), 842-845.

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運動對於改善非酒精性脂肪肝之探討

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