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Practice guidelines on NAFLD

机译:NAFLD实践准则

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I read with interest the practice guidelines on nonalcoholic fatty liver disease (NAFLD), in which the authors fail to reference the association between high fructose corn syrup (HFCS) and NAFLD. The intake of HFCS, a combination of glucose and fructose, has increased over time and parallels both the obesity and NAFLD epidemics. Numerous studies demonstrate that the mechanism by which HFCS causes NAFLD is due to fructose. In animal models, fructose causes steatosis and fibrosis3' by either increasing hepatic lipogenesis, causing activation of pyruvate dehydrogenase, activating inflammatory pathways,6 or up-regulating the expression of sterol regulatory element-binding protein (SREBP).7In humans, excessive fructose intake can lead to increased hepatic lipid deposition, greater insulin resistance, and hypertriglyceridemia.8 NAFLD patients have been found to drink more HFCS soft drinks compared with healthy controls. A retrospective analysis of 341 NAFLD adults found that those consuming high fructose diets had more fibrosis than those consuming low fructose diets. A prospective controlled trial witri histologic endpoints is needed to define the amount of HFCS safe for NAFLD patients and to determine the extent to which fructose contributes to the pathogenesis and progression of NAFLD. However, there are currently sufficient data to recommend that NAFLD patients refrain from excessive consumption of HFCS.
机译:我感兴趣地阅读了非酒精性脂肪肝疾病(NAFLD)的实践指南,其中作者没有提及高果糖玉米糖浆(HFCS)与NAFLD之间的关联。 HFCS(葡萄糖和果糖的组合)的摄入量随时间增加,与肥胖症和NAFLD流行同时发生。大量研究表明,HFCS引起NAF​​LD的机制是由于果糖引起的。在动物模型中,果糖通过增加肝脏脂肪生成,引起丙酮酸脱氢酶激活,激活炎症途径6或上调固醇调节元件结合蛋白(SREBP)的表达而引起脂肪变性和纤维化3'。7在人类中,果糖摄入过多可以导致肝脏脂质沉积增加,胰岛素抵抗增强和高甘油三酯血症。8与健康对照组相比,NAFLD患者被发现喝更多的HFCS软饮料。对341名NAFLD成人的回顾性分析发现,与低果糖饮食相比,高果糖饮食的纤维化程度更高。需要一项前瞻性对照Witri组织学终点研究来确定对NAFLD患者安全的HFCS量,并确定果糖在NAFLD发病机理和进展中的作用程度。但是,目前有足够的数据建议NAFLD患者避免过量食用HFCS。

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