Perm Medical JournalPerm Medical JournalПермский медицинский журнал (сетевое издание "Perm medical journal")0136-14492687-1408Eco-Vector69009210.17816/pmj42420-40Literature reviewОбзор литературыReview ArticlePhenotypes of non-alcoholic fatty liver disease in people with normal and increased body mass: issues of epidemiology and etiology, clinical and pathogenetic features and diagnostic approaches. Literature reviewФенотипы неалкогольной жировой болезни печени у людей с нормальной и повышенной массой тела: вопросы эпидемиологии и этиологии, клинико-патогенетические особенности и диагностические подходы. Обзор литературыhttps://orcid.org/0000-0002-7019-6630ShevlyukovaT. P.ШевлюковаТ. П.
Russian Federation

DSc (Medicine), Professor of the Department of Obstetrics and Gynecology of the Institute of Maternity and Childhood

доктор медицинских наук, профессор кафедры акушерства и гинекологии Института материнства и детства

bula.1977@mail.ruhttps://orcid.org/0000-0002-7802-4796BulatovaI. A.БулатоваИ. А.
Russian Federation

DSc (Medicine), Head of the Department of Normal Physiology, Professor of the Department of Faculty Therapy No. 1

доктор медицинских наук, заведующая кафедрой нормальной физиологии, профессор кафедры факультетской терапии № 1

bula.1977@mail.ruhttps://orcid.org/0000-0001-6451-9045VladimirskyV. E.ВладимирскийВ. Е.
Russian Federation

DSc (Medicine), Head of the Department of Faculty Therapy No. 1

доктор медицинских наук, заведующий кафедрой факультетской терапии № 1

bula.1977@mail.ruhttps://orcid.org/0000-0003-2727-5226SmirnovaE. N.СмирноваЕ. Н.
Russian Federation

DSc (Medicine), Head of the Department of Endocrinology and Clinical Pharmacology

доктор медицинских наук, заведующая кафедрой эндокринологии и клинической фармакологии

bula.1977@mail.ruTrofimovaE. S.ТрофимоваЕ. С.
Russian Federation

Reflexologist, Expert of the BRICS Health Coalition Association, Neurologist, Director of the Clinic

врач-рефлексотерапевт, эксперт ассоциации коалиции здоровья БРИКС, невролог, директор

bula.1977@mail.ruYusupovaA. A.ЮсуповаА. А.
Russian Federation

Therapist

врач-терапевт

bula.1977@mail.ruTyumen State Medical UniversityТюменский государственный медицинский университетYe.A. Vagner Perm State Medical UniversityПермский государственный медицинский университет имени академика Е.А. Вагнера"Alternativa Perm" ClinicКлиника «Альтернатива Пермь»1109202542420400409202504092025Copyright ©; 2025, Eco-VectorCopyright ©; 2025, Эко-Вектор2025Eco-VectorЭко-Векторhttps://permmedjournal.ru/PMJ/article/view/690092

Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease worldwide, affecting 20-40% of the population, and its prevalence continues to steadily increase. However, some individuals with overweight and obesity maintain normal intrahepatic fat content, while others with normal weight develop NAFLD even in the absence of metabolic risk factors. Therefore, recent terminology has introduced a distinct NAFLD phenotype in individuals with normal body weight, the pathophysiology and clinical manifestations of which remain insufficiently studied. This review summarizes literature and original data on the prevalence of NAFLD phenotypes in individuals with normal and increased body weight, risk factors, clinical and pathogenetic features, and diagnostic approaches.

There is a need to develop screening algorithms that are less dependent on BMI and liver transaminase levels, to implement more accurate treatment strategies based on the pathogenesis of the disease, and to include individuals with normal body weight in NAFLD-related clinical trials to identify factors modulating the risk of liver steatosis, including in the absence of clinically significant metabolic dysfunction.

Неалкогольная жировая болезнь печени (НАЖБП) является распространенным хроническим заболеванием печени во всем мире, достигая 20–40 % в популяции, и продолжает неуклонно расти. Однако у некоторых людей, имеющих избыток веса и ожирение, внутрипеченочное содержание жира сохраняется нормальным, в то время как у других при нормальном весе развивается НАЖБП даже при отсутствии метаболических факторов риска. Поэтому в последней терминологии стали выделять особый фенотип НАЖБП у лиц с нормальной массой тела, патофизиология и клинические проявления которого изучены недостаточно. В данном обзоре обобщаются литературные и собственные данные о распространенности фенотипов НАЖБП у лиц с нормальной и повышенной массой тела, факторах риска, клинико-патогенетических особенностях и диагностических подходах.

Необходима разработка алгоритмов скрининга, которые в меньшей степени зависят от индекса массы тела и уровня трансаминаз в печени, внедрение более точных стратегий лечения, основанных на патогенезе заболевания, и включение людей с нормальной массой тела в клинические исследования, связанные с НАЖБП, для выявления факторов, модулирующих риск стеатоза печени, в том числе при отсутствии клинически значимой метаболической дисфункции.

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