非酒精性脂肪肝病之非藥物治療

Non-Pharmacological Treatments for Non-Alcoholic Fatty Liver Disease

肥胖是非酒精性脂肪肝病的重要因子，因此減重也被視為治療非酒精性脂肪肝病的重要方法，目標為減去7%-10%體重。在非酒精性脂肪肝病的非藥物治療方式中，飲食和運動是最關鍵的治療方式，最近的研究強調限制熱量的重要性。地中海飲食證實可顯著改善非酒精性脂肪肝病重要的危險因子，越來越多的證據支持酒精對非酒精性脂肪肝病是有害的，最近的指南也建議有非酒精性脂肪肝病者要完全禁酒。而運動型式可根據患者的喜好制訂，有氧運動和阻力訓練皆可，以確保持之以恆的運動。對於嚴重肥胖患者來說，飲食和運動常無法達到持續減重的效果，而代謝手術的減重效果卻是有效且持久，因此已經被視為治療嚴重肥胖患者的最佳方式，代謝手術可減去25-35%體重，也對非酒精性脂肪肝病有最顯著且長期的改善。內視鏡減重及代謝治療雖然也證實可改善非酒精性脂肪肝病，但大多為針對胃內水球的研究結果，平均可減去13.2%體重，但追蹤時間只有6個月，胃鏡縮胃術可維持較長的減重效果，但對非酒精性脂肪肝病的影響則需更多的研究。至於調節腸道菌叢方式例如益生元、益生菌或微菌叢植入對非酒精性脂肪肝病的治療仍需進一步的研究。

Obesity is an important factor causing non-alcoholic fatty liver disease (NAFLD). Weight loss is regarded as an important method for the treatment of NFALD, and the goal is to lose 7%-10% of total body weight. Among the non-drug treatments for NAFLD, diet and exercise remain the key therapeutic elements in combating NAFLD. Recent studies have highlighted the importance of calorie restriction regardless of dietary composition. In addition, the Mediterranean diet has been shown to significantly improve important risk factors for NAFLD. More and more evidence support the harmful effect of alcohol on NAFLD, and recent guidelines also recommend that people with NAFLD should abstain from alcohol. Exercise patterns can be tailored according to the patient's preferences, and both aerobic exercise and resistance training can be used to ensure long-term adherence. Diet and exercise often fail to achieve sustained weight loss in severely obese patients. Metabolic surgery can achieve effective and sustained weight loss, and has been regarded as the best way to treat severely obese patients. Metabolic surgery can result in 25-35% of total body weight loss and long-term improvement in NAFLD. Although endoscopic bariatric and metabolic therapies have also been proven to improve NAFLD, most studies are derived from intragastric balloons. Intragastric balloons can result in 13.2% of total body weight loss, but the mean follow-up time is only 6 months. Endoscopic sleeve gastroplasty can maintain more sustained weight loss, but its effect on NAFLD requires more research. Methods such as prebiotics, probiotics and fecal microbiota transplantation are used to modulate the gut microbiota. However, further research is also needed to elucidate their effects on NAFLD.