avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2025-15-4-262-274MQICUPavk-2044Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESНеалкогольная жировая болезнь печени у пациентов с нормальной массой тела: эпидемиология, актуальные вопросы скрининга и диагностики, подходы к терапииNonalcoholic Fatty Liver Disease in Patients with Normal Body Weight: Epidemiology, Current Issues of Screening and Diagnosis, Approaches to Therapyhttps://orcid.org/0000-0003-1699-0881НикитинИ. Г.NikitinI. G.

Никитин Игорь Геннадиевич — доктор медицинских наук, профессор, заведующий кафедрой госпитальной терапии им. академика Г.И. Сторожакова

Москва

Igor G. Nikitin — Doctor of Medical Sciences, Professor, Head of the Department of Hospital Therapy named after Academician G.I. Storozhakov, Institute of Clinical Medicine

Moscow

igor.nikitin.64@mail.ruhttps://orcid.org/0000-0001-9262-9233СтародубоваА. В.StarodubovaA. V.

Стародубова Антонина Владимировна — доктор медицинских наук, профессор, заведующая кафедрой факультетской терапии Института клинической медицины

Москва

Antonina V. Starodubova — Doctor of Medical Sciences, Professor, Head of the Department of Faculty Therapy of the Institute of Clinical Medicine 

Moscow

lecebnoedelo@yandex.ruhttps://orcid.org/0000-0002-2028-8748КислякО. А.КislyakO. A.

Кисляк Оксана Андреевна — доктор медицинских наук, почетный профессор кафедры факультетской терапии 

Москва

Oksana A. Kislyak — Doctor of Medical Sciences, Honorary Professor of the Department of Faculty Therapy of the Institute of Clinical Medicine

Moscow

kisliakoa@mail.ruДемидоваТ. Ю.DemidovaT. Yu.

Демидова Татьяна Юльевна — доктор медицинских наук, заведующая кафедрой эндокринологии Института клинической медицины

Москва

Tatyana Yu. Demidova — Doctor of Medical Sciences, Head of the Department of Endocrinology, Institute of Clinical Medicine

Moscow

t.y.demidova@gmail.comhttps://orcid.org/0000-0001-6029-1864ИльченкоЛ. Ю.IlchenkoL. Yu.

Ильченко Людмила Юрьевна — доктор медицинских наук, профессор кафедры госпитальной терапии им. академика Г.И. Сторожакова Института клинической медицины

Москва

Lyudmila Yu. Ilchenko — Doctor of Medical Sciences, Professor of the Department of Hospital Therapy named after Academician G.I. Storozhakov of the Institute of Clinical Medicine

Moscow

ilchenko-med@yandex.ruИнститут клинической медицины ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияInstitute of Clinical Medicine, N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian Federation202529072025154262274Copyright © Никитин И.Г., Стародубова А.В., Кисляк О.А., Демидова Т.Ю., Ильченко Л.Ю., 20252025Никитин И.Г., Стародубова А.В., Кисляк О.А., Демидова Т.Ю., Ильченко Л.Ю.Nikitin I.G., Starodubova A.V., Кislyak O.A., Demidova T.Y., Ilchenko L.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/2044

Неалкогольная жировая болезнь печени (НАЖБП) в настоящий момент времени представляет собой серьезную медико-социальную проблему для общественных систем здравоохранения в связи с ее широким распространением, потенциальным риском развития цирроза печени (ЦП) и гепатоцеллюлярной карциномы (ГЦК). Кроме того, наличие НАЖБП в соматическом континууме пациента сопряжено с достоверно большей частотой развития сердечно-сосудистых событий и сахарного диабета типа 2 (СД2). Наиболее часто НАЖБП регистрируется у пациентов с избыточной массой тела. Отдельного внимания исследователей и клиницистов заслуживают пациенты с НАЖБП, имеющие нормальную массу тела. Несмотря на, казалось бы, относительно благоприятный профиль «метаболического здоровья» риск прогрессирования НАЖБП в ЦП и ГЦК, а также сопряженность с сердечно-сосудистыми событиями в обсуждаемой группе пациентов ничуть не меньше, чем в группе пациентов с НАЖБП и высоким индексом массы тела (ИМТ). Отсутствие ранних симптомов и нарушений со стороны некоторых показателей, характеризующих «метаболическое здоровье» у пациентов с НАЖБП и нормальной массой тела, способствует поздней и несвоевременной диагностике заболевания печени и, как следствие, его прогрессированию и формированию тяжелых сосудистых и метаболических нарушений в последующем. В представленном обзоре авторы предлагают некоторые эпидемиологические данные о распространенности НАЖБП у пациентов с нормальной массой тела, вариантах клинического течения НАЖБП у обсуждаемой группы пациентов и предлагают сделать особый акцент на очевидную необходимость значительно более широкого вовлечения пациентов с нормальной массой тела в клинические и научные исследования, посвященные детальному изучению патогенеза, вопросов организации медицинской помощи и лечения НАЖБП.

Nonalcoholic fatty liver disease (NAFLD) is currently a serious medical and social problem for public health systems due to its high prevalence, potential development of liver cirrhosis (LC) and hepatocellular carcinoma (HCC). In addition, the presence of NAFLD in the patient’s somatic continuum is associated with a significantly higher incidence of cardiovascular events and type 2 diabetes mellitus (T2DM). The most frequent NAFLD is registered in patients with excessive body weight. Patients with normal body weight deserve special attention of researchers and clinicians. Despite the seemingly relatively favorable profile of “metabolic health”, the risk of progression of NAFLD to CKD and HCC, as well as conjugation with cardiovascular events in this group of patients is no less than in the group of patients with NAFLD and high body mass index (BMI). The absence of early symptoms and abnormalities of some indicators characterizing “metabolic health” in patients with NAFLD and normal body weight contributes to late and untimely diagnosis of liver disease and, as a consequence, its progression and the formation of severe vascular and metabolic disorders in the future. In the presented review the authors offer some epidemiological data on the prevalence of NAFLD in patients with normal body weight, variants of the clinical course of NAFLD in the discussed group of patients and propose to make a special emphasis on the obvious need for a much wider involvement of patients with normal body weight in clinical and scientific studies devoted to a detailed study of the pathogenesis, issues of organization of medical care and treatment of NAFLD.

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The authors declare that there are no conflicts of interest present.