伴随生活方式的改变,代谢相关脂肪性肝病(MAFLD)在慢性肝病中占比逐渐增加,影响全球 25%的成人,并被认 为可与其他慢性肝病合并存在。 MAFLD 不仅与慢性肝炎、肝硬化、肝细胞癌发生发展密切相关,与肥胖、2 型糖尿病互为因 果,而且可促进甲状腺功能减退症、代谢综合征、心血管疾病、恶性肿瘤的发病。 MAFLD 目前尚无治疗的特效药物,改变不良 生活方式和减轻体重是防治 MAFLD 及其合并症的关键措施。 生酮饮食是一种低碳水化合物、高脂肪与适量蛋白质的配方饮 食模式,可将机体由葡萄糖供能转换到脂肪动员,进而产生酮体的供能模式。 基于此理论基础,生酮饮食被认为具有潜在的 减轻体质量、改善胰岛素抵抗、调节糖脂代谢的作用,其对 2 型糖尿病、肥胖的辅助治疗效果已在许多动物模型及临床试验中 得到验证,而生酮饮食在 MAFLD 的临床应用中多为短期研究,目前二者关系尚处于探索阶段。 本文就生酮饮食在 MAFLD 患 者减轻体质量、改善胰岛素抵抗方面的机制、研究报道进行综述。

With lifestyle changes metabolism-related fatty liver disease MAFLD accounts for a gradual increase in chronic liver disease affecting 25% of adults worldwide and being thought to be co-present with other chronic liver diseases. MAFLD is not only closely related to the occurrence and development of chronic hepatitis cirrhosis hepatocellular carcinoma but also considered as a cause and effect with obesity and type 2 diabetes. Besides it also promotes the onset of hypothyroidism metabolic syndrome cardiovascular disease and malignant tumors. Given the fact that there is currently no specific drug for treatment adopting a healthy lifestyle and weight loss are key to the prevention and treatment of MAFLD and its comorbidities. The ketogenic diet is a therapeutic diet with low carbohydrate high fat and appropriate protein that converts the body's energy supply from glucose to fat mobilization which in turn produces the energy supply mode of ketone bodies. Based on this theoretical basis ketogenic diet is considered to have the potential to reduce body mass improve insulin resistance regulate glycolipid metabolism. And the effect of it as the adjuvant treatment for diabetes mellitus type 2 and obesity has been verified in many animal models and clinical trials. Still the clinical application of ketogenic diet in MAFLD is mostly short-term research and the relationship between the two is still in the exploration stage. This article reviews the research reports on how ketogenic diets reduce body mass and improve insulin resistance in patients with MAFLD.