Objective: To study the nutritional status and energy metabolic characteristics of patients with nonalcoholic fatty liver disease (NAFLD), and to provide evidence for clinical evaluation and intervention. Methods: A total of 359 NAFLD patients diagnosed on ultrasound from June 2015 to March 2017 were selected as study subjects and divided into mild, moderate to severe fatty liver disease group and 50 healthy subjects as control group. The changes of ICW, ECW, body fat, skeletal muscle, protein and visceral fat area (VFA) of patients and controls were analyzed by using body composition analyzer. The energy metabolism index was measured by the oxidation rate of resting energy expenditure(REE), respiratory quotient (RQ), and the oxidation rates of the three nutrients (CHO %, FAT %, and PRO %). According to different types of data, non-parametric tests like Kruskal-Wallis or χ(2) were used for this analysis. Results: Compared with the mild fatty liver group and the control group, the moderate and severe fatty liver group the BMI, waist circumference, waist-hip ratio were significantly elevated (P-value < 0.001), and their serum alanine aminotransferase, triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein, FBS levels were significantly increased (P value < 0.05). The Body composition analysis showed that there was no significant difference in skeletal muscle content between the three groups (P = 0.067). The ICW, ECW, protein, body fat content of moderate and severe fatty liver group were significantly higher than those of mild fatty liver group and control group (P < 0.01), but there was no significant difference between the mild fatty liver group and the control group. There was significant difference in the VFA between the three groups, while VFA in the moderate and severe fatty liver group was significantly increased. Metabolic results showed that the RQ of patients with moderate-severe fatty liver and mild fatty liver were 0.72 ± 0.08 and 0.78 ± 0.06, respectively, which were lower than those of the control group (0.80 ± 0.02), P = 0.004. Resting energy expenditure (REE) was not significantly different between moderate and severe fatty liver group and mild fatty liver group (P = 0.207), but both were significantly higher than those of the control group (P < 0.001). The percentages of CHO, FAT and PRO in moderate and severe fatty liver group were 19.49% ± 9.71%, 66.23% ± 12.54% and 14.22% ± 6.11% respectively. Compared with the control group, CHO % decreased, and FAT % increased. Conclusion: NAFLD patients have different extent of nutritional imbalance and energy metabolism disorders, the use of Body Composition analyzer and metabolic cart can comprehensively assess and monitor NAFLD patient's nutrition and energy metabolism status, to provide a basis for clinical intervention.
目的： 研究非酒精性脂肪性肝病（NAFLD）患者的营养状态和能量代谢特点，为临床评估及干预提供依据。 方法： 选取2015年6月至2017年3月就诊的359例B型超声检测符合脂肪肝的NAFLD患者为研究对象，分为轻度脂肪肝组及中重度脂肪肝组，以50例健康体检者为对照组，应用人体成分分析仪分析患者及对照的细胞内水（ICW）、细胞外水（ECW）、体脂肪、骨骼肌、蛋白质含量及内脏脂肪面积（VFA）的变化；应用代谢车进行能量代谢指标测定，包括静息能量消耗（REE）、呼吸商（RQ），以及三大营养物质的氧化率（碳水化合物CHO %、脂肪FAT %、蛋白质PRO %）。据资料不同分别用方差分析、K-W非参数检验或χ(2)检验。 结果： 中重度脂肪肝组与轻度脂肪肝组及对照组相比，其BMI、腰围、腰臀比均显著升高（P值均< 0.001），其血清丙氨酸氨基转移酶、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、空腹血糖的水平显著升高（P值均< 0.05）。人体成分分析显示三组间骨骼肌含量差异无统计学意义，P = 0.067；中重度脂肪肝组患者的ICW、ECW、蛋白质、体脂肪含量较轻度脂肪肝组及对照组均明显增加（P值均< 0.01），但轻度脂肪肝组和对照组之差异间均无统计学意义；三组间VFA则差异均有统计学意义，中重度脂肪肝组VFA显著增加。代谢车测定结果显示中重度脂肪肝组及轻度脂肪肝组的RQ分别为0.72±0.08及0.78±0.06，均低于对照组（0.80±0.02），P = 0.004。REE在中重度脂肪肝组及轻度脂肪肝组间差异无统计学意义（P = 0.207），但均明显高于对照组（P值均< 0.001）。中重度脂肪肝组CHO %、FAT %、PRO %分别为19.49%±9.71%、66.23%±12.54%、14.22%±6.11%，与对照组相比较，CHO %下降，FAT %上升。 结论： NAFLD患者存在不同程度营养失衡和能量代谢紊乱，应用人体成分分析仪和代谢车可以综合评估和监测NAFLD患者的营养和能量代谢状态，为临床干预提供依据。.
Keywords: Bioelectric impedance analysis; Nonalcoholic fatty liver disease; Respiratory quotient; Resting energy expenditure.