medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2013-10-46-51medsovet-1123Research ArticleГепатологияHepatologyНеалкогольная жировая болезнь печени: от научных достижений к клиническим алгоритмамNonalcoholic fatty liver disease: from research success to clinical algorithmsВовкЕ. И.VovkE. I.noemail@neicon.ruМГМСУ им. А.И. ЕвдокимоваРоссияMSUMD named after A.I. Evdokimov, subdepartment of clinical pharmacologyRussian Federation2013301220130104651Copyright © Вовк Е.И., 20132013Вовк Е.И.Vovk E.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/1123

Неалкогольная жировая болезнь печени (НАЖБП) развивается при заболеваниях различной этиологии, объединяемых общим патоморфологическим феноменом: жировой инфильтрацией паренхимы печени с присоединением асептического воспаления и последующим фиброгенезом. В общей практике первичная НАЖБП имеет наибольшее значение как ранний маркер сахарного диабета 2 типа и высокого риска ССЗ, а также предиктор инсулинорезистентности и сахарного диабета 2 типа у больных морбидным общим или висцеральным ожирением и метаболическим синдромом. Учитывая клиническое и социальное значение ССЗ, проблема ранней диагностики и лечения НАЖБП требует координации усилий врачей всех специальностей.

Nonalcoholic fatty liver disease (NAFLD) is a comorbidity of diseases of various etiology characterized by a common pathologic phenomenon: fatty infiltration of the liver parenchyma followed by aseptic inflammation and subsequent fibrogenesis. In general practice, primary NAFLD is a valuable early marker of diabetes mellitus type 2 and high cardiovascular risk. It also predicts insulin resistance and type 2 diabetes in patients with morbid general or visceral obesity and metabolic syndrome. Given the clinical and social importance of CVD, early diagnosis and treatment of NAFLD require a joint effort from doctors of all profiles.

неалкогольная жировая болезнь печениметаболический синдромэпидемиологияпатогенезклиникатерапияnon-alcoholic fatty liver diseasemetabolic syndromeepidemiologypathogenesisclinical symptomstreatmentReferencesHarrison’s Principles of Internal Medicine, 17th ed.New York: McGraw-Hill Medical Publishing Division).Harrison’s Principles of Internal Medicine, 17th ed.New York: McGraw-Hill Medical Publishing Division).Гастроэнтерология. Национальное руководство / под ред. В.Т. Ивашкина, Т.Л. Лапина. М.: ГЭОТАР-Медиа, 2008. С. 626–632.Гастроэнтерология. Национальное руководство / под ред. В.Т. Ивашкина, Т.Л. Лапина. М.: ГЭОТАР-Медиа, 2008. С. 626–632.Bellentani S., Scaglioli F., Marino M., Bedogni G. Epidemiology of non–alcoholic fatty liver disease // Dig. Dis. 2010. №28. Р. 155–161.Bellentani S., Scaglioli F., Marino M., Bedogni G. Epidemiology of non–alcoholic fatty liver disease // Dig. Dis. 2010. №28. Р. 155–161.Suzuki A., Angulo P., Lymp J., St. Sauver J., Muto A., Okada T., Lindor K. hronological development of elevated aminotransferases in a nonalcoholic population // HEPATOLOGY. 2005. №41(1). Р. 64–71.Suzuki A., Angulo P., Lymp J., St. Sauver J., Muto A., Okada T., Lindor K. hronological development of elevated aminotransferases in a nonalcoholic population // HEPATOLOGY. 2005. №41(1). Р. 64–71.Hamaguchi M., Kojima T., Takeda N. et al. The metabolic syndrome as a predictor of non-alcoholic fatty liver disease // Ann. Intern. Med. 2005. №143(10). Р. 722–728.Hamaguchi M., Kojima T., Takeda N. et al. The metabolic syndrome as a predictor of non-alcoholic fatty liver disease // Ann. Intern. Med. 2005. №143(10). Р. 722–728.Whalley S., Puvanachandra P., Desai A., Kennedy H. HEPATOLOGY outpatient service provision in secondary care: a study of liver disease incidence and resource costs // Clin. Med. 2007. №7(2). Р. 119–124.Whalley S., Puvanachandra P., Desai A., Kennedy H. HEPATOLOGY outpatient service provision in secondary care: a study of liver disease incidence and resource costs // Clin. Med. 2007. №7(2). Р. 119–124.Lee J.Y., Kim K.M., Lee S.G., Yu E., Lim Y.S., Lee H.C., Chung Y.H., Lee Y.S., Suh D.J. Prevalence and risk factors of non-alcoholic fatty liver disease in potential living liver donors in Korea: a review of 589 consecutive liver biopsies in a single center // J. Hepatol. 2007. №47(2). Р. 239–244.Lee J.Y., Kim K.M., Lee S.G., Yu E., Lim Y.S., Lee H.C., Chung Y.H., Lee Y.S., Suh D.J. Prevalence and risk factors of non-alcoholic fatty liver disease in potential living liver donors in Korea: a review of 589 consecutive liver biopsies in a single center // J. Hepatol. 2007. №47(2). Р. 239–244.Marcos A., Fischer R.A., Ham J.M., Olzinski A.T., Shiffman M.L., Sanyal A.J., Luketic V.A., Sterling R.K., Olbrisch M.E., PosnerMarcos A., Fischer R.A., Ham J.M., Olzinski A.T., Shiffman M.L., Sanyal A.J., Luketic V.A., Sterling R.K., Olbrisch M.E., PosnerM.P. Transplantation. 2000. №69. Р. 2410–2415.M.P. Transplantation. 2000. №69. Р. 2410–2415.Маев И.В., Дичева Д.Т., Лебедева Е.Г., Зайцева Е.В. Роль эссенциальных фосфолипидов в современных схемах лечения неалкогольного стеатогепатита // Гастроэнтерология. Приложение CONSILIUM MEDICUM. 2011. №1. С. 34–37.Маев И.В., Дичева Д.Т., Лебедева Е.Г., Зайцева Е.В. Роль эссенциальных фосфолипидов в современных схемах лечения неалкогольного стеатогепатита // Гастроэнтерология. Приложение CONSILIUM MEDICUM. 2011. №1. С. 34–37.Bellentani S., Pozzato G. et al. Clinical course and risk factors of hepatitis C virus related disease in the general population: report from the Dionysos study // Gut. 1999. №44 (3). Р. 874–880.Bellentani S., Pozzato G. et al. Clinical course and risk factors of hepatitis C virus related disease in the general population: report from the Dionysos study // Gut. 1999. №44 (3). Р. 874–880.Williams C.D., Stenger J., Asike M.I., Torres D.M., Shaw J., Contreras M., Landt C.L., Harrison S.A. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study // Gastroenterology. 2011. №140. Р. 124–131.Williams C.D., Stenger J., Asike M.I., Torres D.M., Shaw J., Contreras M., Landt C.L., Harrison S.A. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study // Gastroenterology. 2011. №140. Р. 124–131.Vernon G., Baranova A., Younossi Z.M. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and nonalcoholic steatohepatitis in adults // Aliment. Pharmacol. Ther. 2011. №34. Р. 274–285.Vernon G., Baranova A., Younossi Z.M. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and nonalcoholic steatohepatitis in adults // Aliment. Pharmacol. Ther. 2011. №34. Р. 274–285.Frith J., Day C.P., Henderson E., Burt A.D., Newton J.L. Non-alcoholic fatty liver disease in older PEOPLE // GERONTOLOGY. 2009. №55(6). Р. 607–613.Frith J., Day C.P., Henderson E., Burt A.D., Newton J.L. Non-alcoholic fatty liver disease in older PEOPLE // GERONTOLOGY. 2009. №55(6). Р. 607–613.Драпкина О.М., Корнеева О.Н. Неалкогольная жировая болезнь печени и сердечно-сосудистый риск: влияние женского пола. ФАРМАТЕКА, 2010, № 15, стр. 1-5.Драпкина О.М., Корнеева О.Н. Неалкогольная жировая болезнь печени и сердечно-сосудистый риск: влияние женского пола. ФАРМАТЕКА, 2010, № 15, стр. 1-5.Chalasani N, obair Younossi Z, Lavine J E. et al. The Diagnosis and Management of Non-Alcoholic Fatty Liver Disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. HEPATOLOGY, 2012, Vol. 55, No. 6, 2005-23.Chalasani N, obair Younossi Z, Lavine J E. et al. The Diagnosis and Management of Non-Alcoholic Fatty Liver Disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. HEPATOLOGY, 2012, Vol. 55, No. 6, 2005-23.Hamaguchi M, Kojima T, Takeda N, et al. Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease. World J Gastroenterol 2007;13(10):1579–84.Hamaguchi M, Kojima T, Takeda N, et al. Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease. World J Gastroenterol 2007;13(10):1579–84.Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006 Feb;43(2 Suppl 1):S99-S11.Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006 Feb;43(2 Suppl 1):S99-S11.Das U.N. Is obesity an inflammatory condition? Nutrtion. – 2001. – Vol. 17. – P.953-966.Das U.N. Is obesity an inflammatory condition? Nutrtion. – 2001. – Vol. 17. – P.953-966.Assy N, Kaita K, Mymin D, Levy C, Rosser B, Minuk G. Fatty infiltration of liver in hyperlipidemic patients. Dig Dis SciAssy N, Kaita K, Mymin D, Levy C, Rosser B, Minuk G. Fatty infiltration of liver in hyperlipidemic patients. Dig Dis SciДрапкина О., Смирин В., Ивашкин В. Сахарный диабет как фактор риска неалкогольной жировой болезни печени. Врач. – 2010; №3: 7.Драпкина О., Смирин В., Ивашкин В. Сахарный диабет как фактор риска неалкогольной жировой болезни печени. Врач. – 2010; №3: 7.Драпкина О.М., Смирин В.И., Ивашкин В.Т. Патогенез, лечение и эпидемиология НАЖБП – что нового? Эпидемиология НАЖБП в России, Русский медицинский журнал, Болезни органов пищеварения, №28. 1717Драпкина О.М., Смирин В.И., Ивашкин В.Т. Патогенез, лечение и эпидемиология НАЖБП – что нового? Эпидемиология НАЖБП в России, Русский медицинский журнал, Болезни органов пищеварения, №28. 1717Targher G, Bertolini L, Rodella S, et al. Nonalcoholic Fatty Liver Disease Is Independently Associated With an Increased Incidence of Cardiovascular Events in Type 2 Diabetic Patients. Diabetes Care 2007;30(8):2119–21.Targher G, Bertolini L, Rodella S, et al. Nonalcoholic Fatty Liver Disease Is Independently Associated With an Increased Incidence of Cardiovascular Events in Type 2 Diabetic Patients. Diabetes Care 2007;30(8):2119–21.Ratziu V. et al. A proposal for current and future therapeutic strategies for NASH // EASL Special Conference «NAFLD/NASH and Related Metabolic Disease», Bologna, Italy, 2009. – Program and Abstracts. – P. 29.Ratziu V. et al. A proposal for current and future therapeutic strategies for NASH // EASL Special Conference «NAFLD/NASH and Related Metabolic Disease», Bologna, Italy, 2009. – Program and Abstracts. – P. 29.Mohanty P., Ghanim H., Hamouda W., et al. Both lipid and protein intakes stimulate increased generation of reactive oxygen species by polymorphonuclear leukocytes and mononuclear cells // Am. J. Clin. Nutr. – 2002. – Vol. 75. – P.767-772.Mohanty P., Ghanim H., Hamouda W., et al. Both lipid and protein intakes stimulate increased generation of reactive oxygen species by polymorphonuclear leukocytes and mononuclear cells // Am. J. Clin. Nutr. – 2002. – Vol. 75. – P.767-772.Ricci R. et al. Requirement of JNK2 for scavenger receptor A-mediated foam cell formation in atherogenesis // Science.– 2004. – Vol. 306. – P.1558-1561.Ricci R. et al. Requirement of JNK2 for scavenger receptor A-mediated foam cell formation in atherogenesis // Science.– 2004. – Vol. 306. – P.1558-1561.Wang S., Leonard S.S., Castranova V., et al. The role of superoxide radical in TNF-alpha induced NF-kappaB activation // Ann. Clin. Lab. Sci. – 199. – Vol. 29. – P.192-199.Wang S., Leonard S.S., Castranova V., et al. The role of superoxide radical in TNF-alpha induced NF-kappaB activation // Ann. Clin. Lab. Sci. – 199. – Vol. 29. – P.192-199.Woronicz J.D., Gao X., Cao Z., et al. IkappaB kinase-beta: NF-kappaB activation and complex formation with IkappaB kinase-alpha and NIK // Science. – 1997. – Vol. 278. – P.866-869Woronicz J.D., Gao X., Cao Z., et al. IkappaB kinase-beta: NF-kappaB activation and complex formation with IkappaB kinase-alpha and NIK // Science. – 1997. – Vol. 278. – P.866-869Seo J.B. Activated liver X receptors stimulate adipocyte differentiation through induction of peroxisome proliferator-activated receptor gamma expression // Mol. Cell. Biol. – 2004. – Vol. 24. – P.3430-3444.Seo J.B. Activated liver X receptors stimulate adipocyte differentiation through induction of peroxisome proliferator-activated receptor gamma expression // Mol. Cell. Biol. – 2004. – Vol. 24. – P.3430-3444.Carroll M.F., Schade D.S. Timing of antioxidant vitamin ingestion alters postprandial proatherogenic serum markers //Circulation. – 2003. – Vol. 108. – P.24-31.Carroll M.F., Schade D.S. Timing of antioxidant vitamin ingestion alters postprandial proatherogenic serum markers //Circulation. – 2003. – Vol. 108. – P.24-31.Nappo F., Esposito K., Cioffi M., et al. Postprandial endothelial activation in healthy subjects and in type 2 diabetic patients: role of fat and carbohydrate meals // J. Am. Coll.Cardio. – 2002. – Vol. l39. – P.1145-1150.Nappo F., Esposito K., Cioffi M., et al. Postprandial endothelial activation in healthy subjects and in type 2 diabetic patients: role of fat and carbohydrate meals // J. Am. Coll.Cardio. – 2002. – Vol. l39. – P.1145-1150.Oostrom A.J., Sijmonsma T.P., Verseyden C., et al. Postprandial recruitment of neutrophils may contribute to endothelial dysfunction // J. Lipid Res. – 2003. – Vol. 44. –P.576-583.Oostrom A.J., Sijmonsma T.P., Verseyden C., et al. Postprandial recruitment of neutrophils may contribute to endothelial dysfunction // J. Lipid Res. – 2003. – Vol. 44. –P.576-583.Malhi H., Gores G. Molecular mechanisms of lipotoxicity in Nonalcoholic Fatty Liver Disease. Semin. Liver.Dis. – 2008; 28:360 – 369.Malhi H., Gores G. Molecular mechanisms of lipotoxicity in Nonalcoholic Fatty Liver Disease. Semin. Liver.Dis. – 2008; 28:360 – 369.Маммаев С.Н., Багомедова Н.В., Богомолов П.О. и др. Цитокиновая система при неалкогольном стеатогепатите // Рос. журн. гастроэнтерол. гепатол. колопроктол. – 2007. – Т. 17, № 4. – С. 30–35.Маммаев С.Н., Багомедова Н.В., Богомолов П.О. и др. Цитокиновая система при неалкогольном стеатогепатите // Рос. журн. гастроэнтерол. гепатол. колопроктол. – 2007. – Т. 17, № 4. – С. 30–35.Mohanty P., Hamouda W., Garg R., et al. Glucose challenge stimulates reactive oxygen species (ROS) generation by leucocytes // J. Clin. Endocrinol. Metab. – 2000. – Vol. 85. – P.2970-2973.Mohanty P., Hamouda W., Garg R., et al. Glucose challenge stimulates reactive oxygen species (ROS) generation by leucocytes // J. Clin. Endocrinol. Metab. – 2000. – Vol. 85. – P.2970-2973.Aljada A., Ghanim H., Mohanty P. et al. Glucose intake induces an increase in AP-1 and Egr-1 binding activities and tissue factor and matrix metalloproteinase expressions in mononuclear cells and plasma tissue factor and matrix metalloproteinase concentrations // Am J Clin Nutr. – 2004. – Vol. 80. – P.51–57.Aljada A., Ghanim H., Mohanty P. et al. Glucose intake induces an increase in AP-1 and Egr-1 binding activities and tissue factor and matrix metalloproteinase expressions in mononuclear cells and plasma tissue factor and matrix metalloproteinase concentrations // Am J Clin Nutr. – 2004. – Vol. 80. – P.51–57.Kaneto H. et al. Possible novel therapy for diabetes with cell-permeable JNK-inhibitory peptide // Nat. Med. – 2004. – Vol. 10. – P.1128-1132.Kaneto H. et al. Possible novel therapy for diabetes with cell-permeable JNK-inhibitory peptide // Nat. Med. – 2004. – Vol. 10. – P.1128-1132.Stulnig, Markus Berger, Michael Roden, Harald Sting. The FASEB Journal. Elevated serum free fatty acid concentrations inhibit T lymphocyte signaling. – 2000. – Vol. 14. – P.939-947.Stulnig, Markus Berger, Michael Roden, Harald Sting. The FASEB Journal. Elevated serum free fatty acid concentrations inhibit T lymphocyte signaling. – 2000. – Vol. 14. – P.939-947.Marschall H.-U. & Einarsson C. Gallstone disease. Journal of Internal Medicine 2007; 261; 529–542.Marschall H.-U. & Einarsson C. Gallstone disease. Journal of Internal Medicine 2007; 261; 529–542.Dowling R.H. Review: pathogenesis of gallstones. Aliment Pharmacol Ther., 2000; 14 (Suppl): 39-47.Dowling R.H. Review: pathogenesis of gallstones. Aliment Pharmacol Ther., 2000; 14 (Suppl): 39-47.Лейшнер У. Практическое руководство по заболеваниям желчных путей.-М.: ГЭОТАР-МЕД, 2001.-264 с.Лейшнер У. Практическое руководство по заболеваниям желчных путей.-М.: ГЭОТАР-МЕД, 2001.-264 с.Kim JM, Lee HL, Moon W et al. Association between insulin, insulin resistance, and gallstone disease in Korean general population. Korean J Gastroenterol. 2007 Sep;50(3):183-7.Kim JM, Lee HL, Moon W et al. Association between insulin, insulin resistance, and gallstone disease in Korean general population. Korean J Gastroenterol. 2007 Sep;50(3):183-7.Méndez-Sánchez N, Bahena-Aponte J, Chávez-Tapia NC et al. Strong association between gallstones and cardiovascular disease. Am J Gastroenterol. 2005 Apr;100(4):827-30.Méndez-Sánchez N, Bahena-Aponte J, Chávez-Tapia NC et al. Strong association between gallstones and cardiovascular disease. Am J Gastroenterol. 2005 Apr;100(4):827-30.Chen CH, Huang MH, Yang JC et al. Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults.J Clin Gastroenterol. 2006 Sep;40(8):745-52.Chen CH, Huang MH, Yang JC et al. Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults.J Clin Gastroenterol. 2006 Sep;40(8):745-52.Dandona P, Aljada A, Chaudhuri A, et al. Metabolic Syndrome A Comprehensive Perspective Based on Interactions Between Obesity, Diabetes, and Inflammation Circulation. – 2005. – Vol. 111. – P.1448-1454.Dandona P, Aljada A, Chaudhuri A, et al. Metabolic Syndrome A Comprehensive Perspective Based on Interactions Between Obesity, Diabetes, and Inflammation Circulation. – 2005. – Vol. 111. – P.1448-1454.Mudipalli A. Indian J Med Res, 2007, 126:518-527.Mudipalli A. Indian J Med Res, 2007, 126:518-527.Simopoulos AP. Human requirement for Ω-3 polyunsaturated fatty acids.Poult Sci. 2000 Jul;79(7):961-70.Simopoulos AP. Human requirement for Ω-3 polyunsaturated fatty acids.Poult Sci. 2000 Jul;79(7):961-70.Mastellone I, Polichetti E, Grиs S. Dietary soybean phosphatidylcholine lowers lipidemia. Mechanisms at the levels of intestine, endothelial cell, and hepatobiliary axis. J Nutr Biochem, 2000, 11, 461–466.Mastellone I, Polichetti E, Grиs S. Dietary soybean phosphatidylcholine lowers lipidemia. Mechanisms at the levels of intestine, endothelial cell, and hepatobiliary axis. J Nutr Biochem, 2000, 11, 461–466.LeBlanc MJ, Brunet S, Bouchard G et al. Effects of dietary soybean lecithin on plasma lipid transport and hepatic cholesterol metabolism in rats. J Nutr Biochem. 2003 Jan;14(1):40-8.LeBlanc MJ, Brunet S, Bouchard G et al. Effects of dietary soybean lecithin on plasma lipid transport and hepatic cholesterol metabolism in rats. J Nutr Biochem. 2003 Jan;14(1):40-8.Lefebvre P, Cariou B, Lien F et al. Role of Bile Acids and Bile Acid Receptors in Metabolic Regulation. Physiol Rev 2009; 89: 147–191,Lefebvre P, Cariou B, Lien F et al. Role of Bile Acids and Bile Acid Receptors in Metabolic Regulation. Physiol Rev 2009; 89: 147–191,Trauner M, Claudel T, Fickert P, et al. Bile acids as regulators of hepatic lipid and glucose metabolism. Dig Dis. 2010; 28(1):220-4.;Trauner M, Claudel T, Fickert P, et al. Bile acids as regulators of hepatic lipid and glucose metabolism. Dig Dis. 2010; 28(1):220-4.;Keizman D. et al. Нarefuah.147(4):344-9,372.Keizman D. et al. Нarefuah.147(4):344-9,372.Rodriguez-Leyva D. et al., The cardiovascular effects of flaxseed and its omega-3 fatty acid, alpha-linolenic acid. Can J Cardiol. 2010 November; 26(9): 489–496.Rodriguez-Leyva D. et al., The cardiovascular effects of flaxseed and its omega-3 fatty acid, alpha-linolenic acid. Can J Cardiol. 2010 November; 26(9): 489–496.Gaby AR. Nutritional approaches to prevention and treatment of gallstones. Altern Med Rev. 2009 Sep;14(3):258-67.Gaby AR. Nutritional approaches to prevention and treatment of gallstones. Altern Med Rev. 2009 Sep;14(3):258-67.Tuomilehto J., Lindstrom J., Eriksson J.G., et al. Uusitupa M: Finnish Diabetes Study: prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance . N. Engl. J. Med. – 2001. – Vol. 344. –P.1343-1350.Tuomilehto J., Lindstrom J., Eriksson J.G., et al. Uusitupa M: Finnish Diabetes Study: prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance . N. Engl. J. Med. – 2001. – Vol. 344. –P.1343-1350.Klein B, Platat C., Drai J., Oujaa M., et al. Plasma fatty acid composition is associated with the metabolic syndrome and low-grade inflammation in overweight adolescents. Am. J. Clin. Nutr. – 2005 – Vol. 82. – P.1178 1184.Klein B, Platat C., Drai J., Oujaa M., et al. Plasma fatty acid composition is associated with the metabolic syndrome and low-grade inflammation in overweight adolescents. Am. J. Clin. Nutr. – 2005 – Vol. 82. – P.1178 1184.Kidd PM. Cell membranes, endothelia, and atherosclerosis – the importance of Phosphatidylcholine. Altern Med Rev 1996;1:148-167.Kidd PM. Cell membranes, endothelia, and atherosclerosis – the importance of Phosphatidylcholine. Altern Med Rev 1996;1:148-167.Mourad AM et al. Influence of Soy Lecithin Administration on Hypercholesterolemia. Cholesterol, Volume 2010, Article ID 824813.Mourad AM et al. Influence of Soy Lecithin Administration on Hypercholesterolemia. Cholesterol, Volume 2010, Article ID 824813.Ma X., Zhao J., Lieber C.S. Polyenylphosphatidylcholine attenuates non-alcoholic hepatic fibrosis and accelerate its regression. J. Hepatol.- 1996. – 24:604-13.Ma X., Zhao J., Lieber C.S. Polyenylphosphatidylcholine attenuates non-alcoholic hepatic fibrosis and accelerate its regression. J. Hepatol.- 1996. – 24:604-13.Watanabe A., Kobayashi M., Morishita N., Nagashima H. Multimodal treatement resulting in a rapid improvement of fatty liver disease in obese patients. Curr Ther. Res.- 1988.- 43:239-46.Watanabe A., Kobayashi M., Morishita N., Nagashima H. Multimodal treatement resulting in a rapid improvement of fatty liver disease in obese patients. Curr Ther. Res.- 1988.- 43:239-46.Weber, P. C., and A. Leaf, 1991. Cardiovascular effects of omega-3 fatty acids.Weber, P. C., and A. Leaf, 1991. Cardiovascular effects of omega-3 fatty acids.Atherosclerosis risk factor modificationAtherosclerosis risk factor modificationKuntz E, Kuntz H-D: Гепатология, Учебное пособие и атлас , 3 издание Springer Press, Heidelberg 2008; глава 40., С.896.Kuntz E, Kuntz H-D: Гепатология, Учебное пособие и атлас , 3 издание Springer Press, Heidelberg 2008; глава 40., С.896.Ревич Б.А., Авалиани С.Л., Тихонова Г.И. Экологическая эпидемиология / М.: Издательский центр «Академия», 2004. — 384 с.Ревич Б.А., Авалиани С.Л., Тихонова Г.И. Экологическая эпидемиология / М.: Издательский центр «Академия», 2004. — 384 с.

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