Полиненасыщенные жирные кислоты: омега-3 и омега-6 и неалкогольная жировая болезнь печени

Бережная И.В., Симакова М.А., Сгибнева А.И., Захарова И.Н. Полиненасыщенные жирные кислоты: омега-3 и омега-6 и неалкогольная жировая болезнь печени. Педиатрия. Consilium Medicum. 2021;4:335–340.
DOI: 10.26442/26586630.2021.4.201348

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Berezhnaya IV, Zakharova IN, Simakova MA, Sgibneva AI. Polyunsaturated fatty acids: omega-3 and omega-6 and nonalcoholic fatty liver disease. Pediatrics. Consilium Medicum. 2021;4:335–340.
DOI: 10.26442/26586630.2021.4.201348

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Аннотация

История изучения полиненасыщенных жирных кислот (ПНЖК) началась более 100 лет назад. В 1909 г. P. Hartley выделил арахидоновую кислоту. Позже, через 21 год, Burr и Burr в 1930 г. показали положительное ее влияние на рост и развитие крыс. Важным в этой работе явилось то, что после повторного введения ПНЖК в рацион питания грызунов функции организма стали восстанавливаться. От момента открытия арахидоновой кислоты до доказательства ее влияния на сердечно-сосудистую систему прошло еще более 60 лет. Сегодня изучение влияния длинноцепочечных ПНЖК на здоровье человека, его интеллект, иммунную систему, связи между нейронами, течение беременности и здоровье новорожденных привело к рекомендациям широкого использования пищевых продуктов или биологических добавок, содержащих омега-3-ПНЖК. Несбалансированный пищевой рацион детей и подростков, избирательность аппетита, нарушение пищевого поведения приводят к развитию дефицитных состояний, когнитивных нарушений, ожирения и метаболического синдрома с поражением печени. Неалкогольная жировая болезнь печени (НАЖБП) и неалкогольный стеатогепатит (НАСГ) на ранних стадиях протекают бессимптомно, но именно в этот период можно изменить прогноз заболевания у детей. В статье рассмотрены международные рекомендации комплексного применения длинноцепочечных ПНЖК в комплексной терапии НАЖБП и НАСГ у детей. Сапплементация пищевого рациона введением очищенного высококачественного рыбьего жира восполняет потребность, улучшает прогноз заболевания, снижает инсулинорезистентность и уровень фиброза печени у пациентов с НАЖБП и НАСГ.

Ключевые слова: дети, печень, ожирение, метаболический синдром, полиненасыщенные жирные кислоты, омега-3-полиненасыщенные жирные кислоты, омега-6-полиненасыщенные жирные кислоты, неалкогольная жировая болезнь печени, неалкогольный стеатогепатит, сапплементация пищевого рациона, рыбий жир

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The history of the study of polyunsaturated fatty acids (PUFAs) began over 100 years ago. In 1909. P. Hartley isolated arachidonic acid. Later, 21 years later, Burr and Burr in 1930 showed its positive effect on the growth and development of rats. The important thing about this work was that after reintroduction of PUFAs into the diet of rodents, body functions began to recover. It took over 60 years from the time of the discovery of arachidonic acid to prove its effect on the cardiovascular system. Today, research into the effects of long-chain PUFAs on human health, intelligence, the immune system, neuronal connections, the course of pregnancy and infant health has led to recommendations for the widespread use of foods or supplements containing omega-3 PUFAs. Unbalanced diets in children and adolescents, selective appetite, and eating disorders lead to the development of deficit conditions, cognitive impairment, obesity, and metabolic syndrome with liver damage. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are asymptomatic in the early stages, but it is during this period that the prognosis in children can be changed. This article reviews international recommendations for the integrated use of long-chain PUFAs in the treatment of NAFLD and NASH in children. Supplementation of the diet with high-quality purified fish oil replenishes the requirement, improves disease prognosis, reduces insulin resistance and the level of liver fibrosis in patients with NAFLD and NASH.

Keywords: children, liver, obesity, metabolic syndrome, polyunsaturated fatty acids, omega-3-polyunsaturated fatty acids, omega-6-polyunsaturated fatty acids, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, dietary supplements, fish oil

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Список литературы

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________________________________________________

1. Wiktorowska-Owczarek A, Berezińska M, Nowak JZ. PUFAs: Structures, Metabolism and Functions. Adv Clin Exp Med. 2015;24(6):931-41.
2. Das UN. Essential Fatty acids – a review. Curr Pharm Biotechnol. 2006;7(6):467-82.
3. Scorletti E, Byrne CD. Omega-3 fatty acids, hepatic lipid metabolism, and nonalcoholic fatty liver disease. Annu Rev Nutr. 2013;33:231-48.
4. Russo GL. Dietary n-6 and n-3 polyunsaturated fatty acids: fr om biochemistry to clinical implications in cardiovascular prevention. Biochem Pharmacol. 2009;77(6):937-46.
5. Benatti P, Peluso G, Nicolai R, Calvani M. Polyunsaturated fatty acids: biochemical, nutritional and epigenetic properties. J Am Coll Nutr. 2004;23:281-302.
6. Lauritzen L, Hansen HS, Jørgensen MH, Michaelsen KF. The essentiality of long chain n-3 fatty acids in relation to development and function of the brain and retina. Prog Lipid Res. 2001;40(1-2):1-94.
7. Uauy R, Birch E, Birch D, et al. Visual and brain function measurements in studies of n-3 fatty acid requirements of infant. J Pediatr. 1992;120:168-80.
8. Farquharson J, Cockburn F, Patrick WA. Infant cerebral cortex phospholipid fatty-acid composition and diet. Lancet. 1992;340:810-13.
9. Hartley P. On the nature of the fat contained in the liver, kidney and heart: Part II. J Physiol. 1909;38(5):353-74.
10. Smedley-Maclean I, Nunn LC. Fat-deficiency disease of rats. The effect of doses of methyl arachidonate and linoleate on fat metabolism, with a note on the estimation of arachidonic acid. Biochem J. 1940;34(6):884-902.
11. Holman RT. Essential fatty acids. Nutr Rev. 1958;16:33-5.
12. Parrish CC. Essential fatty acids in aquatic food webs. In: Arts MT, Brett MT, Kainz M, editors. Lipids in Aquatic Ecosystems. 1st ed. Springer; New York, NY, USA: 2009; p. 309-26.
13. Dyerberg J, Bang HO, Hjorne N. Fatty acid composition of the plasma lipids in Greenland Eskimos. Am J Clin Nutr. 1975;28:958-66.
14. Bjerregaard P, Dyerberg J. Mortality from ischaemic heart disease and cerebrovascular disease in Greenland. Int J Epidemiol. 1988;17(3):514-9.
15. Yashodhara BM, Umakanth S, Pappachan JM, et al. Omega-3 fatty acids: a comprehensive review of their role in health and disease. Postgrad Med J. 2009;85(1000):84-90.
16. Kapoor B, Kapoor D, Gautam S, et al. Dietary Polyunsaturated Fatty Acids (PUFAs): Uses and Potential Health Benefits. Curr Nutr Rep. 2021;10(3):232-42.
17. Ikeda I, Yoshida H, Tomooka M, et al. Effects of long-term feeding of marine oils with different positional distribution of eicosapentaenoic and docosahexaenoic acids on lipid metabolism, eicosanoid production, and platelet aggregation in hypercholesterolemic rats. Lipids. 1998;33(9):897-904.
18. Stillwell W, Wassall SR. Docosahexaenoic acid: membrane properties of a unique fatty acid. Chem Phys Lipids. 2003;126(1):1-27.
19. Koletzko B, Agostoni C, Carlson SE, et al. Long chain polyunsaturated fatty acids (LC-PUFA) and perinatal development. Acta Paediatr. 2001;90:460-4.
20. McCann JC, Ames BN. Is docosahexaeboic acid, an ω-3 longchain polyunsaturated fatty acid required for development of normal brain function? Am J Clin Nutr. 2005;82:281-95.
21. Agostoni C. Role of long-chain polyunsaturated fatty acids in the first year of life. J Pediatr Gastroenterol Nutr. 2008;47(2):41-4.
22. Cockburn F. Neonatal brain and dietary lipids. Arch Dis Child. 1994;70(1):1-2.
23. Lucas A. Breast milk and subsequent intelligence quotient in children born preterm. Lancet. 1992;339:261-4.
24. Zakharova IN, Berezhnaia IV, Sannikova TN, et al. Kesarevo sechenie i problemy laktatsii u zhenshchin. Meditsinskii sovet. 2018;17:22-9 (in Russian).
25. Innis SM. Human milk and formula fatty acids. J Pediatr. 1993;123:386-90.
26. Dennis EA, Norris PC. Eicosanoid storm in infection and inflammation. Nat Rev Immunol. 2015;15(8):511-23.
27. Saini RK, Keum YS. Omega-3 and omega-6 polyunsaturated fatty acids: Dietary sources, metabolism, and significance – A review. Life Sci. 2018;203:255-67.
28. Neuschwander-Tetri BA. Non-alcoholic fatty liver disease. BMC Med. 2017;15(1):45.
29. Goh GB, McCullough AJ. Natural history of nonalcoholic fatty liver disease. Dig Dis Sci. 2016;61:1226-33.
30. Bonsembiante L, Targher G, Maffeis C. Non-alcoholic fatty liver disease in obese children and adolescents: a role for nutrition? Eur J Clin Nutr. 2021.
DOI:10.1038/s41430-021-00928-z
31. Golabi P, Otgonsuren M, de Avila L, et al. Components of metabolic syndrome increase the risk of mortality in nonalcoholic fatty liver disease (NAFLD). Medicine (Baltimore). 2018;97(13):e0214.
32. Anania C, Perla FM, Olivero F, et al. Mediterranean diet and nonalcoholic fatty liver disease. World J Gastroenterol. 2018;24(19):2083-94.
33. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO) EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64:1388-402.
34. Vos MB, Abrams SH, Barlow SE, et al. NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr. 2017;64(2):319-34.
35. Peterkova VA, Bezlepkina OB, Vasiukova OV, et al. Ozhirenie u detei. Klinicheskie rekomendatsii. Rossiiskaia assotsiatsiia endokrinologov. Moscow, 2021 (in Russian).
36. Spooner MH, Jump DB. Omega-3 fatty acids and nonalcoholic fatty liver disease in adults and children: wh ere do we stand? Curr Opin Clin Nutr Metab Care. 2019;22(2):103-10.
37. Chen LH, Wang YF, Xu QH, Chen SS. Omega-3 fatty acids as a treatment for non-alcoholic fatty liver disease in children: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr. 2018;37(2):516-21.
38. Jump DB, Lytle KA, Depner CM, Tripathy S. Omega-3 polyunsaturated fatty acids as a treatment strategy for nonalcoholic fatty liver disease. Pharmacol Ther. 2018;181:108-25.
39. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-57.
40. Cunnane SC. The Canadian Society for Nutritional Sciences 1995 Young Scientist Award Lecture. Recent studies on the synthesis, beta-oxidation, and deficiency of linoleate and alpha-linolenate: are essential fatty acids more aptly named indispensable or conditionally dispensable fatty acids? Can J Physiol Pharmacol. 1996;74(6):629-39.
41. Tutel'ian VA, Baturin AK, Gapparov MG, et al. Normy fiziologicheskikh potrebnostei v energii i pishchevykh veshchestvakh dlia razlichnykh grupp naseleniia Rossiiskoi Federatsii. Metodicheskie rekomendatsii MR 2.3.1.2432-08. 2008; s. 14-5 (in Russian).
42. Dotterud CK, Storro O, Simpson MR, et al. The impact of preand postnatal exposures on allergy related diseases in childhood: a controlled multicentre intervention study in primary health care. BMC Public Health. 2013;13:123.
43. Makarova SG, Chumbadze TR, Poliakov SD, et al. Personifitsirovannyi podkhod k pitaniiu detei-sportsmenov: prakticheskie rekomendatsii. Pediatricheskaia farmakologiia. 2016;13(5):468-77 (in Russian). DOI:10.15690/pf.v13i5.1642
44. Scientific Opinion on Dietary Reference Values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA Panel on Dietetic Products N., Allergies (NDA). EFSA Journal. 2010;8:107.
45. Rangel-Huerta OD, Aguilera CM, Mesa MD, Gil A. Omega-3 long-chain polyunsaturated fatty acids supplementation on inflammatory biomakers: a systematic review of randomised clinical trials. Br J Nutr. 2012;107(Suppl. 2):S159-S170.
46. Minziori G, Polizos SA. Emerging and future therapies for nonalcoholic steatohepatitis in adults. Expert Opin Pharmacother. 2016;17(14):1937-46. DOI:10.1080/14656566.2016.1225727

Авторы

И.В. Бережная, М.А. Симакова, А.И. Сгибнева, И.Н. Захарова*

ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*zakharova-rmapo@yandex.ru

________________________________________________

Irina V. Berezhnaya, Mariia A. Simakova, Aleksandra I. Sgibneva, Irina N. Zakharova*

Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*zakharova-rmapo@yandex.ru

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