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De nombreux faits exp6rimentaux plaident en faveur du r61e des acides gras alimentaires dans la pathog6nie de la maladie alcoolique du foie. Les acides gras polyinsatur6s potentialisent les alterations h6patiques li6es & I'alcool par I'induction du cytochrome P450 2E1, de la cyclo-oxyg6nase-2 et de la peroxydation lipidique. En revanche, les acides gras satur6s diminuent la steatose, la n6crose, I'inflammation et la fibrose parallelement a la diminution de I'expression du TNF-~, de la cyclo-oxyg6nase-2 eta la diminution de la peroxydation lipidique. La dilinol6yl-phosphatidylcholine emp6che le developpement de la fibrose et de la cirrhose chez le babouin et stimule in vitro I'acti-vit6 de la collag6nase des lipocytes. II y a peu d'6tudes confirmant chez I'homme ces faits exp&imentaux. Des 6tudes 6pid6miologiques suggerent que les acides gras polyinsatures alimentaires sont des facteurs de risque de cirrhose chez I'alcoolique. Les 6tudes ayant montr6 que le surpoids 6tait un facteur de risque de cirrhose alcoolique et que le polymorphisme de I'apolipoprot6ine E influengait la s6verit6 de I'atteinte h6patique chez les cirrhotiques alcooliques sont des arguments importants en faveur de I'intervention des acides gras alimentaires darts la pathog6nie de la maladie alcoolique du foie. © 1999 I~ditions scientifiques et m6dicales Elsevier SAS acides gras polyinsatur6s / acides gras satur6s / cytochrome P450 2E1 / graisses alimentaires / maladie alcoolique du foie Summary -The role of fatty acids in human alcoholic liver disease.
Many experimental studies in animals suggest that dietary fat plays an important role in the pathogenesis of alcoholic liver disease. Polyunsaturated fatty acids potentiate alcohol-induced fiver injury at least in part by inducing cytochrome P450 2E1, cyclooxygenase-2 and lipid peroxydation. On the other hand, dietary saturated fatty acids reduce steatosis, necrosis, inflammation and fibrosis in conjunction with decreased expression of TNF-(z and cyclooxygenase-2, and reduce lipid peroxidation. Dilinoleoyl-phosphatidylcholine prevents alcohol-induced fibrosis and cirrhosis in baboons and stimulates collagenase activity in cultured lipocytes.
There are few human studies which confirm these experimental results. Epidemiological studies suggest a relationship between daily fat intake, particularly dietary polyunsaturated fatty acids, and the risk of fiver cirrhosis in alcoholics. The studies having demonstrated that being overweight is a risk factor of alcoholic cirrhosis and that the apolipoprotein E polymorphism influences the severity of liver injury in alcoholic cirrhotics strongly favor the role of fatty acids in the pathogenesis of human alcoholic liver disease.