Metabolic dysfunction‐associated steatotic liver disease in older adults is associated with frailty and social disadvantage

Abstract

Background & AimsThe burden of metabolic dysfunction‐associated steatotic liver disease (MASLD) is growing rapidly, as is the number of older adults globally. However, relatively few studies have been performed evaluating the prevalence and risk factors for MASLD in older adults. As such, we aimed to identify the prevalence of MASLD in older adults, as well as sociodemographic, clinical, functional and biochemical associations.MethodsThe study population included older adults without a history of cardiovascular disease, dementia or independence‐limiting functional impairment who had participated in the ASPirin in Reducing Events in the Elderly (ASPREE) randomised trial. MASLD was defined using the Fatty Liver Index (FLI). Associations were identified using Poisson regression with robust variance for FLI ≥ 60 vs FLI < 30.Results9097 Australian participants aged ≥70 years had complete biochemical and anthropometric data to identify MASLD. The study population had a mean age of 75.1 ± 4.3 years and was 45.0% male. Almost one‐third (33.0%) had prevalent MASLD, and the prevalence decreased with increasing age (adjusted RR [aRR] 0.96, 95% CI: 0.96–0.97). MASLD was also negatively associated with social advantage (aRR 0.94, 95% CI: 0.90–0.99) and exercise tolerance and was positively associated with diabetes mellitus (aRR: 1.22, 95% CI: 1.16–1.29), hypertension (aRR: 1.31, 95% CI: 1.22–1.41), male sex (aRR: 1.66, 95% CI: 1.57–1.74), pre‐frailty (aRR: 1.99, 95% CI: 1.82–2.12) and frailty (aRR: 2.36, 95% CI: 2.16–2.56). MASLD and nonalcoholic fatty liver disease (NAFLD) results were 100% concordant.ConclusionThis study in a large cohort of relatively healthy community‐dwelling older adults shows that MASLD is common, decreases with age and is associated with poorer metabolic health, social disadvantage and frailty.

Red cell distribution width/platelet ratio estimates the 3-year risk of decompensation in Metabolic Dysfunction-Associated Steatotic Liver Disease-induced cirrhosis

“…The irrepressible spreading of MASLD worldwide[ 5 ], in synergy with the evidence that MASLD/MASH-related cirrhosis may more rapidly progress to dACLD[ 7 , 8 ], remark the identification of tools predicting the decompensation in these patients as an absolute global priority. Up to now, in scientific literature, various emerging findings suggested the RPR as a predictor of severe fibrosis and cirrhosis in MASLD[ 21 , 22 ].…”

“…Metabolic dysfunction-associated Steatotic Liver Disease (MASLD), encompassing a spectrum of disease manifestations ranging from simple steatosis to steatohepatitis (MASH) and advanced fibrosis (AF), represents the most common cause of liver cirrhosis worldwide with a severe healthy and socioeconomic burden[ 5 , 6 ]. To make matters worse, recent evidence indicates that MAFLD/MASH-related cACLD may progress more rapidly than other etiologies and a relatively earlier decompensation has been reported in these patients[ 7 , 8 ].…”