NAFLD in the Elderly

Abstract

Non-alcoholic fatty liver disease (NAFLD) is an increasingly prevalent disease globally. Current estimates are that 24% of the adult population, thus, one billion individuals worldwide, are affected. Interestingly, the prevalence of fatty liver seems to peak between 40─50 years of age in males and 60─69 years in females, often slightly decreasing in older (>70 years) cohorts. Furthermore, several risk factors for NAFLD development, such as hypertension, diabetes, hyperlipidemia, and obesity are higher in older adults. The diagnosis and management strategies in older adults are sometimes challenging, and certain age-specific factors have to be taken into account by healthcare professionals. In this review, we provide an overview of considerations relevant to the management and diagnosis of NAFLD in older adults (age >65 years) and discuss the types of pharmacological interventions available for the management of non-alcoholic steatohepatitis (NASH) in the aging population.

Chronic hyperinsulinemia promotes human hepatocyte senescence

“…Multiple risk factors including type 2 diabetes, obesity, and hyperinsulinemia predispose for the development and progression of NAFLD [ 1 ]. As people age, they become more vulnerable to these risk factors, which can be explained in part at the cellular level by the increased senescence [ 19 ]. Thus, cellular senescence represents a potential target of ageing- and metabolic-related diseases [ 20 , 21 ].…”

Significant liver fibrosis is a predictor of poor health-related quality of life in people living with HIV

“…Treatment with ART and HIV infection is known to be pro-steatogenic with worse metabolic outcomes-dependent on the chosen ART regimen [9,10]. Nevertheless, an increasingly sedentary lifestyle with poor dietary and physical habits and a higher age impose an additional threat to the metabolic health of PLWH [11]. These factors have also led to a rise in the prevalence of hepatic steatosis, negatively impacting the HRQL in PLWH [12,13].…”

Prevalence of nonalcoholic fatty liver disease and its association with age in patients with type 2 diabetes mellitus

“…By combining Targher's results and this study, it is suggested that the prevalence of NAFLD increases with age until about 60 years (as in Targher's study) and then decreases with age, as shown in this study. An "inverted U curve," in which the prevalence of NAFLD reaches a peak in late adulthood and decreases afterward has been reported in the general population[ 27 - 29 ]. However, a meta-analysis observed a consistent increase in the NAFLD prevalence across all age groups[ 30 ].…”