Metabolic profiles and fibrosis of nonalcoholic liver disease in the elderly: a community-based study.

BACKGROUND&AIMS: There are sparse data on the epidemiology of fatty liver in the elderly Asian population. We evaluated for predictors of fatty liver and high risk of advanced fibrosis in a community-based elderly population.

METHODS: A total of 1091 participants (mean age was 74.6±6.3 years) were enrolled from 2017 to 2018. Subjects with age younger than 65 years, alcoholism, history of hepatitis B and hepatitis C were excluded. Fatty liver was diagnosed with abdominal ultrasound by using ultrasonographic fatty liver indicator (US-FLI), a semi-quantitative measurement grading the severity (normal, mild, moderate-to-severe). Fibrosis-4(FIB-4) score was used for the prediction of the high risk of advanced fibrosis. Using a multivariable logistic regression model, we identified predictors of fatty liver and high risk of advanced fibrosis.

RESULTS: In this ambulatory elderly Asian population, the prevalence of fatty liver is 41.9% and of high risk of advanced fibrosis is 12.3%. The prevalence of fatty liver decreases (44.5% to 31.8%), and the high risk of advanced fibrosis increases (3.9% to 27.0%) with aging significantly (both p<0.05). Metabolic syndrome is a risk factor for fatty liver (odds ratio (OR), 3.19, 95% CI, 2.41-4.22), but not for high risk of advanced fibrosis (OR:0.67, 95% CI, 0.41-1.08). Hypertriglyceridemia decreases the risk for high risk of advanced fibrosis (OR, 0.53, 95% CI, 0.33-0.87).

CONCLUSION: Fatty liver is prevalent in the ambulatory elderly Asian population, affecting over 40% of this population. Age is a risk factor for high risk of advanced fibrosis, with the disease likely progressing from a steatotic to a fibrotic picture with age.