In elderly patients, fatty liver disease does not impact mortality risk: Study

Netherlands: In senior people, fatty liver disease may not raise the risk of death, says an article published in Hepatology. The Rotterdam Study data was utilized by the researchers to examine the association between fatty liver disease and mortality in the elderly. 

Patients aged 65 and over were included in the research from 2009 to 2014 and were followed up till 2018. Steatosis was assessed using ultrasound, and liver stiffness was assessed using transient elastography. The connection between hepatic steatosis, liver stiffness, and mortality was studied using Cox regression analysis, which controlled for age, education, gender, smoking, individual components of the metabolic syndrome, heart failure, coronary heart disease, and stroke.

The present study comprised a total of 4,093 senior individuals. The average age was 74.4 years, 42.7% of the participants were men, and 36.8% had ultrasound-based steatosis. Because metabolic comorbidity was frequent, Laurens A. van Kleef and the team observed that hepatic evaluation would have been suggested in 85.4% of patients based on the 2021 European Association for the Study of the Liver noninvasive test recommendation. 793 people died over a median of 6.9 years of follow-up.

A multivariable study revealed no link between steatosis and mortality in the general population. These findings were true across clinically significant subgroups such as age, gender, metabolic syndrome, increased liver enzymes, and heart illness. In sensitivity analyses, the results for death rates beyond five years of follow-up, as well as cancer-related and cerebro-cardiovascular mortality, were identical. Greater liver rigidity was not linked to death in steatosis patients.

In conclusion, based on the current study, there is room for improvement in determining which individuals are at risk for hepatic fibrosis and cirrhosis. A careful balance must be struck between screening too many people, which risks over-diagnosis, and cost-effectiveness difficulties, and evaluating too few people, which risks missing those with cirrhosis.

"The findings indicate that screening for FLD and/or fibrosis is unlikely to improve outcomes among the elderly population," the researchers wrote. 

Reference: 

van Kleef, L. A., Sonneveld, M. J., Kavousi, M., Ikram, M. A., de Man, R. A., & de Knegt, R. J. (2022). Fatty liver disease is not associated with increased mortality in the elderly: A prospective cohort study. In Hepatology. Wiley. https://doi.org/10.1002/hep.32635