Nonalcoholic fatty liver disease and aging: Epidemiology to management

Abstract

Nonalcoholic fatty liver disease (NAFLD) is common in the elderly, in whom it carries a more substantial burden of hepatic (nonalcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma) and extra-hepatic manifestations and complications (cardiovascular disease, extrahepatic neoplasms) than in younger age groups. Therefore, proper identification and management of this condition is a major task for clinical geriatricians and geriatric hepatologists. In this paper, the epidemiology and pathophysiology of this condition are reviewed, and a full discussion of the link between NAFLD and the aspects that are peculiar to elderly individuals is provided; these aspects include frailty, multimorbidity, polypharmacy and dementia. The proper treatment strategy will have to consider the peculiarities of geriatric patients, so a multidisciplinary approach is mandatory. Non-pharmacological treatment (diet and physical exercise) has to be tailored individually considering the physical limitations of most elderly people and the need for an adequate caloric supply. Similarly, the choice of drug treatment must carefully balance the benefits and risks in terms of adverse events and pharmacological interactions in the common context of both multiple health conditions and polypharmacy. In conclusion, further epidemiological and pathophysiological insight is warranted. More accurate understanding of the molecular mechanisms of geriatric NAFLD will help in identifying the most appropriate diagnostic and therapeutic approach for individual elderly patients.

Keywords: Adipose tissue, Atherosclerosis, Aortic valve sclerosis, Autonomic dysfunction, Arrhythmia, Cirrhosis, Dementia, Falls, Frailty, Hepatocellular carcinoma, Microbiota, Nuclear receptors, Pathogenesis, Sarcopenia, Treatment

Core tip: Nonalcoholic fatty liver disease (NAFLD) is a common disease in the elderly, in whom it follows a more severe course due to worse hepatic and extrahepatic manifestations. The former include nonalcoholic steatohepatitis and hepatocellular carcinoma; the latter include cardiovascular and metabolic complications. The pathophysiology, diagnosis and principles of treatment that are specifically relevant to elderly patients with NAFLD are critically revised here. Based on these findings, we conclude that a more accurate understanding of the molecular mechanisms of geriatric NAFLD will help in identifying the most appropriate diagnostic and therapeutic approach in the individual elderly patient.