Prevalence and outcomes of steatotic liver disease subtypes in older adults
Abstract
Background: Steatotic liver disease (SLD) is a significant cause of chronic liver disease. However, the relative prevalence and prognostic significance of various disease entities according to recently defined classification systems (MAFLD vs. the SLD-spectrum of MASLD, Met-ALD, and ALD) is understudied in older adults.
Methods: Post hoc analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) study involving 16,703 Australian community-dwelling adults aged ≥70 years free from significant disability, prior cardiovascular disease events, and with a life expectancy ≥5 years. Steatosis was identified by Fatty Liver Index (FLI) ≥60. Alcohol intake was self-reported. SLD subtypes were classified according to European Association for the Study of the Liver (EASL)/American Association for the Study of Liver Diseases (AASLD) guidelines. Cox regression was used to estimate hazard ratios for adjudicated outcomes: mortality, major adverse cardiovascular events (MACE), and persistent physical disability.
Results: Of 9847 participants with calculable FLI and a median 8.6 years follow-up, 3748 (38.1%) had hepatic steatosis. Substratifying by MAFLD criteria versus the SLD type, 3743 had MAFLD (38.0%), and 3464 (35.2%) met SLD criteria (MASLD 3132 [90.4%], Met-ALD 262 [7.6%], ALD 74 [2.0%]) (excluding steatogenic medication users). There was no increased mortality risk with MAFLD or SLD. MAFLD and MASLD were associated with MACE when adjusted for age and sex (HR 1.42 [95% CI…
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