Prevalence and outcomes of steatotic liver disease subtypes in older adults.

IF 5.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Hepatology Communications Pub Date : 2025-06-30 eCollection Date: 2025-07-01 DOI:10.1097/HC9.0000000000000756

Daniel Clayton-Chubb, Ammar Majeed, Isabella Commins, Robyn L Woods, Andrew T Chan, Joanne Ryan, Johannes T Neumann, Hans G Schneider, Andrew M Tonkin, Mark R Nelson, Sharyn M Fitzgerald, Suzanne G Orchard, John S Lubel, Daniel R Sikavi, Cammie Tran, Alexander D Hodge, John J McNeil, William W Kemp, Stuart K Roberts

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引用次数: 0

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 1.17-1.71] and HR 1.40 [95% CI 1.15-1.71], respectively), but not in the fully adjusted model. MAFLD, MASLD, and ALD were associated with an increased risk of persistent physical disability even when fully adjusted (HR 1.46 [95% CI 1.19-1.79], HR 1.49 [95% CI 1.20-1.83], HR 2.53 [95% CI 1.27-5.05], respectively), but not Met-ALD.

Conclusions: MAFLD and the metabolic-SLD spectrum are common in community-dwelling older adults. No subclassification is associated with increased mortality in this group, although there is an association between both MACE and persistent physical disability with SLD.

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老年人脂肪变性肝病亚型的患病率和预后

背景：脂肪变性肝病（SLD）是慢性肝病的重要病因。然而，根据最近定义的分类系统（MAFLD与MASLD、Met-ALD和ALD的sld谱），各种疾病实体的相对患病率和预后意义在老年人中尚未得到充分研究。方法：对阿司匹林降低老年人事件（ASPREE）研究进行事后分析，该研究涉及16703名年龄≥70岁、无重大残疾、既往心血管疾病事件、预期寿命≥5年的澳大利亚社区居民。脂肪肝指数(FLI)≥60诊断为脂肪变性。酒精摄入量是自我报告的。根据欧洲肝脏研究协会(EASL)/美国肝脏疾病研究协会（AASLD）指南对SLD亚型进行分类。Cox回归用于估计已确定结局的风险比：死亡率、主要不良心血管事件（MACE）和持续性身体残疾。结果：在9847名可计算FLI的参与者中，随访8.6年，3748名（38.1%）患有肝脂肪变性。根据MAFLD标准和SLD类型进行次分层，3743例（38.0%）患有MAFLD， 3464例（35.2%）符合SLD标准（MASLD 3132 [90.4%], met -ALD 262 [7.6%], ALD 74[2.0%]）（不包括脂肪性药物使用者）。MAFLD或SLD的死亡风险没有增加。经年龄和性别调整后，MAFLD和MASLD与MACE相关（HR分别为1.42 [95% CI 1.17-1.71]和1.40 [95% CI 1.15-1.71]），但在完全调整后的模型中没有相关。即使在完全调整后，MAFLD、MASLD和ALD也与持续性身体残疾的风险增加相关（HR分别为1.46 [95% CI 1.19-1.79]、HR 1.49 [95% CI 1.20-1.83]、HR 2.53 [95% CI 1.27-5.05]），但Met-ALD无关。结论：mald和代谢- sld谱在社区老年人中很常见。尽管MACE和持续性身体残疾与SLD之间存在关联，但在该组中，没有亚分类与死亡率增加相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hepatology Communications GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

8.00

自引率

2.00%

发文量

248

审稿时长

8 weeks

期刊介绍： Hepatology Communications is a peer-reviewed, online-only, open access journal for fast dissemination of high quality basic, translational, and clinical research in hepatology. Hepatology Communications maintains high standard and rigorous peer review. Because of its open access nature, authors retain the copyright to their works, all articles are immediately available and free to read and share, and it is fully compliant with funder and institutional mandates. The journal is committed to fast publication and author satisfaction.