Metabolic profiles and fibrosis of non-alcoholic fatty liver disease in the elderly: A community-based study

Background and 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, and history of hepatitis B and hepatitis C were excluded. Fatty liver was diagnosed with abdominal ultrasound by using ultrasonographic fatty liver indicator, a semi-quantitative measurement grading the severity (normal, mild, and moderate-to-severe). Fibrosis-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.