LIVER disease is an escalating global health issue, responsible for nearly two million deaths annually. Traditionally associated with younger adults, liver disease is increasingly recognised as a serious concern among older populations. Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease, is now the most common form worldwide, driven by rising rates of obesity and Type 2 diabetes.
A recent study within the Whitehall II cohort offers new insight into the prevalence and implications of steatotic liver disease (SLD) in older adults. Using transient elastography (TE), researchers assessed liver health in nearly 1,000 individuals and found that one in three had SLD, while one in 40 showed signs of significant fibrosis. Rates were higher in older men, with SLD linked not only to cardiometabolic risk factors but also to frailty, multimorbidity, and reduced motor function.
Importantly, the study revealed associations between SLD and markers of ageing such as limited mobility and disability, even when fibrosis was absent. This suggests that SLD may play a broader role in age-related health decline. The mechanisms may involve chronic inflammation and sarcopenia, muscle loss driven by insulin resistance and impaired metabolic function.
Unlike in some younger populations, alcohol use was not significantly associated with SLD in this older group, possibly due to low reported alcohol consumption or survivorship bias. However, the presence of multiple chronic conditions, such as cardiovascular disease, arthritis, and dementia, was linked to SLD, highlighting the disease’s systemic impact.
While the study has limitations, including its predominantly Caucasian male sample, it represents the first UK analysis of SLD in older adults using TE. These findings have significant public health implications. Screening strategies may need to be tailored to older populations, and treatment approaches, especially those affecting muscle mass, must be adapted accordingly. Long-term studies are now essential to determine whether managing SLD in older adults could help prevent frailty and reduce multimorbidity.
Reference
Oduwole O et al. Steatotic liver disease is a marker of multimorbidity, not underlying cirrhosis, in older adults. NPJ Gut Liver. 2025;2(1):10.
