Prevalence of metabolically associated steatotic liver disease in the elderly: analysis and perspectives

Metabolically associated steatotic liver disease (MASLD) is becoming a major public health problem, especially among the elderly. The recent change in nomenclature from “nonalcoholic fatty liver disease” to “MASLD” reflects a more accurate understanding of the pathogenesis of the disease, linking it to metabolic disorders such as insulin resistance, obesity, and metabolic syndrome. This new terminology emphasizes the importance of a comprehensive approach to the diagnosis and treatment of the disease, given its close association with metabolic disorders and cardiovascular risk. Current estimates suggest that 24 % of the adult population, i. e. one billion people worldwide, suffer from the disease. Interestingly, the prevalence of fatty liver disease peaks between the ages of 40–50 years in men and 60–69 years in women, and then declines slightly in older age groups (over 70 years). The prevalence of MASLD is increasing worldwide, reflecting the increasing incidence of obesity, type 2 diabetes mellitus, and metabolic syndrome. The elderly are particularly susceptible to MASLD due to age-related metabolic changes, comorbidities. Aging is associated with changes in lipid metabolism, insulin resistance, and increased fat mass, which predispose the elderly to hepatic lipid accumulation and subsequent liver damage. In addition, age-related decline in the liver»s regenerative capacity may exacerbate the progression of hepatic steatosis to advanced stages such as steatohepatitis and hepatic fibrosis. However, MASLD in the elderly remains under-recognized and under-diagnosed, posing challenges for timely intervention and treatment. Prospects for addressing MASLD in the elderly emphasize the importance of comprehensive geriatric assessment, including evaluation of metabolic health and liver function.