Biological aging across the metabolic dysfunction–associated steatotic liver disease spectrum: A systematic review

Across 19 observational studies, accelerated biological aging (assessed using clinical composite indices, epigenetic clocks, and telomere length) was consistently associated with higher MASLD/NAFLD risk, greater fibrosis severity, and higher mortality. These findings support BA as potentially a clinically relevant risk integrator in MASLD spectrum diseases. However, heterogeneity in BA measures and disease definitions limits comparability and highlight the need for harmonized BA measures in longitudinal studies.