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Review
. 2014 Oct 21;20(39):14185-204.
doi: 10.3748/wjg.v20.i39.14185.

Nonalcoholic fatty liver disease and aging: epidemiology to management

Marco Bertolotti  1 , Amedeo Lonardo  1 , Chiara Mussi  1 , Enrica Baldelli  1 , Elisa Pellegrini  1 , Stefano Ballestri  1 , Dante Romagnoli  1 , Paola Loria  1
Affiliations
Review

Nonalcoholic fatty liver disease and aging: epidemiology to management

Marco Bertolotti et al. World J Gastroenterol. .

Abstract

Nonalcoholic fatty liver disease (NAFLD) is common in the elderly, in whom it carries a more substantial burden of hepatic (nonalcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma) and extra-hepatic manifestations and complications (cardiovascular disease, extrahepatic neoplasms) than in younger age groups. Therefore, proper identification and management of this condition is a major task for clinical geriatricians and geriatric hepatologists. In this paper, the epidemiology and pathophysiology of this condition are reviewed, and a full discussion of the link between NAFLD and the aspects that are peculiar to elderly individuals is provided; these aspects include frailty, multimorbidity, polypharmacy and dementia. The proper treatment strategy will have to consider the peculiarities of geriatric patients, so a multidisciplinary approach is mandatory. Non-pharmacological treatment (diet and physical exercise) has to be tailored individually considering the physical limitations of most elderly people and the need for an adequate caloric supply. Similarly, the choice of drug treatment must carefully balance the benefits and risks in terms of adverse events and pharmacological interactions in the common context of both multiple health conditions and polypharmacy. In conclusion, further epidemiological and pathophysiological insight is warranted. More accurate understanding of the molecular mechanisms of geriatric NAFLD will help in identifying the most appropriate diagnostic and therapeutic approach for individual elderly patients.

Keywords: Adipose tissue; Aortic valve sclerosis; Arrhythmia; Atherosclerosis; Autonomic dysfunction; Cirrhosis; Dementia; Falls; Frailty; Hepatocellular carcinoma; Microbiota; Nuclear receptors; Pathogenesis; Sarcopenia; Treatment.

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Figures

Figure 1
Figure 1
Geriatric nonalcoholic fatty liver disease at a glance (modified from Refs[39,75]). A: Epidemiology; B: Pathogenesis; C: Clinical manifestations. Schematic representation of chief epidemiological, pathogenic and clinical features of nonalcoholic fatty liver disease (NAFLD) observed in geriatric age based on data critically reviewed in the text. From an epidemiological point of view, NAFLD tends to peak in middle life and its occurrence is reduced in the extreme decades. Pathogenically, altered body fat distribution and changes in gut microbiota predispose to those metabolic changes which tend to be even more closely associated with NAFLD in the elderly than in the young. The biochemical and molecular mechanisms underlying the development of fatty liver may involve insulin resistance and inherent hormonal changes, as well as mediators of inflammation and possibly vitamin D and a number nuclear receptors. Regarding the latter, only indirect evidence can be inferred from the literature (see text for details). Clinically, NAFLD tends to be associated with the typical geriatric syndromes, such as dementia, sarcopenia, autonomic dysfunction, aortic valve sclerosis and autonomic changes predisposing to fatigue, falls and arrhythmia. HNF4: Hepatocyte nuclear factor 4 alpha; IGF-1: Insulin-like growth factor 1; PPAR: Peroxisome proliferator-activated receptor; DHEA: Dehydroepiandrosterone; LXR: Liver X receptor.
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