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. 2025 Jun 30;9(7):e0756.
doi: 10.1097/HC9.0000000000000756. eCollection 2025 Jul 1.

Prevalence and outcomes of steatotic liver disease subtypes in older adults

Daniel Clayton-Chubb  1   2   3   4 , Ammar Majeed  1   2 , Isabella Commins  1   4 , Robyn L Woods  5 , Andrew T Chan  6   7 , Joanne Ryan  5 , Johannes T Neumann  8   9 , Hans G Schneider  5   10 , Andrew M Tonkin  5 , Mark R Nelson  5   11 , Sharyn M Fitzgerald  5 , Suzanne G Orchard  5 , John S Lubel  1   2 , Daniel R Sikavi  6   7 , Cammie Tran  5 , Alexander D Hodge  3   12   13 , John J McNeil  5 , William W Kemp  1   2 , Stuart K Roberts  1   2
Affiliations

Prevalence and outcomes of steatotic liver disease subtypes in older adults

Daniel Clayton-Chubb et al. Hepatol Commun. .

Abstract

Background: Steatotic liver disease (SLD) is a significant cause of chronic liver disease. However, the relative prevalence and prognostic significance of various disease entities according to recently defined classification systems (MAFLD vs. the SLD-spectrum of MASLD, Met-ALD, and ALD) is understudied in older adults.

Methods: Post hoc analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) study involving 16,703 Australian community-dwelling adults aged ≥70 years free from significant disability, prior cardiovascular disease events, and with a life expectancy ≥5 years. Steatosis was identified by Fatty Liver Index (FLI) ≥60. Alcohol intake was self-reported. SLD subtypes were classified according to European Association for the Study of the Liver (EASL)/American Association for the Study of Liver Diseases (AASLD) guidelines. Cox regression was used to estimate hazard ratios for adjudicated outcomes: mortality, major adverse cardiovascular events (MACE), and persistent physical disability.

Results: Of 9847 participants with calculable FLI and a median 8.6 years follow-up, 3748 (38.1%) had hepatic steatosis. Substratifying by MAFLD criteria versus the SLD type, 3743 had MAFLD (38.0%), and 3464 (35.2%) met SLD criteria (MASLD 3132 [90.4%], Met-ALD 262 [7.6%], ALD 74 [2.0%]) (excluding steatogenic medication users). There was no increased mortality risk with MAFLD or SLD. MAFLD and MASLD were associated with MACE when adjusted for age and sex (HR 1.42 [95% CI 1.17-1.71] and HR 1.40 [95% CI 1.15-1.71], respectively), but not in the fully adjusted model. MAFLD, MASLD, and ALD were associated with an increased risk of persistent physical disability even when fully adjusted (HR 1.46 [95% CI 1.19-1.79], HR 1.49 [95% CI 1.20-1.83], HR 2.53 [95% CI 1.27-5.05], respectively), but not Met-ALD.

Conclusions: MAFLD and the metabolic-SLD spectrum are common in community-dwelling older adults. No subclassification is associated with increased mortality in this group, although there is an association between both MACE and persistent physical disability with SLD.

Keywords: alcohol; biochemistry; epidemiology; liver function; metabolic syndrome; older adults.

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Conflict of interest statement

Daniel Clayton-Chubb received grants from Norgine and NovoNordisk. Andrew Chan consults for Boehringer Ingelheim and Pfizer Incorporated. He received grants from Freenome Holdings. Hans Schneider received grants from Abbott Diagnostics. John Lubel consults, is on the speaker’s bureau, and has received grants from Ipsen. He advises Gilead and AbbVie. He is on the speaker’s bureau for Roche and Ferring. He received grants from Norgine. The remaining authors have no conflicts to report.

Figures

FIGURE 1
FIGURE 1
Participant flowchart and MAFLD/SLD breakdown. Abbreviations: BMI, body mass index; FLI, Fatty Liver Index; MAFLD, metabolic dysfunction–associated fatty liver disease; SLD, steatotic liver disease; T2DM, type 2 diabetes mellitus.
FIGURE 2
FIGURE 2
Overlap between SLD subtypes and MAFLD. Abbreviations: ALD, alcohol-associated liver disease; FLI, Fatty Liver Index; MAFLD, metabolic dysfunction–associated fatty liver disease; SLD, steatotic liver disease.
See this image and copyright information in PMC

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