Fatty liver disease is not associated with increased mortality in the elderly: A prospective cohort study

L. A. van Kleef*, M. J. Sonneveld, M. Kavousi, M. A. Ikram, R. A. de Man, R. J. de Knegt

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

16 Citations (Scopus)
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Background and Aims: Fatty liver disease (FLD) has been associated with excess mortality. Screening for hepatic steatosis (HS) in patients with metabolic dysfunction is therefore recommended by several guidelines, despite a paucity of evidence on the clinical relevance of FLD in this specific subgroup. Approach and Results: We studied participants of an ongoing prospective cohort (the Rotterdam Study). Persons ≥65 years old were enrolled from 2009 to 2014 and were followed through 2018. Steatosis was assessed by ultrasound and liver stiffness (LS) by transient elastography. The association between HS and LS with mortality was assessed using Cox regression analysis adjusted for age, sex, education, smoking, individual components of metabolic syndrome (MetS), heart failure, coronary heart disease, and stroke. We included 4093 elderly participants (74.4 ± 6.6 years old; 42.7% male); 36.8% had ultrasound-based steatosis. During the median follow-up of 6.9 years, 793 participants died (29.6 per 1000 person-years). In the overall population, steatosis was not associated with mortality in multivariable analysis (adjusted HR [aHR], 0.87; 95% CI, 0.73–1.03). Findings were consistent across a range of clinically relevant subgroups, including age categories, sex, MetS, elevated liver enzymes, and cardiac disease. Sensitivity analyses showed similar results for mortality beyond 5 years of follow-up and cancer-related and cerebro-cardiovascular mortality. Furthermore, among participants with steatosis, higher LS (aHR, 1.04 per kPa; 95% CI, 0.95–1.14) was not associated with mortality. Conclusions: Presence of FLD was not associated with mortality in this cohort nor in a range of subgroups. This indicates that screening for FLD and/or fibrosis is unlikely to improve outcomes among the elderly population.

Original languageEnglish
Pages (from-to)585-593
Number of pages9
Issue number2
Publication statusPublished - Feb 2023

Bibliographical note

Funding Information:
M.J.S. has received speaker's fees and research support from Fujirebio and received grants from Gilead. R.dK. is a speaker for Echosens, a consultant for AbbVie, and received grants from AbbVie, Gilead, and Janssen. Other authors had no conflict of interest.

Funding Information:
The Rotterdam Study is funded by the Erasmus Medical Center and Erasmus University (Rotterdam, The Netherlands); the Organization for the Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); the Ministry of Education, Culture and Science; the Ministry for Health, Welfare and Sports; the European Commission (DG XII); and the Municipality of Rotterdam. Financial support was also provided by the Foundation for Liver and Gastrointestinal Research (Rotterdam, The Netherlands). The funding sources did not influence study design, data collection, analysis and interpretation of the data, nor the writing of the report and decision to submit for publication.

Publisher Copyright:
© 2023 John Wiley and Sons Inc.. All rights reserved.


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