| Abstract: | BACKGROUND & AIMS: Fatty liver disease has been associated with excess mortality. Screening for hepatic steatosis in patients with metabolic dysfunction is therefore recommended by several guidelines, despite a paucity of evidence on the clinical relevance of fatty liver disease in this specific subgroup. APPROACH & RESULTS: We studied participants of an ongoing prospective cohort (the Rotterdam Study). Individuals aged ≥65 years were enrolled from 2009-2014 and were followed through 2018. Steatosis was assessed by ultrasound, and liver stiffness by transient elastography. The association between hepatic steatosis and liver stiffness with mortality was assessed using Cox regression analysis adjusted for age, sex, education, smoking, individual components of the metabolic syndrome, heart failure, coronary heart disease, and stroke. We included 4.093 elderly participants (aged 74.4±6.6; 42.7%male), 36.8% had ultrasound-based steatosis. During the median follow-up of 6.9 years, 793 participants died (29.6 per 1.000 person-years). In the overall population, steatosis was not associated with mortality in multivariable analysis (aHR 0.87, 95%CI 0.73-1.03). Findings were consistent across a range of clinically relevant subgroups, including age categories, sex, metabolic syndrome, elevated liver enzymes and cardiac disease. Sensitivity analyses showed similar results for mortality beyond five years of follow-up, cancer-related and cerebro-cardiovascular mortality. Furthermore, among participants with steatosis, higher liver stiffness (aHR 1.04 per kPa, 95%CI 0.95-1.14) was not associated with mortality. CONCLUSIONS: The presence of fatty liver disease was not associated with mortality in this cohort nor in a range of subgroups. This indicates that screening for fatty liver disease and/or fibrosis is unlikely to improve outcomes among the elderly population. |
