The Progression of Non-alcoholic Fatty Liver Disease and Lifestyle Intervention in Older Adults

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. It encompasses a spectrum of liver histology in individuals who drink little or no alcohol, ranging from simple fatty liver (steatosis), through fat accompanied by signs of hepatocyte injury, mixed inflammatory cell infiltrate, and variable hepatic fibrosis (non-alcoholic steatohepatitis, NASH), to cirrhosis and hepatocellular carcinoma. Approximately 19.0% of the general United States population has NAFLD, and around 11.8% of NAFLD patients develop NASH. The prevalence, severity, and progression of NAFLD/NASH are significantly associated with the presence of metabolic syndrome components, especially obesity and diabetes, and are also governed by the interactive effects of age, sex, genetic susceptibility, and lifestyle (diet and exercise). In particular, advanced age is associated with disease severity and fibrosis progression. A combination of dietary modification and physical activity is the cornerstone of NAFLD management, as there is a lack of efficacious and safe pharmacotherapy for this disease.