It took several years for this selleck inhibitor large multicenter study to recruit patients with biopsy-proven NAFLD. Age correlates with duration of disease and the association with more advanced disease may not be attributable to age alone, but also to duration of disease. However, it is not possible to control for duration of disease. Despite this limitation, it is elderly patients
who have higher rates of NASH and advanced fibrosis whether it is due to aging or due to duration of disease. Longitudinal studies with serial liver biopsies will be required to investigate the natural progression of the disease in younger and older adults and to examine the evolution of fat distribution. In conclusion, elderly patients with NAFLD are more likely to have features find more of advanced fibrosis as well as aggressive NASH. NAFLD cannot be considered a benign disease in elderly patients. Elderly patients are at increased risk of NASH and advanced fibrosis but are underrepresented in cohort studies. Advanced fibrosis can also occur in elderly patients with NAFLD without specific histologic features of
NASH. This observation may reflect the previous observation that key features of NASH such as steatosis, ballooning, and Mallory-Denk bodies may be lost as the disease progresses towards cirrhosis. Thus, liver biopsy evaluation can be helpful in this age group to guide the implementation of treatment recommendations such as weight reduction and increased physical activity. Due to the aging of American Tangeritin society, further research is needed in NAFLD in
elderly patients. It is important to identify elderly NAFLD patients who are at risk of progressive liver disease, especially because newer treatment modalities are emerging.[23, 48-54] Furthermore, clinical trials should be conducted to test the efficacy and safety of the available treatment modalities, such as vitamin E, in this subpopulation and every effort should be made to avoid excluding patients older than 65 years in future trials and cohort studies. The study was sponsored by the NIDDK, NIH. As per the policy of the network, the article was reviewed by the NIDDK prior to publication. The authors take full responsibility for the data analyses and credibility of findings. All authors approved the final submission. Mazen Noureddin: Drafting of the article, interpretation of data, critical revision of the article. Katherine P. Yates: Analysis and interpretation of data, statistical analysis, critical revision of the article. Ivana A. Vaughn: Analysis and interpretation of data, statistical analysis, critical revision of the article. Brent A. Neuschwander-Tetri, Arun J. Sanyal, Arthur McCullough, Raphael Merriman, Bilal Hameed, Edward Doo, David E. Kleiner, Cynthia Behling: Critical revision of the article.