title: Nonalcoholic fatty liver disease and aging: epidemiology to management.
abstract: Nonalcoholic fatty liver disease (NAFLD) is common in the elderly, in whom it carries a more substantial burden of hepatic (nonalcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma) and extra-hepatic manifestations and complications (cardiovascular disease, extrahepatic neoplasms) than in younger age groups. Therefore, proper identification and management of this condition is a major task for clinical geriatricians and geriatric hepatologists. In this paper, the epidemiology and pathophysiology of this condition are reviewed, and a full discussion of the link between NAFLD and the aspects that are peculiar to elderly individuals is provided; these aspects include frailty, multimorbidity, polypharmacy and dementia. The proper treatment strategy will have to consider the peculiarities of geriatric patients, so a multidisciplinary approach is mandatory. Non-pharmacological treatment (diet and physical exercise) has to be tailored individually considering the physical limitations of most elderly people and the need for an adequate caloric supply. Similarly, the choice of drug treatment must carefully balance the benefits and risks in terms of adverse events and pharmacological interactions in the common context of both multiple health conditions and polypharmacy. In conclusion, further epidemiological and pathophysiological insight is warranted. More accurate understanding of the molecular mechanisms of geriatric NAFLD will help in identifying the most appropriate diagnostic and therapeutic approach for individual elderly patients.
authors.affiliation: Marco Bertolotti, Amedeo Lonardo, Chiara Mussi, Enrica Baldelli, Elisa Pellegrini, Stefano Ballestri, Dante Romagnoli, Paola Loria, Department of Biomedical, Metabolic and Neural Sciences, Nuovo Ospedale Civile di Modena, University of Modena and Reggio Emilia and Azienda USL of Modena, Baggiovara, 41126 Modena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bertolotti
authors.affiliation: Marco Bertolotti, Amedeo Lonardo, Chiara Mussi, Enrica Baldelli, Elisa Pellegrini, Stefano Ballestri, Dante Romagnoli, Paola Loria, Department of Biomedical, Metabolic and Neural Sciences, Nuovo Ospedale Civile di Modena, University of Modena and Reggio Emilia and Azienda USL of Modena, Baggiovara, 41126 Modena, Italy.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Lonardo
authors.affiliation: Marco Bertolotti, Amedeo Lonardo, Chiara Mussi, Enrica Baldelli, Elisa Pellegrini, Stefano Ballestri, Dante Romagnoli, Paola Loria, Department of Biomedical, Metabolic and Neural Sciences, Nuovo Ospedale Civile di Modena, University of Modena and Reggio Emilia and Azienda USL of Modena, Baggiovara, 41126 Modena, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mussi
authors.affiliation: Marco Bertolotti, Amedeo Lonardo, Chiara Mussi, Enrica Baldelli, Elisa Pellegrini, Stefano Ballestri, Dante Romagnoli, Paola Loria, Department of Biomedical, Metabolic and Neural Sciences, Nuovo Ospedale Civile di Modena, University of Modena and Reggio Emilia and Azienda USL of Modena, Baggiovara, 41126 Modena, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Baldelli
authors.affiliation: Marco Bertolotti, Amedeo Lonardo, Chiara Mussi, Enrica Baldelli, Elisa Pellegrini, Stefano Ballestri, Dante Romagnoli, Paola Loria, Department of Biomedical, Metabolic and Neural Sciences, Nuovo Ospedale Civile di Modena, University of Modena and Reggio Emilia and Azienda USL of Modena, Baggiovara, 41126 Modena, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Pellegrini
authors.affiliation: Marco Bertolotti, Amedeo Lonardo, Chiara Mussi, Enrica Baldelli, Elisa Pellegrini, Stefano Ballestri, Dante Romagnoli, Paola Loria, Department of Biomedical, Metabolic and Neural Sciences, Nuovo Ospedale Civile di Modena, University of Modena and Reggio Emilia and Azienda USL of Modena, Baggiovara, 41126 Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ballestri
authors.affiliation: Marco Bertolotti, Amedeo Lonardo, Chiara Mussi, Enrica Baldelli, Elisa Pellegrini, Stefano Ballestri, Dante Romagnoli, Paola Loria, Department of Biomedical, Metabolic and Neural Sciences, Nuovo Ospedale Civile di Modena, University of Modena and Reggio Emilia and Azienda USL of Modena, Baggiovara, 41126 Modena, Italy.
authors.forename: Dante
authors.initials: D
authors.lastname: Romagnoli
authors.affiliation: Marco Bertolotti, Amedeo Lonardo, Chiara Mussi, Enrica Baldelli, Elisa Pellegrini, Stefano Ballestri, Dante Romagnoli, Paola Loria, Department of Biomedical, Metabolic and Neural Sciences, Nuovo Ospedale Civile di Modena, University of Modena and Reggio Emilia and Azienda USL of Modena, Baggiovara, 41126 Modena, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Loria
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology; D016330:Frail Elderly; D015577:Geriatric Assessment; D054884:Host-Pathogen Interactions; D006801:Humans; D007422:Intestines / Q000382:microbiology; D008019:Life Style; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D019338:Polypharmacy; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D055948:Sarcopenia / Q000453:epidemiology
keywords: Adipose tissue; Aortic valve sclerosis; Arrhythmia; Atherosclerosis; Autonomic dysfunction; Cirrhosis; Dementia; Falls; Frailty; Hepatocellular carcinoma; Microbiota; Nuclear receptors; Pathogenesis; Sarcopenia; Treatment