Nonalcoholic fatty liver disease and aging: Epidemiology to management
Nonalcoholic fatty liver disease and aging: Epidemiology to management
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DOI：
10.3748/wjg.v20.i39.14185
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发表时间：
2014-10-21
影响因子：
4.3
通讯作者：
Loria, Paola
中科院分区：
文献类型：
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作者：
Bertolotti, Marco;Lonardo, Amedeo;Loria, Paola
非酒精性脂肪性肝病（NAFLD）在老年人中很常见，与年轻群体相比，老年人的肝脏负担（非酒精性脂肪性肝炎、肝硬化和肝细胞癌）以及肝外表现和并发症（心血管疾病、肝外肿瘤）更为严重。因此，正确识别和管理这种情况是临床老年病学家和老年肝病学家的一项主要任务。本文回顾了该病的流行病学和病理生理学，并全面讨论了 NAFLD 与老年人特有的方面之间的联系；这些方面包括虚弱、多重疾病、多重用药和痴呆。正确的治疗策略必须考虑老年患者的特殊性，因此必须采用多学科方法。考虑到大多数老年人的身体限制和充足热量供应的需要，非药物治疗（饮食和体育锻炼）必须单独定制。同样，在多种健康状况和多重用药的共同背景下，药物治疗的选择必须仔细平衡不良事件和药理相互作用方面的益处和风险。总之，需要进一步的流行病学和病理生理学见解。更准确地了解老年 NAFLD 的分子机制将有助于为个体老年患者确定最合适的诊断和治疗方法。 (C) 2014 百事登出版集团有限公司版权所有。
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. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.