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Background <p>Multimorbidity and polypharmacy are common in older adults with cardiometabolic diseases, but their burden in metabolic dysfunction-associated steatotic liver disease (MASLD) is less understood.</p> Objective <p>To characterize multimorbidity and polypharmacy among older adults with MASLD.</p> Design <p>Retrospective cohort study.</p> Participants <p>Adults ≥ 65&#xa0;years with transient elastography data in NHANES 2017–2020.</p> Main Measures <p>MASLD was defined as steatosis plus ≥ 1 metabolic risk factor; polypharmacy was ≥ 5 medications. Participants were stratified by age (65–69, 70–74, and ≥ 75&#xa0;years). Survey-weighted analyses evaluated age and polypharmacy in MASLD and non-MASLD adults. Multivariable models adjusted for comorbidities.</p> Key Results <p>An estimated 42 million US adults ≥ 65&#xa0;years were included, 39.8% had MASLD. The proportion of women with MASLD decreased with age (55.5 to 39.3%, <i>p</i> = 0.04). Diabetes, obesity, and cardiometabolic burden were higher in MASLD across all age groups (<i>p</i> &lt; 0.01). Polypharmacy was most common in MASLD adults ≥ 75&#xa0;years (60.3%), exceeding younger MASLD adults (36.9%, <i>p</i> = 0.002) and non-MASLD peers (42.7%; <i>p</i> = 0.005). MASLD adults had higher antidiabetic but lower antihypertensive use (<i>p</i> &lt; 0.05). MASLD adults ≥ 75&#xa0;years had over three times the odds of polypharmacy versus those 65–69&#xa0;years (aOR 3.12, 95%CI 2.21–4.42).</p> Conclusions <p>Older adults with MASLD ≥ 75&#xa0;years face a significant and independent burden of polypharmacy. This challenge is especially salient in MASLD, where aggressive management of cardiometabolic comorbidities is essential to preventing disease progression and non-liver mortality, yet the medications used may heighten geriatric vulnerabilities. Age-appropriate medication review, deprescribing, and goal concordant care are critical to navigating this tension in this high-risk population.</p>

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Polypharmacy Among Older Adults with Metabolic Dysfunction–Associated Steatotic Liver Disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月14日

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  • Melinda Wang,
  • Leena Usman,
  • Benjamin Cho,
  • Kenneth Covinsky,
  • Jennifer C. Lai

摘要

Background

Multimorbidity and polypharmacy are common in older adults with cardiometabolic diseases, but their burden in metabolic dysfunction-associated steatotic liver disease (MASLD) is less understood.

Objective

To characterize multimorbidity and polypharmacy among older adults with MASLD.

Design

Retrospective cohort study.

Participants

Adults ≥ 65 years with transient elastography data in NHANES 2017–2020.

Main Measures

MASLD was defined as steatosis plus ≥ 1 metabolic risk factor; polypharmacy was ≥ 5 medications. Participants were stratified by age (65–69, 70–74, and ≥ 75 years). Survey-weighted analyses evaluated age and polypharmacy in MASLD and non-MASLD adults. Multivariable models adjusted for comorbidities.

Key Results

An estimated 42 million US adults ≥ 65 years were included, 39.8% had MASLD. The proportion of women with MASLD decreased with age (55.5 to 39.3%, p = 0.04). Diabetes, obesity, and cardiometabolic burden were higher in MASLD across all age groups (p < 0.01). Polypharmacy was most common in MASLD adults ≥ 75 years (60.3%), exceeding younger MASLD adults (36.9%, p = 0.002) and non-MASLD peers (42.7%; p = 0.005). MASLD adults had higher antidiabetic but lower antihypertensive use (p < 0.05). MASLD adults ≥ 75 years had over three times the odds of polypharmacy versus those 65–69 years (aOR 3.12, 95%CI 2.21–4.42).

Conclusions

Older adults with MASLD ≥ 75 years face a significant and independent burden of polypharmacy. This challenge is especially salient in MASLD, where aggressive management of cardiometabolic comorbidities is essential to preventing disease progression and non-liver mortality, yet the medications used may heighten geriatric vulnerabilities. Age-appropriate medication review, deprescribing, and goal concordant care are critical to navigating this tension in this high-risk population.