Polypharmacy Among Older Adults with Metabolic Dysfunction-Associated Steatotic Liver Disease.

Authors

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

Published in

Journal of general internal medicine. Jul 14, 2026. Epub Jul 14, 2026.

Abstract

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.
To characterize multimorbidity and polypharmacy among older adults with MASLD.
Retrospective cohort study.
Adults ≥ 65 years with transient elastography data in NHANES 2017-2020.
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.
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).
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.

PMID:
42448928
Bibliographic data and abstract were imported from PubMed on 15 Jul 2026.

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