The number of people aged 65 years and older is expected to balloon over the next few decades. As people are living longer, however, the likelihood of developing chronic diseases, such as liver diseases, increases.
In the U.S. alone, about 4.5 million adults have liver disease, and about 57,000 people die from it every year. Globally, liver disease causes about 2 million deaths every year, or 4% of all deaths. Those deaths mostly stem from complications of cirrhosis, which is when the liver becomes scarred and permanently damaged.
For years, Yale hepatologist Joseph Lim has studied chronic liver disease, with particular attention to liver cirrhosis, chronic hepatitis B and C infections, and fatty liver disease. He's professor of medicine, director of clinical hepatology, and vice-chief of the Section of Digestive Diseases at Yale School of Medicine.
In an interview, Lim explains how the liver changes as we age, the common types of liver disease, and what we can do to improve the health of this organ.
The interview has been edited for length and clarity.
How does the liver change with age?
Joseph Lim: That's a question applicable to our entire human body in terms of physiologic changes that occur with aging, from cellular functions to metabolic processes. Many of the processes for which the liver has primary or secondary responsibility are all affected by age. The biggest ones are pretty obvious. The actual size and volume of the liver shrinks as one ages, and this is particularly true for those who are aged 65 years or older. The vascular supply to the liver in terms of blood volume declines by as much as 40% with more advanced age. With this, the metabolic capacity of the liver will decrease in concert with decreasing volume and size and change in circulation.
What are some of the most common types of liver disease for older adults?
Lim: Most liver conditions are not specific to age, but the clinical manifestation may be different in older adults. The common conditions in those who are considered elderly or of advanced age are the same for those individuals who are younger. These most common include what's called MASLD [metabolic dysfunction-associated steatotic liver disease], also known as fatty liver disease. With aging, many of the functions of the liver, including lipid and carbohydrate metabolism, are impaired gradually over time. Therefore, the predisposition to developing excess liver fat increases with age.
The second most common is probably ALD, or alcohol-related liver disease. Epidemiologically, we know that the prevalence of alcohol consumption does appear to be increased in individuals with older age. We also know that the metabolism of alcohol by an aging liver is different than someone who has a normal liver earlier in life. Other common conditions include viral hepatitis, including hepatitis B and C autoimmune liver diseases.
How important is the liver for our overall health, especially as we age?
Lim: The liver is a central metabolic organ for the body regardless of age. As we age, it's common that individuals will often have one or more medical conditions. The aging liver certainly doesn't help because it can potentially further exacerbate the predisposition to chronic inflammation, immune dysfunction, the efficacy of medications, or the predisposition to toxicity from medications.
How can we better care of our livers as we age?
Lim: The treatment of liver disease is specific to each condition. But, in general, the key principles for trying to counteract the effects of aging on the liver focus on diet. You want to really focus on trying to de-stress the liver, and so what you want really is a low-fat, low-sugar diet. The aging liver is less able to optimize carbohydrate and lipid metabolism.
One common diet often recommended in patients with liver disease is the Mediterranean diet. You want to have high fiber content. So this would be fruits, vegetables, legumes, whole grains. That's very beneficial both for the liver and the gut microbiome in terms of bacterial diversity within the gut. You want to make sure that your diet includes plenty of natural antioxidants, not in a pill but in dietary form. You also want healthy proteins like fish and poultry because the building block for a highly functioning liver is protein.
Another piece of advice is to avoid alcohol consumption. That's because the liver may be less able to handle it in the same way as when someone is younger. The liver may be more vulnerable even if a person didn't have issues in the past.
