Associations between metabolic dysfunction-associated steatotic liver disease and physical and mental health-related quality of life in older adults.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common, often overlooked liver condition. Its impact on quality-of-life in older adults is not well understood. We examined the association between MASLD and physical and mental quality of life in a well-characterized cohort of Australians aged 70 and older. MASLD was identified using Fatty Liver Index ≥ 60 and consensus lifestyle and cardiometabolic criteria and assessed at baseline and at 3 years. PCS and MCS scores were measured annually using the 12-Item Short Form Health Survey. Generalized estimating equations adjusted for key confounders were used to evaluate the association of baseline and time-updated MASLD with longitudinal HRQoL outcomes. Analysis of 8880 participants (median follow-up 5.5 years) showed that baseline MASLD was associated with lower, then declining PCS over follow-up compared with no MASLD (mean difference -1.3; 95% CI -1.8, -0.9). Exploratory analysis showed stronger associations among women and individuals with frailty. Findings were similar when time-updated MASLD was modelled. While the presence of MASLD was associated with a deterioration in PCS, the difference was below the minimal clinically important difference (MCDI) of 4.2, indicating limited clinical implications at the individual level. For MCS, associations with MASLD were inconsistent and did not show a clear linear pattern, whereas MASLD was associated with lower mental HRQoL. Although the differences in PCS and MCS were small and below the MCID, these findings, at the population level, support integrating metabolic liver risk assessment with geriatric and psychiatric care, including screening for frailty, functional limitations, and depression.