Animal protein intake and hepatic steatosis in the elderly

We read with interest the work by Alferink et al,1 which reports that intake of animal protein, but not that of monosaccharides and disaccharides, was found to be independently associated with non-alcoholic fatty liver disease (NAFLD). This is a surprising finding from a well-conducted cohort study that facilitated adjustment for metabolic covariates, in addition to sociodemographics and other lifestyle factors. However, we have reservations about the generalisability of these findings to patients with NAFLD or non-alcoholic steatohepatitis (NASH).

The studied population had an average age of 70 years, which is unusual for a first presentation of NAFLD. A large retrospective study identified 52.8 years as the average age of NASH-cirrhosis.2 Given the estimated rate of disease progression in NAFLD and NASH, most patients with clinically significant NAFLD are likely to have presented before the age of 70 years.3

Table 1 of the trial shows that the...

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