A retrospective study associated GLP-1-based treatment with lower risks of liver complications and death among adults aged 65 years and older with metabolic dysfunction-associated steatotic liver disease (MASLD).

Published in Age and Aging, the study analyzed electronic health records from 69 US healthcare organizations. Among 44,196 glucagon-like peptide-1 receptor agonist (GLP-1 RA) initiators and 384,672 unexposed patients, propensity matching yielded 43,930 participants per group. Mean age was 71.8 years, and 62% were women.

GLP-1 RA use was associated with lower risks of hepatic decompensation (hazard ratio [HR] 0.72; 95% confidence interval [CI] 0.66–0.79), all-cause mortality (HR 0.55; 95% CI 0.52–0.58), and hospitalization (HR 0.95; 95% CI 0.93–0.97). Major adverse cardiovascular events were not significantly reduced (HR 0.98; 95% CI 0.92–1.04).

Osteoporosis without fracture and retinopathy were more frequent among treated patients, while pancreatitis, sarcopenia, and fractures showed no significant differences. Gastrointestinal events occurred more often as the first recorded event.

The observational findings do not establish causality. Randomized controlled trials are needed to confirm benefits and assess safety in older adults with MASLD.

Source: Koutouratsas T, Kalligeros M, Michael M, Das S, Mylonakis SC, Mylonakis E. GLP-1-based treatments and long-term clinical outcomes in MASLD amongst older adults: a retrospective cohort study. Age and Ageing. 2026;55(9):afag281. Published September 21, 2026. doi:10.1093/ageing/afag281.