In 2023, approximately 1.3 billion people were estimated to be living with metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease, according to a new study published in The Lancet Gastroenterology & Hepatology. By 2025, MASLD incidence will increase by 42%, reaching 1.8 billion.

 

“These projections represent what will happen if nothing changes at a population level, making them a call to action as much as a forecast,” said lead study author Jiyeon Oh, MD, in an interview with MedCentral.

 

MASLD and its more severe form, metabolic dysfunction-associated steatohepatitis (MASH), are responsible for a growing proportion of advanced liver disease worldwide. Estimates suggest that around a third of people in the United States have MASLD, and about 5% have MASH. Over time, the buildup of fat in the liver can lead to serious complications, including cirrhosis and liver cancer. MASLD often occurs in people with obesity, type 2 diabetes and other metabolic conditions. With only two approved medications (Rezdiffra and Wegovy), management still largely depends on lifestyle changes such as weight loss and exercise.

 

To learn more about MASLD, read Hep’s “What Is Fatty Liver Disease? (MASLD and MASH).”

 

The researchers used data from the 2023 Global Burden of Diseases, Injury and Risk Factors study, which provided estimates on the combined impact of 375 diseases/injuries and 85 risk factors in 204 countries and territories. The data included information on age, sex, year, location, healthcare access and socioeconomic status.

 

Globally, MASLD burden increased by 142.7% since 1990 to 2023 (approximately 0.5 billion to 1.3 billion). The highest age-standardized prevalence rates were in the Middle East and North Africa, at approximately 14,500 cases per 100,000 people, which was 3.4 times higher than the lowest rate in the high-income Asia Pacific region with about 8,600 cases per 100,000 people. The highest rate was in Kuwait (about 35,300 per 100,000 people) in 2023, and the lowest was in Finland (about 7,700 per 100,000).

 

An estimated 3.6 million absolute disability adjusted life years, or DALYs, a measure of the total burden of disease representing a lost year of healthy life through premature death, could be attributed to MASLD in 2023. North Africa and the Middle East, which had the highest prevalence rates, had a low DALY rate of 52.6 per 100,000 people. East Asia had the lowest DALY in 2023 (16.3 per 100,000) which was nine times lower than the highest regional rate in Andean Latin America (152.33 per 100,000). Nationally, Mexico had the highest DALY in 2023 (192.1 per 100,000).

 

MASLD prevalence was higher in men (15,600 per 100,000) than women (13,200 per 100,000), and prevalence increased with age for both sexes. DALY rates were only slightly higher in men (42.8 per 100,000) than women (36.4 per 100,000). Lower socioeconomic status and healthcare access were associated with higher age-standardized DALY rates.

 

“Lower SDIs [sociodemographic indices] and HAQs [healthcare quality and access indices] were associated with higher age-standardized DALY rates, suggesting that inadequate healthcare access, socioeconomic disparities and underdiagnosis of mild cases in lower-income settings might contribute to a higher proportion of MASLD cases with advanced stages of disease that cause morbidity and premature mortality,” wrote the study’s authors.

 

Overall, three outcome pairs were relevant to MASLD in 2023: smoking plus liver cancer, high BMI plus liver cancer and high fasting plasma glucose plus liver cancer. By 2050, MASLD will increase by 42%, reaching 1.8 billion people worldwide.

 

Somaya Albhaisi, MBBCh, MPH, a spokesperson for the American Gastroenterological Association, explained that these study findings could inform policies and set targets for resource allocation when addressing MASLD and MASH.

 

“This is really the whole purpose of doing studies like this,” Albhaisi told MedCentral. “It’s not just to paint a grim picture of this health problem. It’s really to ring the alarm that there’s a big problem we’re not paying enough attention to. So let’s work together in mitigating this so that, in the next few years, this doesn’t turn out to be a global health disaster.”

 

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