Epidemiology of metabolic dysfunction-associated steatotic liver disease

Abstract

As the rates of obesity and type 2 diabetes (T2D) continue to increase globally, so does the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD). Currently, 38% of all adults and 7-14% of children and adolescents have MASLD. By 2040, the MASLD prevalence rate for adults is projected to increase to more than 55%. Although MASLD does not always develop into progressive liver disease, it has become the top indication for liver transplant in the United States for women and those with hepatocellular carcinoma (HCC). Nonetheless, the most common cause of mortality among patients with MASLD remains cardiovascular disease. In addition to liver outcomes (cirrhosis and HCC), MASLD is associated with an increased risk of developing de novo T2D, chronic kidney disease, sarcopenia, and extrahepatic cancers. Furthermore, MASLD is associated with decreased health-related quality of life, decreased work productivity, fatigue, increased healthcare resource utilization, and a substantial economic burden. Similar to other metabolic diseases, lifestyle interventions such as a heathy diet and increased physical activity remain the cornerstone of managing these patients. Although several obesity and T2D drugs are available to treat co-morbid disease, resmetirom is the only MASH-targeted medication for patients with stage 2-3 fibrosis that has approved by the Food and Drug Administration for use in the United States. This review discusses MASLD epidemiology and its related risk factors and outcomes and demonstrates that without further global initiatives, MASLD incidence could continue to increase.

Keywords: Insulin resistance; MASLD; Metabolic syndrome; Type 2 diabetes.

Figure 1.

Timeline for the evolution of metabolic dysfunction–associated steatotic liver disease (MASLD). NASH, nonalcoholic steatohepatitis.

Figure 2.

Role of hepatokines and other factors in the development of insulin resistance and cardiovascular disease. MASLD, metabolic dysfunction-associated steatotic liver disease. Adopted and modified from the article of Stefan et al.22 (Cell Metab 2023;35:236-252) with permission from creative commons.

Figure 3.

Current understanding of the progression and regression of metabolic dysfunction–associated steatotic liver disease (MASLD). MASH, metabolic dysfunction-associated steatohepatitis.

Figure 4.

Parallel increases in obesity, diabetes, and NAFLD from 2013 to 2020. NAFLD, nonalcoholic fatty liver disease; T2D, type 2 diabetes.