Addressing the High and Rising Global Burden of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH): From the Growing Prevalence to Payors' Perspective

Zobair M Younossi^{1

2}, Homie Razavi³, Michael Sherman^{4

5}, Alina M Allen⁶, Quentin M Anstee^{7

8}, Kenneth Cusi⁹, Scott L Friedman¹⁰, Eric Lawitz¹¹, Jeffrey V Lazarus^{12

13

14}, Detlef Schuppan^{15

16}, Manuel Romero-Gómez¹⁷, Jörn M Schattenberg¹⁸, Miriam B Vos¹⁹, Vincent Wai-Sun Wong²⁰, Vlad Ratziu²¹, Marcus Hompesch²², Arun J Sanyal²³, Rohit Loomba²⁴

Affiliations

¹ Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA.
² The Global NASH Council, Washington, DC, USA.
³ Center for Disease Analysis Foundation, Lafayette, Colorado, USA.
⁴ RA Capital Management, L.P., Boston, Massachusetts, USA.
⁵ Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Division of Gastroenterology and Hepatology, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
⁷ Faculty of Medical Sciences, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
⁸ Newcastle NIHR Biomedical Research Center, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
⁹ Division of Endocrinology, Diabetes & Metabolism, University of Florida, Gainesville, Florida, USA.
¹⁰ Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹¹ Texas Liver Institute, University of Texas Health San Antonio, San Antonio, Texas, USA.
¹² Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
¹³ Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
¹⁴ City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA.
¹⁵ Mainz University, Mainz, Germany.
¹⁶ Germany & Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
¹⁷ Department of Medicine, UCM Digestive Diseases, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (HUVR/CSIC/US), CIBEREHD, ISCIII, University of Seville, Seville, Spain.
¹⁸ Department of Internal Medicine II, Saarland University Medical Center, Homburg, Germany.
¹⁹ Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
²⁰ State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
²¹ Sorbonne Université and Pitié-Salpêtrière Hospital Paris, Paris, France.
²² ProSciento Inc., San Diego, California, USA.
²³ Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
²⁴ Division of Gastroenterology and Hepatology at UC San Diego, MASLD Research Center California, La Jolla, California, USA.

PMID: 39967239
DOI: 10.1111/apt.70020

Review

Addressing the High and Rising Global Burden of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH): From the Growing Prevalence to Payors' Perspective

Zobair M Younossi et al. Aliment Pharmacol Ther. 2025 May.

. 2025 May;61(9):1467-1478.

doi: 10.1111/apt.70020. Epub 2025 Feb 18.

Authors

Affiliations

¹ Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA.
² The Global NASH Council, Washington, DC, USA.
³ Center for Disease Analysis Foundation, Lafayette, Colorado, USA.
⁴ RA Capital Management, L.P., Boston, Massachusetts, USA.
⁵ Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Division of Gastroenterology and Hepatology, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
⁷ Faculty of Medical Sciences, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
⁸ Newcastle NIHR Biomedical Research Center, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
⁹ Division of Endocrinology, Diabetes & Metabolism, University of Florida, Gainesville, Florida, USA.
¹⁰ Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹¹ Texas Liver Institute, University of Texas Health San Antonio, San Antonio, Texas, USA.
¹² Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
¹³ Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
¹⁴ City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA.
¹⁵ Mainz University, Mainz, Germany.
¹⁶ Germany & Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
¹⁷ Department of Medicine, UCM Digestive Diseases, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (HUVR/CSIC/US), CIBEREHD, ISCIII, University of Seville, Seville, Spain.
¹⁸ Department of Internal Medicine II, Saarland University Medical Center, Homburg, Germany.
¹⁹ Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
²⁰ State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
²¹ Sorbonne Université and Pitié-Salpêtrière Hospital Paris, Paris, France.
²² ProSciento Inc., San Diego, California, USA.
²³ Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
²⁴ Division of Gastroenterology and Hepatology at UC San Diego, MASLD Research Center California, La Jolla, California, USA.

PMID: 39967239
DOI: 10.1111/apt.70020

Abstract

Background: The continuum of metabolic syndrome encompasses a spectrum of dysfunctions impacting obesity-linked insulin resistance, glucose homeostasis, lipid metabolism and pro-inflammatory immune responses. The global prevalence of metabolic diseases, including diabetes, chronic liver disease, cardiometabolic disease and kidney disease, has surged in recent decades, contributing significantly to population mortality. Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease, is a leading cause of liver disease worldwide. MASLD poses a significant global health challenge with its rising prevalence, placing a substantial burden on healthcare systems, impacts patient well-being and incurs significant economic costs. Addressing MASLD requires a comprehensive understanding of its interconnected factors, including its prevalence, healthcare burden and economic implications. Lack of awareness, imprecise non-invasive diagnostic methods and ineffective preventive interventions are core components of the MASLD-related problem.

Aim: The aim of this article was to summarise the global burden of MASLD from the payer's perspective.

Methods: We carried out a review of the global comprehensive burden of MASLD. These topics led to discussions and insights by an expert panel during the 7th Metabolic Continuum Roundtable meeting, which took place in November 2023. This meeting focused on the burden, patient-reported outcomes and health economics, from payor and societal perspectives, and aimed to identify opportunities for improving patient care, optimise resource allocation and mitigate the overall impact on individuals and society related to MASLD. During the roundtable, an emphasis emerged on the need for greater awareness and strategic deployment of diagnostic, therapeutic and preventative measures to address MASLD effectively.

Conclusion: The global burden of MASLD is high and growing. Prioritising the prevention of metabolic dysregulation and timely therapeutic interventions can yield a holistic strategy to combat MASLD, its progression and potentially lower disease costs.

Trial registration: NCT06309992.

Keywords: metabolic continuum; metabolic disease; metabolic dysfunction‐associated steatotic liver disease; type 2 diabetes mellitus.

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References

1. N. W. S. Chew, C. H. Ng, D. J. H. Tan, et al., “The Global Burden of Metabolic Disease: Data From 2000 to 2019,” Cell Metabolism 35, no. 3 (2023): 414–428.e3.
1. R. Loomba, S. L. Friedman, and G. I. Shulman, “Mechanisms and Disease Consequences of Nonalcoholic Fatty Liver Disease,” Cell 184, no. 10 (2021): 2537–2564.
1. J. V. Lazarus, H. E. Mark, Q. M. Anstee, et al., “Advancing the Global Public Health Agenda for NAFLD: A Consensus Statement,” Nature Reviews. Gastroenterology & Hepatology 19, no. 1 (2022): 60–78.
1. M. Eslam, P. N. Newsome, S. K. Sarin, et al., “A New Definition for Metabolic Dysfunction‐Associated Fatty Liver Disease: An International Expert Consensus Statement,” Journal of Hepatology 73, no. 1 (2020): 202–209.
1. M. E. Rinella, J. V. Lazarus, V. Ratziu, et al., “A Multisociety Delphi Consensus Statement on New Fatty Liver Disease Nomenclature,” Hepatology 78, no. 6 (2023): 1966–1986.

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Addressing the High and Rising Global Burden of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH): From the Growing Prevalence to Payors' Perspective

Affiliations

Addressing the High and Rising Global Burden of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH): From the Growing Prevalence to Payors' Perspective

Authors

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Abstract

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LinkOut - more resources

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Medical