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. 2024 Nov 14;7(3):101271.
doi: 10.1016/j.jhepr.2024.101271. eCollection 2025 Mar.

Global burden of metabolic dysfunction-associated steatotic liver disease, 2010 to 2021

Gong Feng  1   2 , Giovanni Targher  3   4 , Christopher D Byrne  5 , Yusuf Yilmaz  6   7 , Vincent Wai-Sun Wong  8 , Cosmas Rinaldi Adithya Lesmana  9   10   11 , Leon A Adams  12   13 , Jerome Boursier  14   15 , George Papatheodoridis  16 , Mohamed El-Kassas  17   18 , Nahum Méndez-Sánchez  19   20 , Silvia Sookoian  21   22   23 , Laurent Castera  24 , Wah-Kheong Chan  25 , Feng Ye  2 , Sombat Treeprasertsuk  26 , Helena Cortez-Pinto  27 , Hon Ho Yu  28 , Won Kim  29   30 , Manuel Romero-Gómez  31 , Atsushi Nakajima  32 , Khin Maung Win  33 , Seung Up Kim  34 , Adriaan G Holleboom  35 , Giada Sebastiani  36 , Ponsiano Ocama  37 , John D Ryan  38 , Monica Lupșor-Platon  39 , Hasmik Ghazinyan  40 , Mamun Al-Mahtab  41 , Saeed Hamid  42 , Nilanka Perera  43 , Khalid A Alswat  44 , Qiuwei Pan  45 , Michelle T Long  46 , Vasily Isakov  47 , Man Mi  1 , Marco Arrese  48 , Arun J Sanyal  49 , Shiv Kumar Sarin  50 , Nathalie Carvalho Leite  51 , Luca Valenti  52   53 , Philip N Newsome  54 , Hannes Hagström  55   56 , Salvatore Petta  57 , Hannele Yki-Järvinen  58   59 , Jörn M Schattenberg  60 , Marlen I Castellanos Fernández  61 , Isabelle A Leclercq  62 , Gulnara Aghayeva  63 , Abdel-Naser Elzouki  64   65   66 , Ali Tumi  67 , Ala I Sharara  68 , Asma Labidi  69 , Faisal M Sanai  70 , Khaled Matar  71 , Maen Al-Mattooq  72 , Maisam Waid Akroush  73 , Mustapha Benazzouz  74 , Nabil Debzi  75 , Maryam Alkhatry  76 , Salma Barakat  77 , Said A Al-Busafi  78 , John Rwegasha  79 , Wah Yang  80 , Agyei Adwoa  81   82 , Christopher Kenneth Opio  83 , Mohammadjavad Sotoudeheian  84   85 , Yu Jun Wong  86   87 , Jacob George  88 , Ming-Hua Zheng  89   90
Affiliations

Global burden of metabolic dysfunction-associated steatotic liver disease, 2010 to 2021

Gong Feng et al. JHEP Rep. .

Abstract

Background & aims: This study used the Global Burden of Disease data (2010-2021) to analyze the rates and trends of point prevalence, annual incidence, and years lived with disability (YLDs) for metabolic dysfunction-associated steatotic liver disease (MASLD) in 204 countries.

Methods: Total numbers and age-standardized rates per 100,000 population for MASLD prevalence, annual incidence, and YLDs were compared across regions and countries by age, sex, and sociodemographic index (SDI). Smoothing spline models were used to evaluate the relationship between the burden of MASLD and SDI. Estimates were reported with uncertainty intervals (UI).

Results: Globally, in 2021, the age-standardized rates per 100,000 population of point prevalence of MASLD were 15,018.1 cases (95% UI 13,756.5-16,361.4), annual incidence rates were 608.5 cases (598.8-617.7), and YLDs were 0.5 (0.3-0.8) years. MASLD point prevalence was higher in men than women (15,731.4 vs. 14,310.6 cases per 100,000 population). Prevalence peaked at ages 45-49 for men and 50-54 for women. Kuwait (32,312.2 cases per 100,000 people; 95% UI: 29,947.1-34,839.0), Egypt (31,668.8 cases per 100,000 people; 95% UI: 29,272.5-34,224.7), and Qatar (31,327.5 cases per 100,000 people; 95% UI: 29,078.5-33,790.9) had the highest prevalence rates in 2021. The largest increases in age-standardized point prevalence estimates from 2010 to 2021 were in China (16.9%, 95% UI 14.7%-18.9%), Sudan (13.3%, 95% UI 9.8%-16.7%) and India (13.2%, 95% UI 12.0%-14.4%). MASLD incidence varied with SDI, peaking at moderate SDI levels.

Conclusions: MASLD is a global health concern, with the highest prevalence reported in Kuwait, Egypt, and Qatar. Raising awareness about risk factors and prevention is essential in every country, especially in China, Sudan and India, where disease incidence and prevalence are rapidly increasing.

Impact and implications: This research provides a comprehensive analysis of the global burden of MASLD, highlighting its rising prevalence and incidence, particularly in countries with varying sociodemographic indices. The findings are significant for both clinicians and policymakers, as they offer critical insights into the regional disparities in MASLD burden, which can inform targeted prevention and intervention strategies. However, the study's reliance on modeling and available data suggests cautious interpretation, and further research is needed to validate these findings in clinical and real-world settings.

Keywords: Epidemiology; Metabolic dysfunction-associated fatty liver disease; Metabolic dysfunction-associated steatotic liver disease; Non-alcoholic fatty liver disease.

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Conflict of interest statement

CDB has received grant support from Echosens. YY is a consultant to Zydus and Novo Nordisk. WK reports grants from Glaxo-SmithKline, Gilead, Novartis, Pfizer, Roche, Springbank, Ildong, Galmed, Dicerna, Enyo, Hanmi, Novo Nordisk, and KOBIOLABS; consulting fees from Boehringer Ingelheim, Novo Nordisk, Standigm, Daewoong, TSD Life Sciences Ildong, Olix Pharma, HK Inoen, and KOBIOLABS; honoraria for lectures from Ildong, Samil, and Novo Nordisk, and owns stocks in KOBIOLABS and Lepidyne and he is the founder of Remedygen. GS reports honoraria from Merck, Gilead, AbbVie, Novonordisk, and Pfizer, and unrestricted research funding from Theratecnologies Inc. VW-SW reports grants from Gilead Sciences; consulting fees from AbbVie, Boehringer Ingelheim, Echosens, Gilead Sciences, Intercept, Inventiva, Novo Nordisk, Pfizer, TARGET PharmaSolutions; honoraria for lectures from Abbott, AbbVie, Gilead Sciences, Novo Nordisk and he is Chairman of Subspecialty Board of Gastroenterology and Hepatology, Hong Kong College of Physicians and Co-founder of Illuminatio Medical Technology Limited. JB reported receiving grants and personal fees from Echosens. W-KC is a consultant or advisory board member for Abbott, Roche, AbbVie, Boehringer Ingelheim and Novo Nordisk; and a speaker for Abbott, Novo Nordisk, Echosens, Viatris and Hisky Medical. JDR received consultancy fees from Falk, Gilead, Pfizer and a speaker honorarium from Takeda. LV reports consulting fees from Gilead, Pfizer, Astra Zeneca, Novo Nordisk, Intercept pharmaceuticals, Diatech Pharmacogenetics, IONIS, and Viatris; honoraria from MSD, Gilead, AlfaSigma, AbbVie, and Resalis, and grants from Gilead. JMS serves as a consultant for Akero, Alentis Therapeutics, Astra Zeneca, Apollo Endosurgery, Boehringer Ingelheim, GSK, Ipsen, Inventiva Pharma, Madrigal, MSD, Northsea Therapeutics, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, and Siemens Healthineers. He has received research funding from Gilead Sciences, Boehringer Ingelheim, and Siemens Healthcare GmbH. He holds stock options in AGED diagnostics and Hepta Bio. He has also received speaker honorarium from Gilead Sciences, Advanz, Echosens, MedPublico GmbH. MR-G reported receiving personal fees from Echosens. SUK reported personal fees from Gilead Sciences, GSK, Bayer, Eisai, AbbVie, Echosens, MSD, Bristol-Myers Squibb, AstraZeneca, and grants from AbbVie, Bristol-Myers Squibb, and Gilead Sciences. PNN reported receiving grants from Novo Nordisk, advisory board and personal consulting fees, honoraria for lectures and travel expenses from Novo Nordisk, personal consulting and advisory board fees from Boehringer Ingelheim, Gilead, Intercept, Poxel Pharmaceuticals, Bristol-Myers Squibb, Pfizer, MSD, Sun Pharma, Eli Lilly, Madrigal, GSK, and nonfinancial support for educational events from AiCME. AS reported receiving grants from Intercept, Merck, personal consulting fees from Gilead, Pfizer, Genentech, ALnylam, Regeneron, Zydus, LG chem, Hanmi, Madrigal, Path AI, and 89 Bio, grants and personal consulting fees from Eli Lilly, Novo Nordisk, Boehringer Ingelheim, Novartis, and Histoindex, and stock options from Genfit, Tiziana, Durect, Inversago, and Galmed. LAA reports consulting fees from Novo Nordisk, Pfizer, Gilead, and CSL Behring. HH reported personal fees from AstraZeneca, Bristol-Myers Squibb, MSD, Novo Nordisk, Boehringer Ingelheim, KOWA, and GW Phara outside the submitted work, and grants from AstraZeneca, Echosens, Gilead Sciences, Intercept, MSD, Novo Nordisk, and Pfizer outside the submitted work. JG serves on Advisory Boards and receives honoraria for talks from Novo Nordisk, Astra Zeneca, Roche, BMS, Pfizer, Cincera, Pharmaxis, Gilead, AbbVie, and Boehringer Ingelheim. M-HZ has received honoraria for lectures from AstraZeneca, Hisky Medical Technologies, and Novo Nordisk, and consulting fees from Boehringer Ingelheim. No other disclosures were reported. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Age-standardized point prevalence rates of MASLD per 100,000 population in 2021 by country.
Fig. 2
Fig. 2
Age-standardized annual incidence rates of MASLD per 100,000 people in 2021 by country.
Fig. 3
Fig. 3
Total number of prevalent cases and age-standardized point prevalence rates of MASLD per 100,000 population by age and sex in 2021. (A) Prevalence and rate of disease by age and sex. Dashed lines indicate 95% upper and lower uncertainty intervals (UIs). (B) Age and sex distribution of disease prevalence. (C) Regional distribution of disease prevalence by sex.
Fig. 4
Fig. 4
Age-standardized incidence rates of MASLD per 100,000 population for 21 Global Burden of Disease regions by sociodemographic index (SDI) between 2010 and 2021. The purple line represents expected values based on the sociodemographic index and incidence rates in all locations. Twelve points are plotted for each Global Burden of Disease region and show the observed age-standardized incidence rates for that region from 2010 to 2021.
Fig. 5
Fig. 5
Age-standardized incidence rates of MASLD per 100,000 population by 204 countries and sociodemographic index (SDI) in 2021. The black line represents expected values based on the sociodemographic index and incidence rates in 204 countries. Each point shows observed age-standardized incidence rates for a specified country in 2021.
See this image and copyright information in PMC

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