In an interview with Pharmacy Times, Jiyeon Oh, MD, first author and staff at the Department of Medicine at Kyung Hee University College of Medicine in Seoul, South Korea; Min Seo Kim, MD, MS, corresponding author and staff at the Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard University; and Dong Keon Yon, MD, PhD, corresponding author and professor in the Department of Pediatrics at Kyung Hee University, discussed the global burden and epidemiologic drivers of metabolic dysfunction-associated steatotic liver disease (MASLD), emphasizing its rapid rise and strong association with metabolic diseases.1
The authors emphasized the striking scale of disease burden found in a study they authored, noting that approximately 1.3 billion people—16.1% of the global population—were living with MASLD in 2023, a 142.7% increase in case numbers since 1990. The rise in MASLD was strongly attributed to metabolic drivers, particularly high fasting plasma glucose, followed by elevated body mass index (BMI) and smoking. The authors linked this trend closely to the global epidemics of type 2 diabetes and obesity, exacerbated by urbanization, sedentary lifestyles, and dietary shifts.1
Pharmacy Times: What was the most striking or unexpected finding from this study?
Jiyeon Oh, MD, Min Seo Kim, MD, MS, and Dong Keon Yon, MD, PhD: The most striking finding is the sheer scale of the burden: approximately 1.3 billion people (ie, 16.1% of the global population) were living with metabolic dysfunction-associated steatotic liver disease (MASLD) in 2023, representing a 142.7% increase in crude case numbers since 1990.
The geographic distribution also stands out. North Africa and the Middle East had the highest age-standardized prevalence rate, roughly 3.4 times higher than the lowest-burden region (ie, high-income Asia Pacific), and all 20 of the highest-prevalence countries in 2023 were concentrated in that single region. That degree of regional concentration was notable, particularly given that many of these countries have socio-demographic Index (SDI) levels similar to other regions with far lower rates.
Pharmacy Times: MASLD prevalence has increased significantly since 1990. What are the primary drivers behind this rise, and how much is tied to trends in diabetes and obesity?
Oh, Kim, and Yon: This study identified metabolic risk factors as the center engine of rising prevalence. Among the 3 modifiable risk factors, high fasting plasma glucose contributed the largest share of disability-adjusted life year (DALY) attributable to MASLD, followed by high body mass index (BMI) and smoking.
We further link this to the global rise in type 2 diabetes (T2D) and obesity. This relationship is especially evident in North Africa and the Middle East, which not only recorded the highest MASLD prevalence rate but also carried the highest burden of T2D. Rapid urbanization, driving more sedentary lifestyles and shifts toward unhealthy dietary patterns, is cited as an important contextual factor linking these metabolic trends to the growth of MASLD, particularly in low- and middle-income settings, where such transitions have accelerated sharply over recent decades.
The forecasting model, which used mean BMI and fasting plasma glucose as its two key predictors, projects that 1.8 billion people will have MASLD by 2050, a 42% increase from 2023, suggesting that without population-level interventions targeting these metabolic drivers, the trajectory will continue upward.
Pharmacy Times: Despite rising prevalence, DALY rates have remained relatively stable. How should clinicians interpret that in terms of disease progression and patient outcomes?
Key Takeaways
- MASLD affects 16.1% of the global population, with major geographic disparities in prevalence.
- Metabolic risk factors—especially hyperglycemia and obesity—are the primary drivers of disease growth.
- Stable DALY rates likely reflect earlier disease stages rather than true reduction in disease burden.
Oh, Kim, and Yon: The authors believe 2 complementary interpretations are possible. First, the stable DALY rate likely reflects genuine advances in managing MASLD’s severe complications, particularly cirrhosis and hepatocellular carcinoma. Improved clinical management may be counterbalancing the growing pool of people with the disease, preventing proportional escalation in death and disability.
The second interpretation is more cautionary: the prevalence increase has been largely driven by precirrhotic stages of MASLD—stages that do not directly generate further disability. This means there is an accumulating reservoir of individuals who have MASLD but have not yet had sufficient time to progress to cirrhosis or liver cancer. The authors describe this as “an accumulating pool of at-risk individuals” who are likely to develop complications in the coming years. The stable DALY rate today may therefore be a lagging indicator, not reassurance that the situation is under control.
Therefore, the majority of patients with MASLD are currently asymptomatic and at pre-cirrhotic stages, which is simultaneously the stage most amenable to lifestyle and pharmacological intervention and the stage at which patients are least likely to present spontaneously. Waiting for symptoms or advanced disease before acting is likely to miss the window for meaningful prevention.
