Epidemiology of metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-related liver disease (ALD)

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-related liver disease (ALD) together represent the majority of individuals with steatotic liver disease (SLD). MASLD and ALD prevalence continues to rise globally, which is driven by several factors including an aging population, increasing prevalence of cardiometabolic risk factors such as obesity and diabetes mellitus, and the increasing trends in high-risk unhealthy alcohol use which surged during the COVID-19 pandemic. As a result, MASLD, as well as ALD-related cirrhosis and hepatocellular carcinoma, is also on the rise, becoming major etiologies contributing to end-stage liver disease among adults awaiting liver transplantation. Accurately understanding MASLD and ALD epidemiology is critical to guide healthcare resource planning and health policy. Accurate estimates of MASLD and ALD epidemiology are particularly important to understand in the context of recent updates in nomenclature terminology. This review provides an updated assessment of existing literature describing the epidemiology of MASLD and ALD.

Keywords

MASLD / ALD / epidemiology / cirrhosis / hepatocellular carcinoma

References

[1] Rinella ME, Lazarus JV, Ratziu V, et al; NAFLD Nomenclature consensus group. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2023;78:1966-86. PMCID:PMC10653297

[2] Paik JM,Younossi Y,Younossi ZM.Changes in the global burden of chronic liver diseases from 2012 to 2017: the growing impact of NAFLD.Hepatology2020;72:1605-16

[3] Younossi Z,Marietti M.Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention.Nat Rev Gastroenterol Hepatol2018;15:11-20

[4] Paik JM,Younossi Y,Alqahtani S.The burden of nonalcoholic fatty liver disease (NAFLD) is rapidly growing in every region of the world from 1990 to 2019.Hepatol Commun2023;7:e0251 PMCID:PMC10545420

[5] Wong VW,Wong GL.Changing epidemiology, global trends and implications for outcomes of NAFLD.J Hepatol2023;79:842-52

[6] 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017.Lancet Gastroenterol Hepatol2020;5:245-66 PMCID:PMC7026710

[7] Hirode G,Wong RJ.Increasing clinical and economic burden of nonalcoholic fatty liver disease among hospitalized adults in the United States.J Clin Gastroenterol2019;53:765-71

[8] Wong RJ,Martinez DJ,Ozbay AB.Real-world comorbidity burden, health care utilization, and costs of nonalcoholic steatohepatitis patients with advanced liver diseases.J Clin Gastroenterol2021;55:891-902 PMCID:PMC8500367

[9] Gordon SC,Parker E,Ozbay AB.Health care use and costs among patients with nonalcoholic steatohepatitis with advanced fibrosis using the Fibrosis-4 score.Hepatol Commun2020;4:998-1011 PMCID:PMC7327220

[10] Loomba R,Fraysse J.Nonalcoholic fatty liver disease progression rates to cirrhosis and progression of cirrhosis to decompensation and mortality: a real world analysis of Medicare data.Aliment Pharmacol Ther2020;51:1149-59

[11] Wong RJ.Trends in prevalence of the metabolic syndrome-reply.JAMA2015;314:950-1

[12] Aguilar M,Torres S,Wong RJ.Prevalence of the metabolic syndrome in the United States, 2003-2012.JAMA2015;313:1973-4

[13] Hirode G.Trends in the prevalence of metabolic syndrome in the United States, 2011-2016.JAMA2020;323:2526-8 PMCID:PMC7312413

[14] Wong RJ.Trends in liver disease etiology among adults awaiting liver transplantation in the United States, 2014-2019.JAMA Netw Open2020;3:e1920294

[15] Wong T,Ladhani S,Wong RJ.Prevalence of alcoholic fatty liver disease among adults in the United States, 2001-2016.JAMA2019;321:1723-5 PMCID:PMC6506872

[16] Wong T,Ladhani S.Prevalence of alcoholic fatty liver disease among adults in the United States, 2001-2016.JAMA2019;321:1723-25 PMCID:PMC6506872

[17] Dang K,Singal AK.Alcoholic liver disease epidemiology in the United States: a retrospective analysis of 3 US databases.Am J Gastroenterol2020;115:96-104

[18] Tapper EB.Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: observational study.BMJ2018;362:k2817 PMCID:PMC6050518

[19] White AM,Powell PA,Koob GF.Alcohol-related deaths during the COVID-19 pandemic.JAMA2022;327:1704-6 PMCID:PMC8933830

[20] Shaheen AA,Ma C.Impact of the COVID-19 pandemic on hospitalizations for alcoholic hepatitis or cirrhosis in Alberta, Canada.Clin Gastroenterol Hepatol2022;20:e1170-9 PMCID:PMC8547973

[21] Rutledge SM,Florman S.COVID-19 aftershocks on alcohol-associated liver disease: an early cross-sectional report from the U.S. epicenter.Hepatol Commun2021;5:1151-5 PMCID:PMC8013370

[22] Lee BP,Leventhal A.Retail alcohol and tobacco sales during COVID-19.Ann Intern Med2021;174:1027-9 PMCID:PMC7983313

[23] Julien J,Tapper EB,Dowd WN.Effect of increased alcohol consumption during COVID-19 pandemic on alcohol-associated liver disease: a modeling study.Hepatology2022;75:1480-90 PMCID:PMC9015640

[24] Anderson MS,Brown CS.Association of COVID-19 with new waiting list registrations and liver transplantation for alcoholic hepatitis in the United States.JAMA Netw Open2021;4:e2131132 PMCID:PMC8548949

[25] Pollard MS,Green HD Jr.Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US.JAMA Netw Open2020;3:e2022942 PMCID:PMC7525354

[26] Rinella ME.Examining the nomenclature change from NAFLD and NASH to MASLD and MASH.Gastroenterol Hepatol (N Y)2023;19:697-9 PMCID:PMC10882866

[27] Shiha G,Eskridge W.Redefining fatty liver disease: an international patient perspective.Lancet Gastroenterol Hepatol2021;6:73-9

[28] Eslam M,Sarin SK.A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement.J Hepatol2020;73:202-9

[29] Rinella ME,Ratziu V.A multisociety Delphi consensus statement on new fatty liver disease nomenclature.Hepatology2023;78:1966-86 PMCID:PMC10653297

[30] Carlsson B,Brolén G.Review article: the emerging role of genetics in precision medicine for patients with non-alcoholic steatohepatitis.Aliment Pharmacol Ther2020;51:1305-20 PMCID:PMC7318322

[31] Younossi ZM,Paik JM,Van Dongen C.The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review.Hepatology2023;77:1335-47 PMCID:PMC10026948

[32] Li J,Yeo YH.Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: a systematic review and meta-analysis.Lancet Gastroenterol Hepatol2019;4:389-98

[33] Zhou F,Wang W.Unexpected rapid increase in the burden of NAFLD in China from 2008 to 2018: a systematic review and meta-analysis.Hepatology2019;70:1119-33

[34] Kruger FC,Kidd M.Non-alcoholic fatty liver disease (NAFLD) in the Western cape: a descriptive analysis.S Afr Med J2010;100:168-71

[35] Ahmed MH,Bushara SO.Non-alcoholic fatty liver disease in Africa and middle East: an attempt to predict the present and future implications on the healthcare system.Gastroenterology Res2017;10:271-9 PMCID:PMC5667692

[36] Kalligeros M,Shehadeh F.Prevalence and characteristics of nonalcoholic fatty liver disease and fibrosis in people living with HIV monoinfection: a systematic review and meta-analysis.Clin Gastroenterol Hepatol2023;21:1708-22

[37] Lee BP,Terrault NA.National prevalence estimates for steatotic liver disease and subclassifications using consensus nomenclature.Hepatology2024;79:666-73 PMCID:PMC11232657

[38] Younossi ZM,Price JK.The global epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among patients with type 2 diabetes.Clin Gastroenterol Hepatol2024;22:1999-2010.e8

[39] Díaz LA,Arnold J.Liver diseases in latin america: current status, unmet needs, and opportunities for improvement.Curr Treat Options Gastroenterol2022;20:261-78 PMCID:PMC9202671

[40] Barritt AS 4th, Yu F, Mospan AR, et al; TARGET-NASH investigators. High concordance between nonalcoholic fatty liver disease and metabolic dysfunction-associated steatotic liver disease in the TARGET-NASH real-world cohort. Am J Gastroenterol 2024;119:1624-7.

[41] Younossi ZM,Stepanova M,Alqahtani S.Clinical profiles and mortality rates are similar for metabolic dysfunction-associated steatotic liver disease and non-alcoholic fatty liver disease.J Hepatol2024;80:694-701

[42] Yeoh A,Cheung R,Ahmed A.Incidence of cirrhosis and hepatocellular carcinoma among veterans with noncirrhotic metabolic dysfunction-associated fatty liver disease.J Clin Gastroenterol2024;58:718-25

[43] Wong RJ,Cheung R.Impact of longitudinal alcohol use patterns on long-term risk of cirrhosis among US veterans with steatotic liver disease.Gastroenterology2024;166:1156-65.e4

[44] Huang DQ,Tacke F.Global epidemiology of cirrhosis - aetiology, trends and predictions.Nat Rev Gastroenterol Hepatol2023;20:388-98 PMCID:PMC10043867

[45] Stine JG,Zimmet A.Systematic review with meta-analysis: risk of hepatocellular carcinoma in non-alcoholic steatohepatitis without cirrhosis compared to other liver diseases.Aliment Pharmacol Ther2018;48:696-703 PMCID:PMC7495494

[46] Huang DQ,Loomba R.Global epidemiology of NAFLD-related HCC: trends, predictions, risk factors and prevention.Nat Rev Gastroenterol Hepatol2021;18:223-38 PMCID:PMC8016738

[47] Younossi ZM,Al Shabeeb R.The changing epidemiology of adult liver transplantation in the United States in 2013-2022: the dominance of metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease.Hepatol Commun2024;8:e0352 PMCID:PMC10749707

[48] Niu X,Xu Y.Global prevalence, incidence, and outcomes of alcohol related liver diseases: a systematic review and meta-analysis.BMC Public Health2023;23:859 PMCID:PMC10173666

[49] Amonker S,Hinkson A,Parker R.Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis.Hepatol Commun2023;7:e0133 PMCID:PMC10146123

[50] Burra P, Bizzaro D, Gonta A, et al; Special Interest Group Gender in Hepatology of the Italian Association for the Study of the Liver (AISF). Clinical impact of sexual dimorphism in non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). Liver Int 2021;41:1713-33.

[51] Ruhl CE.Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States.Gastroenterology2003;124:71-9

[52] Clark JM,Diehl AM.The prevalence and etiology of elevated aminotransferase levels in the United States.Am J Gastroenterol2003;98:960-7

[53] Browning JD,Dobbins R.Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity.Hepatology2004;40:1387-95

[54] Ioannou GN,Lee SP.The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999-2002.Am J Gastroenterol2006;101:76-82

[55] Wong RJ.Trends in the Prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease in the United States, 2011-2018.Clin Gastroenterol Hepatol2022;20:e610-3

[56] Riazi K,Charette JH.The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis.Lancet Gastroenterol Hepatol2022;7:851-61

[57] Karaye IM,Hassan N.Trends in alcohol-related deaths by sex in the US, 1999-2020.JAMA Netw Open2023;6:e2326346 PMCID:PMC10383009

[58] Anouti A.The changing epidemiology of alcohol-associated liver disease: gender, race, and risk factors.Semin Liver Dis2023;43:50-9

[59] Arab JP,Im G.Changing landscape of alcohol-associated liver disease in younger individuals, women, and ethnic minorities.Liver Int2024;44:1537-47