MASLD now affects one in six people worldwide as prevalence keeps climbing
Metabolic dysfunction-associated steatotic liver disease, or MASLD, has moved far beyond a niche hepatology diagnosis. A systematic analysis tied to the Global Burden of Disease Study 2023 estimates that roughly 1.3 billion people were living with the condition in 2023, equal to 16.1% of the global population. The scale alone is hard to ignore, but the trajectory is more concerning: crude case counts have climbed sharply since 1990, and projections point to another large increase by 2050.
This is not just a matter of more diagnoses being recorded. The prevalence rate itself has risen over time, which means the burden is expanding even after accounting for population size. MASLD now sits at the intersection of obesity, dysglycemia, and chronic metabolic injury, a combination that steadily drives hepatic fat accumulation and downstream fibrosis risk across every health system that has not built enough preventive infrastructure.
The burden is rising in both head count and rate
In 2023, age-standardized prevalence reached 14,429.3 per 100,000 population. Compared with 1990, crude case counts rose by 142.7%, while the age-standardized prevalence rate increased by 28.6%. Those two trends tell a different story from the raw case total alone. Population growth explains part of the jump, but the disorder is also becoming more common in a way that cannot be attributed to demographics alone.
The disability burden follows a somewhat different pattern. MASLD accounted for an estimated 3.6 million disability-adjusted life-years worldwide in 2023, with an age-standardized DALY rate of 39.6 per 100,000 population. Crude DALYs increased by 116.3% from 1990, yet the age-standardized DALY rate remained broadly stable over the study period. In practical terms, more people are living with the disease, but the average burden per age-adjusted population unit has not accelerated at the same pace as case counts.
A stable age-standardized DALY rate does not mean the problem is under control.
Regional variation tracks access, metabolic risk, and health-system capacity
The distribution of MASLD is uneven enough to matter for policy and clinical planning. North Africa and the Middle East had the highest age-standardized prevalence rate at 29,246.1 per 100,000 population, while Andean Latin America carried the highest DALY rate at 152.3 per 100,000. At the other end of the spectrum, high-income Asia Pacific had the lowest prevalence rate, and east Asia had the lowest DALY rate among GBD regions.
The geographic pattern is not random. North Africa and the Middle East showed disproportionately high prevalence relative to regions with similar Socio-demographic Index values, suggesting that factors beyond broad development status are influencing disease expression. Lower SDI and lower Healthcare Access and Quality scores were linked to higher age-standardized DALY rates. Clinically, that points to delayed recognition, less consistent metabolic risk control, and weaker pathways for fibrosis surveillance, all of which can allow steatotic liver disease to progress unnoticed until injury becomes more entrenched.
The inverse relationship with the HAQ Index is especially important. Countries with poorer access and quality may be less prepared to absorb a chronic liver disease epidemic that is being fueled by diabetes, obesity, and sedentary lifestyles. If blood pressure and lipid disorders are already straining primary care systems, MASLD adds another layer of long-term demand, with hepatology services often entering the picture too late.
Metabolic risk factors dominate the attributable burden
Three modifiable risk factors were examined: smoking, high body mass index, and high fasting plasma glucose. Among them, high fasting plasma glucose contributed the most to the age-standardized DALY rate in 2023 at 2.2 per 100,000 people. High BMI followed at 1.4 per 100,000, and smoking contributed 1.0 per 100,000.
The pattern is biologically coherent. Hyperglycemia and insulin resistance promote hepatic de novo lipogenesis, impair fat handling, and worsen inflammatory signaling inside the liver. Elevated adiposity adds substrate overload and systemic metabolic stress, while smoking likely amplifies vascular and inflammatory injury across organ systems already under strain. In MASLD, these risks do not operate separately at the bedside; they compound one another, accelerating progression from simple steatosis toward steatohepatitis and fibrosis.
Aging shifts the peak burden, but younger adults still account for many cases
Age patterns add another layer of urgency. The age-standardized prevalence rate was higher in males than females in 2023, and prevalence peaked between ages 80 and 84 years in both sexes. Yet the number of people living with MASLD was highest in younger adults, peaking at ages 35 to 39 years in males and 55 to 59 years in females.
That split matters for service planning. Older adults carry the highest age-specific prevalence, but the larger absolute number of cases in midlife means long windows of cumulative exposure before cirrhosis, cardiovascular complications, or transplant-level disease emerge. For clinicians, this means MASLD cannot be treated as a late-life hepatology problem alone. It is also a working-age metabolic disease with decades of future morbidity embedded in the current age profile.
2050 projections point to continued growth driven mainly by population expansion
Forecasting models project that 1.8 billion people will be living with MASLD by 2050, a 42.0% increase from 2023. The age-standardized prevalence rate is expected to rise to 15,774.9 per 100,000 people, with an average annual percentage change of 0.3%. Even if the annual rate of increase looks modest, the absolute number of affected people will be enormous because the base is already so large.
The decomposition analysis points to population growth as the dominant driver of that increase, particularly in sub-Saharan Africa and in North Africa and the Middle East. Population ageing and epidemiologic change contribute less to the projected rise than sheer growth in the number of people alive. For health systems, this means the future MASLD load will be shaped not only by obesity and diabetes control, but also by the size and age structure of populations entering risk years.
Hepatology now has a systems-level prevention problem
The implications extend well beyond liver clinics. MASLD is now entrenched as a global chronic disease problem with major economic and clinical consequences, and the burden is unlikely to recede without broad metabolic prevention strategies. The data support a simple conclusion: countries with weaker access and quality scores are likely to face a heavier downstream toll from the same disease process.
What remains unresolved is how quickly health systems can scale screening, metabolic risk reduction, and fibrosis triage before prevalence rises further. The analysis covers 204 countries and territories, but forecasting models still depend on the quality of current estimates and on the assumption that future exposure patterns will follow predictable paths. If diabetes and obesity continue to expand, the liver disease curve may prove even steeper than these projections suggest.