Reviewed by Dietitian Katey Davidson, M.Sc.FN, RD, CPT

Credit: Design elements: Getty Images. EatingWell design.

Key Takeaways

Metabolic dysfunction-associated steatotic liver disease (MASLD) has risen 142.7% since 1990, affecting 1.3 billion people globally.

Key risks include high blood sugar, BMI and smoking.

Without intervention, MASLD rates may reach 1.8 billion people by 2050.

Liver health often takes a backseat to heart or brain health in casual conversation, but a condition known as metabolic dysfunction-associated steatotic liver disease (MASLD)—previously known as non-alcoholic fatty liver disease (NAFLD)—is changing that narrative.

This condition involves fat building up in the liver, typically alongside other metabolic factors like high blood sugar, excess weight or high blood pressure. Because it rarely causes symptoms in its early stages, MASLD operates quietly, yet it has become one of the most common chronic conditions worldwide.

To grasp exactly how widespread this condition has become, a massive new global health study published in The Lancet Gastroenterology and Hepatology recently analyzed data spanning more than three decades. The resulting report provides a detailed map of the condition's impact on global health and where it might be heading next.

How Was the Study Conducted?

To understand the scope of MASLD, researchers analyzed massive datasets from the Global Burden of Diseases, Injuries and Risk Factors Study 2023. This ongoing project tracks health metrics across 204 countries and territories, and for this specific analysis, the team looked at data from 1990 all the way to 2023.

The research team focused heavily on two main measurements: prevalence and disability-adjusted life-years, also known as DALYs. Prevalence simply refers to the total number or percentage of people living with the condition at a given time. DALYs offer a way to measure the overall burden of the disease by combining the years of life lost due to early death and the years of healthy life lost due to disability or illness. By looking at these two factors together, researchers could map out not just how many people have MASLD, but how severely it impacts global quality of life over time.

What Did the Study Find?

The data revealed a substantial increase in total cases over the 33-year study period. In 2023, an estimated 1.3 billion people worldwide—which is about 16.1% of the global population—were living with MASLD. This represents a 142.7% increase in the total number of people with the condition since 1990.

Regional differences were striking. North Africa and the Middle East reported the highest rates of the condition, while the high-income Asia Pacific region saw the lowest prevalence. The researchers also found that high fasting blood sugar was the largest contributing risk factor to the disease burden, followed by high body mass index (BMI) and smoking.

The research team also looked ahead, projecting that by 2050, roughly 1.8 billion people will have MASLD. This represents a 42% increase from 2023 levels. This growth is largely driven by expected global population increases, along with rising rates of underlying metabolic conditions. Interestingly, while the total number of people with the condition has grown significantly, the age-standardized DALY rate remained relatively stable. This suggests that while more people are developing the early stages of liver fat accumulation, medical advances might be helping to manage and prevent severe complications like cirrhosis, which is irreversible liver scarring.

Advertisement

Limitations

As with any large-scale global analysis, the research has a few constraints to keep in mind. First, the medical community only recently updated the terminology from NAFLD to MASLD. Because the data spans three decades, the study had to rely on older diagnostic frameworks. For instance, the older NAFLD definition measured fatty liver based on excluding alcohol use rather than identifying specific metabolic markers.

Additionally, reliable health data is scarce in many lower-resource countries. Researchers had to use statistical models to fill in these gaps, which introduces some uncertainty into the exact numbers for those specific regions. Finally, much of the data comes from ultrasound imaging rather than invasive liver biopsies. While ultrasounds are standard for broad population studies, they can sometimes overestimate the presence of early-stage liver disease compared to a physical biopsy.

How Does This Apply to Real Life?

You might not feel the early effects of metabolic dysfunction-associated steatotic liver disease (MASLD), but its rapid growth makes it a global health priority. The liver performs vital functions for your body, from filtering blood to processing nutrients. When fat builds up in this organ, it can quietly progress to more severe complications over time.

Based on the study data, the most significant risk factors for developing this condition include high fasting blood sugar, a high body mass index (BMI) and smoking. You can support your liver health directly by targeting these specific areas. Managing your blood sugar levels, maintaining a healthy weight and avoiding tobacco use are practical steps that protect your liver function.

While this condition affects populations worldwide, the data shows that it impacts certain geographic regions much more severely. North Africa and the Middle East currently report the highest rates of MASLD. If you want to help address this growing global health disparity, consider supporting international medical and relief organizations. Donating to global health charities like Project Hope can help provide necessary medical resources, training and education to the regions facing the heaviest burden of this disease.

Our Expert Take

This study published in The Lancet Gastroenterology and Hepatology found that the disease status of MASLD is growing steadily. In 2023, about 1.3 billion people lived with MASLD. By 2050, the researchers project this number will reach 1.8 billion. The data also highlights stark regional differences, with North Africa and the Middle East facing the highest rates, while the high-income Asia Pacific region sees the lowest prevalence.

High blood sugar, an elevated body mass index and smoking are the primary drivers of this condition. By taking practical steps to manage your weight, monitor your blood sugar and avoid tobacco, you can actively support your liver function and reduce your personal risk.

Beyond individual prevention, this vast study points to a clear need for broader health initiatives, particularly in regions where the disease burden is the heaviest. Tackling a health issue of this scale requires a collective approach to improve education, diagnostic tools and medical resources worldwide. By staying informed about metabolic health and supporting international medical relief organizations, we can help shift the focus toward early management and ensure better long-term health outcomes across the globe.

Read the original article on EatingWell