Burden of metabolic dysfunction–associated steatotic liver disease in the Asia-Pacific region from 1990 to 2023

Abstract

Background: metabolic dysfunction-associated steatotic liver disease (MASLD) is an increasing health problem in the Asia-Pacific region, contributing significantly to morbidity and healthcare burden. This study provides a comprehensive analysis of the burden of MASLD across countries and territories in the Asia-Pacific region from 1990 to 2023. 

Methods: we used the Global Burden of Disease 2023 data set to assess the burden of MASLD in the Asia-Pacific region, calculating age-standardised prevalence, incidence, death and disability-adjusted life year (DALY) rates. Temporal trends, age-specific and sex-specific patterns, and the relationship between MASLD burden and Socio-demographic Index (SDI) were also analysed, along with regional variations driven by ageing, population growth and epidemiological changes. 

Results: in 2023, MASLD prevalence varied across the Asia-Pacific region, with the highest rates in Oceania (15 360.55 per 100 000), Central Asia (15 201.10 per 100 000), South-East Asia (15 116.91 per 100 000) and East Asia (15 042.06 per 100 000), and lower rates in Australasia (9336.02 per 100 000) and high-income regions (8654.71 per 100 000). Over the past three decades, MASLD prevalence has increased across all regions, with the largest growth in Australasia (29%) and East Asia (27%). In addition, marked regional disparities were observed in age-standardised death and DALY rates, with Central Asia exhibiting the highest health loss across the region. Age-stratified analyses revealed that the highest incidence occurred in individuals aged 20–24 years in 2023. MASLD burden followed an inverse U-shaped pattern with SDI, increasing in regions with lower SDI and decreasing in those above 0.62. Population growth and lifestyle changes were the primary drivers of MASLD in East Asia, while ageing significantly contributed to the rising burden in South Asia. 

Conclusions: MASLD is increasingly prevalent across the Asia-Pacific region, driven by ageing, population growth and epidemiological changes, with significant regional variations in the disease burden.

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