The Global Epidemiology of Metabolic Dysfunction-Associated Steatotic Liver Disease: Regional Hotspots, Trends, and Future Projections

Abstract

This review highlights the global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD), assesses comparability of the former definition of non-alcoholic fatty liver disease (NAFLD)-era estimates with the 2023 steatotic liver disease (SLD) framework, and identifies emerging regional hotspots. High concordance between NAFLD-era definitions and SLD subclassification supports continuity of established cohorts for trend analyses. Globally, imaging-based steatosis prevalence was 38%, with the highest in Latin America (44%) and remains high in the Middle East and North Africa (37%). Europe (25%) and sub-Saharan Africa (14%) show lower prevalence, while East and South Asia account for the largest absolute burden (375 million and 325 million, respectively). Estimates vary by steatosis assessment methods (ultrasound, MRI, CAP), emphasizing measurement dependence. Population-based data indicate strong enrichment of advanced fibrosis among affected individuals with steatosis. MASLD is the leading cause of chronic liver disease worldwide, increasingly shaped by ageing and cardiometabolic risk, especially in global hotspots.