Epidemiology of metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis and associated cardiometabolic factors in adults in China (2013-2023): A systematic review and meta-analysis

doi:10.3748/wjg.v31.i46.113608

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World Journal of Gastroenterology

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Meta-Analysis

World J Gastroenterol. Dec 14, 2025; 31(46): 113608
Published online Dec 14, 2025. doi: 10.3748/wjg.v31.i46.113608

Epidemiology of metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis and associated cardiometabolic factors in adults in China (2013-2023): A systematic review and meta-analysis

Shang-Yu Chai, Ru-Ya Zhang, Gail Fernandes, Yi-Man Zheng, Lai Wei

Shang-Yu Chai, Ru-Ya Zhang, Yi-Man Zheng, Value & Implementation Global Medical & Scientific Affairs, MSD China, Shanghai 200233, China

Gail Fernandes, Value & Implementation Outcomes Research, MRL, Merck & Co., Inc., Rahway, NJ 19454, United States

Lai Wei, Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China

Lai Wei, Key Laboratory of Digital Intelligent Hepatobiliary Medicine (Tsinghua University), Ministry of Education, Beijing 102218, China

Author contributions: Chai SY, Zhang RY, and Wei L conceived, designed, and planned the study; Chai SY collected and assembled the data, performed and supervised analyses, and wrote the initial draft; Chai SY, Zhang RY, Fernandes G, Zheng YM, and Wei L interpreted the results; Chai SY and Zheng YM obtained funding. All authors provided substantive suggestions for revision or critically reviewed, reviewed and approved final version of the paper, and agreed to be accountable for all aspects of the work.

Supported by the funding from MSD, China.

Conflict-of-interest statement: Wei L consults for Hiskynedical, BI, Gilead, Kaiyin, MSD, Novo Nordisk, Pfizer, Roche and VirsiRNA, Speaker for Novo Nordisk, Sanofi, and receives research grants from Amoytop, AZ, Gilead, Kaiyin, Pfizer and Sanofi; Chai SY, Zhang RY, and Zheng YM are employees of MSD China; Fernandes G is an employee of Merck & Co, Inc., Rahway, NJ, United States, and hold stocks/stock options.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Lai Wei, MD, PhD, Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing 102218, China. weilai@mail.tsinghua.edu.cn

Received: August 29, 2025
Revised: September 23, 2025
Accepted: October 31, 2025
Published online: December 14, 2025
Processing time: 103 Days and 4.1 Hours

Abstract

BACKGROUND

Although epidemiological data on non-alcoholic fatty liver disease in China are available, data on cardiometabolic risk factors have not been addressed under the metabolic dysfunction-associated steatotic liver disease (MASLD) consensus.

AIM

To synthesize the epidemiological characteristics of MASLD/metabolic dysfunction-associated steatohepatitis (MASH), especially their associated cardiometabolic risk factors in China.

METHODS

We searched EMBASE, MEDLINE, Central Cochrane, CNKI, and Wangfan for studies from January 1, 2013 to December 31, 2023. Studies involving individuals with MASLD/MASH in China that reported epidemiological outcomes were included. Meta-analysis was performed to assess the prevalence of MASLD/MASH. Exploratory outcomes included extrahepatic comorbidities and genetic variants related to MASLD.

RESULTS

In total, 561 studies involving 6632718 participants were included in this analysis. The prevalence of MASLD and MASH and the annual incidence of MASLD were 30.4% [95% confidence interval (CI): 29.4-31.3], 6.7% (95%CI: 2.2-13.4), and 37 cases per 1000 person-years (95%CI: 28-47), respectively. In addition, the prevalence rates of MASLD in individuals with dyslipidemia, obesity, and hypertension were 59.9% (95%CI: 52.6-67.0), 53.9% (95%CI: 47.9-59.9), and 44.3% (95%CI: 41.1-47.6), respectively. The prevalence of lean MASLD (body mass index < 24 kg/m²) was 12.0% (95%CI: 10.0-14.0), and 21.7% of the total MASLD population in China had lean MASLD.

CONCLUSION

This study provides a comprehensive overview of the epidemiology and disease burden of MASLD/MASH in China, providing additional evidence for optimizing MASLD/MASH management in China and a reference for the global understanding of MASLD/MASH epidemiology.

Keywords: Metabolic dysfunction-associated steatohepatitis; Metabolic dysfunction-associated steatotic liver disease; Epidemiology; Disease burden; Meta-analysis

Core Tip: According to our analysis, the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) was 30.4% [95% confidence interval (CI): 29.4-31.3] during the study period in China, and its prevalence is increasing over time. Several prevalent extrahepatic comorbidities of MASLD were identified. Meanwhile, the prevalence rates of MASLD in individuals with dyslipidemia, obesity, and hypertension were 59.9% (95%CI: 52.6-67.0), 53.9% (95%CI: 47.9-59.9), and 44.3% (95%CI: 41.1-47.6), respectively. Furthermore, the prevalence of lean MASLD (body mass index < 24 kg/m²), which is usually ignored in clinical practice, was 12.0% (95%CI: 10.0-14.0), with 21.7% of the total MASLD population in China having lean MASLD. Additionally, several single-nucleotide polymorphisms were linked to the risk of MASLD.