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Egypt’s metabolic dysfunction associated steatotic liver disease: Genetic and dietary nexus, shaping artificial intelligence driven healthier future
Mona Hegazy, Mona Fathy, Omar Ashoush, Samah Abdelshafy, Dalia Abdelfatah, Samar Saad, Sawsan Abd El-Moniem, Wesam Ibrahim, Osama Ashraf, Shereen Saleh, Tarek Ahmed, Ragab Adly, Ali Abdel-Wahab, Ahmed Ahmed, Shadia Hussein, Ahmed Othman, Ahmed Abdelghani
Mona Hegazy, Omar Ashoush, Ahmed Abdelghani, Department of Internal Medicine, Hepatology and Gastroenterology, Kasr Alainy School of Medicine, Cairo University, Cairo 12572, Al Qahirah, Egypt
Mona Fathy, Samar Saad, Shadia Hussein, Department of Clinical Pathology, Kasr Alainy School of Medicine, Cairo University, Cairo 12572, Al Qahirah, Egypt
Samah Abdelshafy, Department of Internal Medicine, Cairo University, Cairo 12572, Al Qahirah, Egypt
Dalia Abdelfatah, Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo 12572, Al Qahirah, Egypt
Sawsan Abd El-Moniem, Department of Hepato-Gastroenterology, Mansoura University, Mansoura 35516, Egypt
Wesam Ibrahim, Osama Ashraf, Shereen Saleh, Ahmed Ahmed, Department of Internal Medicine, Ain Shams University, Cairo 12572, Al Qahirah, Egypt
Tarek Ahmed, Ragab Adly, Department of Internal Medicine, Fayoum University, Fayoum 63514, Egypt
Ali Abdel-Wahab, Department of Internal Medicine, Endocrinology and Diabetes, Kasr Alainy School of Medicine, Cairo University, Cairo 12572, Al Qahirah, Egypt
Ahmed Othman, Faculty of Engineering, Cairo University, Cairo 12572, Al Qahirah, Egypt
Author contributions: Hegazy M conceived and designed the research plan ideas; Hegazy M and Abdelghani A concept and design, performing the sonographic assessment of the patient and writing the manuscript; Fathy M, Ashoush O, Abdelshafy S, Abd El-Moniem S, Ibrahim W, Ashraf O, Saleh S, Ahmed T, Adly R, Abdel-Wahab A, Ahmed A, and Abdelghani A were responsible for patients data collection; Saad S, Abd El-Moniem S, Hussein S, and Abdelshafy S performed the laboratory analysis and interpretation of the study; Abdelfatah D and Othman A analyzed the statistical data of the study; all authors revised and approved the final manuscript draft.
Supported by Cairo University.
Institutional review board statement: The study was reviewed and approved by the Cairo University’s Ethics Committee, No. N-41-2019.
Informed consent statement: All participants provided informed consent.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
monahegazy@cu.edu.eg. Participants gave informed consent for data sharing.
Corresponding author: Mona Hegazy, MD, Professor, Department of Internal Medicine, Hepatology and Gastroenterology, Kasr Alainy School of Medicine, Cairo University, Kasr Alainy Street, Cairo 12572, Al Qahirah, Egypt.
monahegazy@cu.edu.eg
Received: September 16, 2025
Revised: November 21, 2025
Accepted: January 8, 2026
Published online: March 21, 2026
Processing time: 183 Days and 0.4 Hours
BACKGROUND
Metabolically dysfunction-associated steatotic liver disease (MASLD) has emerged as a significant global health concern; however, its burden and determinants in Egypt remain poorly characterized.
AIM
To determine the prevalence of MASLD, identify risk factors, and evaluate genetic influences in the Egyptian population.
METHODS
In this multicenter observational cross-sectional study (2019-2024), 1060 adults from 22 governorates underwent a comprehensive assessment, including anthropometrics, metabolic profiling, dietary evaluation (validated Food Frequency Questionnaire), abdominal ultrasonography, vibration-controlled transient elastography (FibroScan®), and PNPLA3 rs738409 genotyping. MASLD was diagnosed according to the European Association for the Study of the Liver 2024 guidelines.
RESULTS
An alarmingly high prevalence of MASLD (67.7%) was revealed. Obesity conferring a 27.5-fold increased risk (P < 0.001), insulin resistance was associated with a 3.4-fold higher risk, metabolic syndrome present in 41.2% of cases. Each 1-gram increase in monounsaturated fatty acid and polyunsaturated fatty acid intake raised the risk by 3% and 10%, respectively. High glycemic load increased the risk by 1% per unit. PNPLA3 gene variant present in 48.1% of MASLD cases compared to 43.6% of healthy individuals. Variant carriers exhibited distinct risk profiles related to age and polyunsaturated fatty acid intake. Demographic patterns were notable, as prevalence increased from 52% in individuals < 38 years to 83% in those ≥ 38 years, while lean individuals still demonstrated a prevalence of 22.2%.
CONCLUSION
Egypt faces an epidemic of MASLD reflecting complex interactions among metabolic, dietary and genetic factors. Implementation of national screening programs and culturally tailored lifestyle interventions is urgently needed.
Core Tip: Egypt faces the world’s highest reported metabolic dysfunction associated steatotic liver disease prevalence (67.7%), driven by synergistic metabolic, dietary, and genetic factors. Obesity (27.5 times the risk), insulin resistance, high intake of refined carbohydrates, and PNPLA3 variants (present in 48% of cases) create a perfect metabolic storm. Alarmingly, 22% of lean individuals are affected, challenging traditional risk paradigms. These findings necessitate the implementation of urgent nationwide screening programs, culturally adapted lifestyle interventions, and the integration of genetic risk assessment into preventive strategies to combat this growing public health crisis.
