Global epidemiology of metabolic dysfunction-associated steatotic liver disease: 2026 update

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) now affects approximately one-third of the global adult population and is the most common chronic liver disease worldwide. An epidemiological update is needed because recent developments have implications for clinical care and treatment of MASLD as a multisystem disease. The epidemic of MASLD is growing. Global Burden of Disease 2023 analyses estimate approximately 1.3 billion prevalent cases, with projections approaching 1.8 billion by 2050, and a disproportionate rise in metabolic dysfunction-associated steatohepatitis (MASH) and advanced fibrosis. MASLD is increasingly recognized as a systemic metabolic disorder with hepatic, cardiovascular, renal, and other extrahepatic manifestations. Recently, the 79^th World Health Assembly adopted a resolution recognizing steatotic liver disease as a major global noncommunicable disease challenge. Concurrently, cardiovascular-kidney-metabolic frameworks and non-hepatology guidelines have incorporated liver fibrosis assessment into evaluations of selected high-risk populations. Advances in non-invasive diagnostics have expanded case-finding, while the availability of MASH-directed pharmacotherapies has shifted the clinical and economic rationale for earlier detection. This narrative review synthesizes the latest epidemiological data on global and regional prevalence and incidence, comorbidities, hepatic and extrahepatic outcomes, advances in screening and prevention strategies, and future directions.

Keywords: Metabolic dysfunction-associated steatotic liver disease; Metabolic dysfunction-associated steatohepatitis; Epidemiology; Comorbidity; Hepatic and extrahepatic outcomes; Screening; Prevention

Core Tip: The epidemiology of metabolic dysfunction-associated steatotic liver disease (MASLD) is rapidly evolving, driven by a rising global burden and shifting patterns across populations. MASLD is no longer viewed as a simple liver-specific disease but as a condition associated with a broad spectrum of hepatic and extrahepatic complications. Advances in non-invasive diagnostics and new pharmacotherapies are reshaping approaches to disease detection and management. This narrative review summarizes recent updates on MASLD epidemiology and discusses their implications for clinical practice.