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

Table 1 Meta-analytic estimates of hepatic and extrahepatic outcomes of metabolic dysfunction-associated steatotic liver disease

Ref.	Study characteristics	MASLD definition	Outcomes	Pooled estimates (95%CI)
Hepatic outcomes
Zamani et al[65], 2025	46 studies; ~8 million adults from general-population cohorts	Liver imaging or blood-based scores	Advanced fibrosis (F3-F4)	Prevalence 3.3% (2.4-4.2)
			Cirrhosis	Prevalence 1.3% (0.9-1.7)
Owrangi et al[66], 2025	35 studies; 513742 MASLD patients	Liver imaging, ICD codes, or histology	Liver-specific mortality	Incidence 2.12 per 100 PY
			Decompensation events	Incidence 7.17 per 100 PY
			HCC	Incidence 4.45 per 100 PY
	General outpatient/primary-care settings (4 studies)		Cirrhosis	Prevalence 3.26% (2.47-4.31)
	High-risk hospitalized or biopsy-referred subgroup (31 studies)		Cirrhosis	Prevalence 14.5% (11.2-18.6)
Le et al[67], 2024	79 studies; 1377466 patients	Liver imaging, ICD codes, or histology	Cirrhosis	Incidence 10.9 per 1000 PY
			HCC	Incidence 3.39 per 1000 PY
Extrahepatic outcomes
Cardiovascular disease
Yang et al[75], 2026	9 studies; 3202447 MASLD patients	Liver imaging, blood-based scores, ICD codes, or histology	Incident CVD	HR 1.33 (1.21-1.46)
Mantovani et al[76], 2021	36 cohort studies; ~5.8 million middle-aged adults across several countries	Liver imaging, ICD codes, or histology	Any fatal or non-fatal CVD event	HR 1.45 (1.31-1.61)
			Fatal CVD events	HR 1.30 (1.08-1.56)
			Nonfatal CVD events	HR 1.40 (1.20-1.64)
			Combined fatal and nonfatal CVD endpoint	HR 1.81 (1.39-2.36)
	Subgroup analyses in patients with advanced MASLD		Fatal CVD events	HR 2.03 (1.17-3.54)
			Nonfatal CVD events	HR 2.30 (1.20-4.42)
			Combined fatal and nonfatal CVD endpoint	HR 2.54 (1.73-3.73)
Myocardial infarction
Lv and Zhao[77], 2024	7 articles comprising 8 prospective and 2 retrospective cohort studies	Liver imaging, blood-based scores, or ICD codes	Incident myocardial infarction	HR 1.26 (1.08-1.47)
Heart failure
Mantovani et al[79], 2022	11 studies; ~12.2 million middle-aged adults across several countries	Liver imaging, blood-based scores, ICD codes, or histology	Incident heart failure	HR 1.50 (1.34-1.67)
Atrial fibrillation
Mantovani et al[80], 2025	16 studies; ~19.5 million middle-aged adults across several counties	Liver imaging, blood-based scores, ICD codes, or histology	Incident atrial fibrillation	HR 1.20 (1.10-1.32)
Chronic kidney disease
Mantovani et al[84], 2022	13 cohort studies; 1222032 individuals	Liver imaging, blood-based scores, ICD codes, or histology	Incident CKD stage ≥ 3	HR 1.43 (1.33-1.54)
Kueh et al[85], 2026	36 studies; 23 prevalence studies (575615 participants; 56248 CKD cases) and 13 incidence studies (27996 incident CKD events)	Liver imaging, blood-based scores, or ICD codes	Prevalence of CKD	15.22% (9.69-23.12)
			Incidence of CKD	22.17 per 1000 PY (11.44-32.89)
Extrahepatic malignancies
Mantovani et al[88], 2022	10 cohort studies; 182202 middle-aged individuals	Liver imaging or ICD codes	Incident oesophagus, stomach, pancreas, colorectal cancers	RR 1.5-2.0
			Incident lung, breast, gynaecological, and urinary system cancers	RR 1.2-1.5
Zhou et al[89], 2024	18 studies; ~16.7 million individuals	Liver imaging, blood-based scores, ICD codes, or histology	Incident gastric, pancreatic, thyroid, urinary cancers	RR 1.4-1.5
			Incident colorectal and female genital cancers	RR 1.3-1.4
Duan et al[90], 2026	29 studies	Liver imaging, ICD codes, or histology	Colorectal polyps	HR 1.42 (1.22-1.66)
			Colorectal cancer	HR 1.22 (1.16-1.29)
			Gastric cancer	HR 1.18 (1.10-1.26)
			Cholangiocarcinoma	HR 1.26 (1.17-1.36)
Musculoskeletal disorders
Hussaini et al[95], 2025	16 studies; individual study sample sizes 57-18815	Liver imaging or ICD codes	Sarcopenia	OR 2.24 (1.74-2.89)
Su et al[96], 2023	19 studies: 9 studies (21294 participants) for bone mineral density, 6 studies (133319) for osteoporosis, 5 studies (227901) for osteoporotic fractures	Liver imaging or histology	Incident osteoporosis	RR 1.28 (1.08-1.52)
			Incident osteoporotic fractures	RR 1.17 (1.00-1.37)
Endocrine disorders
Manzano-Nunez et al[97], 2023	36 studies; 7374 participants	Liver imaging or blood-based scores	MASLD prevalence in PCOS	43% (35-52)
Mantovani et al[98], 2021	33 studies; 501022 individuals	Liver imaging, or histology	Incident T2DM	HR 2.19 (1.93-2.48)
	Subgroup with more severe MASLD			HR 2.69 (2.08-3.49)
	Subgroup with advanced fibrosis			HR 3.42 (2.29-5.11)
Chan et al[99], 2024	129 studies; ~6 million individuals	Liver imaging, blood-based scores, ICD codes, or histology	Incident T2DM	HR 2.56 (2.10-3.13)
	Subgroup with advanced liver disease			HR 3.60 (2.10-6.18)
Neurological and psychiatric
Mou and Yao[101], 2025	16 studies; ~2 million patients	Liver imaging, blood-based scores, ICD codes, or histology	Prevalent depression	OR 1.28 (1.06-1.55)
Lu et al[102], 2022	6 studies; 2345929 patients	Liver imaging, blood-based scores, or ICD codes	Incident dementia	HR 1.04 (1.00-1.08)
Huang et al[103], 2023	7 studies; 879749 patients	Liver imaging or ICD codes	Incident dementia	HR 1.01 (0.94-1.08)
Respiratory diseases
Mantovani et al[104], 2019	6 cohort studies; 133707 individuals	Liver imaging or blood-based scores	Predicted FEV1	WMD -2.43% (-3.28 to -1.58)
			Predicted FVC	WMD -2.96% (-4.75 to -1.17)
Anisa and Adrianison[105], 2025	6 studies; 185432 patients	Liver imaging or ICD codes	Incident OSA	HR 1.65 (1.39-1.96)

MASLD: Metabolic dysfunction-associated steatotic liver disease; CI: Confidence interval; HR: Hazard ratio; ICD: International Classification of Diseases; HCC: Hepatocellular carcinoma; PY: Person-year; CVD: Cardiovascular disease; CKD: Chronic kidney disease; RR: Relative risk; OR: Odds ratio; PCOS: Polycystic ovary syndrome; T2DM: Type 2 diabetes mellitus; FEV1: Forced expiratory volume in 1 second; FVC: Forced vital capacity; OSA: Obstructive sleep apnea; WMD: Weighted mean difference.