Fatty Liver Disease Could Affect 1.8 Billion People by 2050

The critical importance of reinforcing prevention efforts, growing screening efforts, and enhancing treatment for liver disease has been underscored by new data showing that the global burden of metabolic dysfunction–associated steatotic liver disease (MASLD) is projected to grow by approximately 38% by 2050.¹ That jump would equate to MASLD affecting about 1.3 billion people in 2023 vs 1.8 billion by 2050, according to research published today in The Lancet Gastroenterology & Hepatology, for an age-standardized prevalence rate of 14,429.3 (95% UI, 13,268.3-15,990.6) per 100,000 population and an age-standardized disability-adjusted life-years (DALYs) rate of 39.6 (95% UI, 31.2-49.9).

In Europe and the US alone, MASLD—formerly known as nonalcoholic fatty liver disease—was the second leading cause of end-stage liver disease and liver transplantation as of 2023.² Further, liver disease has been implicated in more than 2 million annual deaths and 4% of all global deaths.

MASLD is an umbrella term for liver conditions that develop in the presence of 1 or more cardiometabolic risk factors—including high blood sugar, elevated body mass index (BMI), and hypertension—but in the absence of other causes of liver fat accumulation, the study authors explain. Their new Global Burden of Disease 2023 analysis, covering 204 countries and territories from 1990 to 2023, is the most comprehensive global accounting of this liver disease burden to date.

Countries Shouldering the Greatest Burden

The data reveal a sharply divided world. North Africa and the Middle East carried the highest age-standardized prevalence rate in 2023, at 29,246.1 (95% UI, 26,843.3032,048.7) cases per 100,000 people, more than 3 times the rate in high-income Asia Pacific countries, which had the lowest rate globally, at 8653.5 (95% UI, 7923.7-9595.8). Nationally, Kuwait had the highest prevalence rate of any country, and Finland had the lowest: 35,363.5 (95% UI, 32,631.6-38,514.7) vs 7,761.8 (95% UI, 7075.6-8602.7).

Wealth alone does not explain these disparities, the authors explained. Countries with comparable levels of socioeconomic development showed markedly different MASLD rates, depending on dietary patterns, health system capacity, and metabolic risk profiles. North Africa and the Middle East also recorded the highest burden of type 2 diabetes globally in the GBD 2021 survey, consistent with rapid urbanization, increasingly sedentary lifestyles, and dietary shifts toward calorie-dense foods driving metabolic risk in the region. Meanwhile, high-income regions, including Western Europe and Australasia, exhibited both lower prevalence and DALY rates, suggesting effective health systems are limiting disease progression even as cases rise.

Who Is Most Affected?

Of the 3 modifiable risk factors examined—smoking, high BMI, and high fasting plasma glucose—the last contributed the most to MASLD-related DALYs globally, accounting for 2.2 per 100,000 people in 2023. High BMI ranked second at 1.4 per 100,000, followed by smoking at 1.0 per 100,000. In North Africa and the Middle East, elevated fasting glucose alone contributed 9.13 DALYs per 100,000, approximately 4 times the global average.

Men had higher age-standardized prevalence rates than women, at 15,616 (95% UI, 14,349.2-17,263.3) vs 13,245.2 (95% UI, 12,132.0-14,692.6) per 100,000, which the authors attribute to greater exposure to metabolic risk factors. However, women older than age 69 had higher DALY rates than men of the same age, a pattern the authors attribute to hormonal changes around and after menopause. The number of people living with MASLD also differed for its peak totals between men and women, with men being younger (aged 35-39) and women being older (aged 55-59).

The authors flag childhood obesity as a growing and underappreciated contributor: individuals who develop obesity in childhood accumulate a longer exposure to metabolic dysfunction, which may accelerate liver disease progression decades before symptoms emerge.

Projections and a Policy Gap

The forecasting model projects that without major intervention, 1.8 billion people will have MASLD by 2050, and a decomposition analysis identified population growth—not aging or worsening epidemiology—as the primary driver. Sub-Saharan Africa, North Africa, and the Middle East are expected to see the steepest absolute increases.

Despite this scale, MASLD remains absent from the United Nations’ Sustainable Development Goals and the World Health Organization’s primary noncommunicable disease action plans. The authors argue this must change, calling for specific global targets, expanded screening, and integration of MASLD prevention into broader metabolic disease strategies. At present, they highlight, there are just 2 pharmacotherapies approved by the FDA alone to treat MASLD—resmetirom³ and semaglutide⁴—but recent data also support promise for FGF-21 analogues and other agents.

Translating clinical advances into policy action, especially in lower-resource settings, remains the defining challenge ahead.

“We hope that these findings will guide the worldwide community in setting a specific target for this condition, assessing regional and temporal trends,” they conclude, “and allocating resources to prevent, diagnose, and manage MASLD, with interventions and policies to mitigate risk factors associated with the disease.”

Limitations of these findings include scarce data from low-resourced countries, basing the risk-attributable burden for MASLD on relative risk relationships for liver cancer due to MASLD, missing quantifiable data on other risk and protective factors for the MASLD burden, and relying on ultrasound-based data without histological confirmation.

References

1. Kim S, Oh J, Shin JI, et al. Global burden of metabolic dysfunction-associated steatotic liver disease, 1990-2023, and projections to 2050: a systematic analysis for the Global Burden of Disease study, 2023. Lancet Gastroenterol Hepatol. Published online April 13, 2026. doi:10.1016/S2468-1253(26)00011-7
2. Deverbhavi H, Asrani SK, Arab JP, Nartey YA, Pose E, Kamath PS. Global burden of liver disease: 2023 update. J Hepatol. 2023;79(2):516-537. doi:10.1016/j.jhep.2023.03.017
3. Joszt L. FDA approves resmetirom, first treatment for NASH with liver fibrosis. AJMC^®. March 14, 2024. Accessed April 13, 2026. https://www.ajmc.com/view/fda-approves-resmetirom-first-treatment-for-nash-with-liver-fibrosis
4. Klein H. FDA approves semaglutide for MASH with fibrosis. AJMC. August 18, 2025. Accessed April 13, 2026. https://www.ajmc.com/view/fda-approves-semaglutide-for-mash-with-fibrosis