Estimated Burden of Metabolic Dysfunction–Associated Steatotic Liver Disease in US Adults, 2020 to 2050

Jan 17, 2025JAMA network open

Estimated Number of US Adults with Metabolic-Related Fatty Liver Disease from 2020 to 2050

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Abstract

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is projected to rise from 33.7% in 2020 to 41.4% by 2050, affecting an estimated 121.9 million people in the US.

Cases of metabolic dysfunction-associated steatohepatitis (MASH) are expected to increase from 14.9 million (5.8% of US adults) in 2020 to 23.2 million (7.9%) by 2050.
The number of individuals with clinically significant fibrosis (F≥F2) is projected to grow from 6.7 million to 11.7 million during the same period.
By 2046 to 2050, MASLD may lead to 22,440 new cases of hepatocellular carcinoma (HCC) and 6,720 new cases of liver transplant (LT) annually, compared to 11,483 new HCC cases and 1,717 new LT cases from 2020 to 2025.
Liver-related mortality could increase from 30,500 deaths (1.0% of all-cause deaths) in 2020 to 95,300 deaths (2.4%) by 2050.

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IMPORTANCE: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common cause of chronic liver disease and is projected to become the leading indication for liver transplant (LT) in the US. Understanding its clinical burden can help to identify opportunities for prevention and treatment.

OBJECTIVE: To project the burden of MASLD in US adults from 2020 to 2050.

DESIGN, SETTING, AND PARTICIPANTS: This decision analytical modeling study used an agent-based state transition model that simulates the natural history of MASLD progression among adults 18 years of age or older. Primary data sources for model inputs were the published literature.

EXPOSURE: Natural history of MASLD.

MAIN OUTCOMES AND MEASURES: Cases of MASLD, metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, hepatocellular carcinoma (HCC), LT, and liver-related death.

RESULTS: The model simulated 2 821 624 individuals (mean age. 35.8 years; 50.9% female). The model predicted a steady increase in the prevalence of MASLD from 33.7% (86.3 million people) in 2020 to 41.4% (121.9 million people) by 2050. Cases of MASH would increase from 14.9 million (5.8% of US adults) in 2020 to 23.2 million (7.9% of US adults) by 2050. The number of cases of MASH and clinically significant fibrosis (ie, F≥F2, centrilobular and periportal fibrosis or more severe disease) were estimated to increase from 6.7 million to 11.7 million. By 2046 to 2050, MASLD would cause 22 440 new cases of HCC and 6720 new cases of LT per year compared with 11 483 new cases of HCC and 1717 new cases of LT in 2020 to 2025. Liver-related mortality was estimated to increase from 30 500 deaths (1.0% of all-cause deaths in adults) in 2020 to 95 300 deaths (2.4%) in 2050.

CONCLUSIONS AND RELEVANCE: In this decision analytical modeling study, the model forecast a substantial increase in clinical burden of MASLD over the next 3 decades in the absence of effective treatments. These results suggest that health systems should plan for large increases in the number of HCC cases and in the need for LT.

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Estimated Burden of Metabolic Dysfunction–Associated Steatotic Liver Disease in US Adults, 2020 to 2050

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