MASLD, MASH Projected to Grow by 23% in the US Through 2050

BOSTON — The nomenclature may have changed, but the steady rise in the most common form of liver disease — metabolic dysfunction-associated steatotic liver disease (MASLD, formerly known as NAFLD) — is predicted to continue into the middle of this century.

That’s according to Phuc Le, PhD, MPH, and colleagues at the Cleveland Clinic Lerner College of Medicine in Cleveland, Ohio. They created a mathematical model incorporating data on the growth of the US population and the natural history of MASLD/NAFLD. The model projected a relative 23% increase in MASLD among US adults from 2020 to 2050.

“Our model forecasts a substantial clinical burden of NAFLD over the next three decades. In the absence of effective treatments, health systems should plan for large increases in the number of liver cancer cases and the need for liver transplant,” Le said in a media briefing held on November 7 prior to her presentation of the data at The Liver Meeting 2023: American Association for the Study of Liver Diseases (AASLD).

The estimated worldwide prevalence of MASLD is 38%. In the US, an estimated 27.8% of adults had MASLD as of 2020.

Le and colleagues wanted to get a clearer picture of the expected increase in the clinical burden of MASLD in the coming decades. The researchers used data from the medical literature to create an individual-level state transition model. They took into account projections of the growth of the US population and the progression of MASLD and metabolic dysfunction-associated steatohepatitis (MASH, formerly NASH) through stages of fibrosis to decompensation, hepatocellular carcinoma (HCC), transplant, and liver-related death as a proportion of all-cause mortality.

Validated Model

They validated the model by testing it against liver outcomes from 2000 through 2018 and published data on the US population. The model closely matched trends in MASLD prevalence, MASH proportion, HCC and liver transplant incidences, and overall survival rates for patients with MASLD.

As noted, the model predicted a steady increase in MASLD prevalence, from 27.8% in 2020 to 34.3% by 2050, a relative increase of about 23%. The model also predicted a slight uptick in the proportion of MASH among patients with MASLD, from 20% to 21.8%.

The investigators said that the prevalence of MASLD/MASH would likely remain relatively stable among people aged 18 to 29 years but would increase significantly for all other age groups.

In addition, the model predicted an increase in the proportion of cirrhosis among patients with MASLD from 1.9% to 3.1%, as well as a rise in liver-related deaths from 0.4% of all deaths in 2020 to 1% by 2050.

The investigators also foresaw a rise in HCC cases, from 10,400 annually to 19,300 by 2050 and a more than twofold increase in liver transplants, from 1700 in 2020 to 4200 in 2050.

A “Tsunami” of Liver Disease

In the question-and-answer portion of the briefing, AASLD President Norah Terrault, MD, commented on the study findings and “the frightening trajectory in terms of disease burden.

“I’m thinking to myself there’s no way we’re going to be able to transplant our way out of this tsunami of disease that’s coming our way,” she said, and asked Le what policy or societal approaches might be implemented to help stem the tide.

“This is a really huge question,” Le acknowledged. The study only provides estimates of what the future burden of disease might be if there are no changes in clinical care for patients with MASLD or if the trajectory of contributing factors, such as obesity, diabetes, and other metabolic diseases, continued to increase, she cautioned.

Raising awareness of MASLD/MASH and working to improve collaboration among liver specialists and general practitioners could help to flatten the curve, she suggested.

The study was supported by a grant from the Agency for Healthcare Research and Quality. Le and Terrault have disclosed no relevant financial relationships.

Neil Osterweil, an award-winning medical journalist, is a long-standing and frequent contributor to Medscape.

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