Fatty liver set to balloon

Fat can build up inside the liver for years without symptoms, and researchers now project this disease could affect about 1.8 billion people worldwide by 2050. (thelancet.com) The disease is called metabolic dysfunction-associated steatotic liver disease, or MASLD. A Global Burden of Disease 2023 analysis published in *The Lancet Gastroenterology & Hepatology* estimated 1.3 billion people were living with it in 2023, up 143% from 1990. (thelancet.com) The same analysis put global prevalence at 16.1% in 2023 and projected roughly 38% growth by 2050. The American Journal of Managed Care said that would take the total to about 1.8 billion people. (ajmc.com) MASLD means liver fat linked to metabolic problems such as high blood sugar, obesity, or high blood pressure, rather than another clear cause of fat buildup. The European liver, diabetes, and obesity societies said the condition spans simple fat buildup, liver inflammation, scarring, cirrhosis, and liver cancer. (pmc.ncbi.nlm.nih.gov) Many people do not know they have it. The European guideline says doctors should look for advanced scarring in people with cardiometabolic risk factors, especially those with type 2 diabetes or obesity plus another metabolic risk factor. (pmc.ncbi.nlm.nih.gov) The new estimates point to sharp regional gaps. The American Journal of Managed Care reported prevalence above 29,000 cases per 100,000 people in North Africa and the Middle East, versus about 8,650 per 100,000 in high-income Asia Pacific, with Kuwait highest and Finland lowest nationally. (ajmc.com) Researchers said population growth is the biggest force behind the rising case count, alongside higher obesity rates and high fasting blood sugar. SciMex, citing the Lancet release, said the disease is also increasingly affecting younger adults in low- and middle-income countries. (scimex.org) The burden is not limited to liver clinics. The American Journal of Managed Care said MASLD was the second leading cause of end-stage liver disease and liver transplantation in Europe and the United States in 2023, and liver disease is linked to more than 2 million deaths a year worldwide. (ajmc.com) Doctors do have tools to find the most dangerous cases earlier. The European guideline recommends a step-by-step approach that starts with blood tests such as the fibrosis-4 index and then uses imaging such as transient elastography to check for advanced scarring. (pmc.ncbi.nlm.nih.gov) Treatment still starts with weight loss, diet, exercise, and better control of diabetes and other metabolic conditions. The same guideline said resmetirom can be considered for some adults with non-cirrhotic metabolic dysfunction-associated steatohepatitis and significant fibrosis, while semaglutide or tirzepatide may be used when indicated for diabetes or obesity. (pmc.ncbi.nlm.nih.gov) The projected rise to 1.8 billion cases is a count of people who may be carrying a mostly silent disease, not a sudden outbreak. The concern in the new research is what happens years later, when unnoticed liver fat turns into scarring, cirrhosis, or cancer. (thelancet.com)