Model Estimates Prevalence of MASLD Will Increase From 33.7% in 2020 to 41.4% in 2050

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common cause of chronic liver disease and is predicted to become the leading cause for liver transplant within the US. With this information, authors of a study published in JAMA Network Open estimated the disease burden of MASLD, liver-related deaths, and transplants from 2020 to 2050 among US adults.

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The decision analytical modeling study used an agent-based state transition model with a yearly cycle and lifetime time horizon. The agent-based or microsimulation approach was used to capture heterogeneity within the study population, take individual-level variation into consideration, as well as track the impact of the variation on individual outcomes, leading to a more accurate prediction. Conditions included MASLD, metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, hepatocellular carcinoma (HCC), liver transplant, and liver-related death.

For this study, the model simulated 2,821,624 individuals with a mean age 35.8 years to predict the incidence of disease burden and liver-related deaths. The model accurately replicated the growth of the US population from 2000 to 2020, with all yearly estimates within 0.5% of observed data, according to the authors. In addition, the overall prevalence of MASLD among US adults predicted by the model from 2001 through 2018 was observed to closely match estimates from 2001 through 2018 in the National Health and Nutrition Examination Survey, as well as the age-specific prevalence in 2018 and the proportion with MASH.

The model predicted a steady increase in the prevalence of MASLD from approximately 33.7% (86.3 million people) in 2020 to 36.8% in 2030 (101.2 million people), and 41.4% in 2050 (121.9 million people). These case counts increased across age groups, with the highest increase in people aged 80 or older (300%), followed by people aged 70 to 79 years (58%). When stratifying by fibrosis stage, nearly half (48.4%) of patients with MASLD did not have fibrosis (F0) in 2020, whereas 29.1% had stage 1 (F1), 14.5% had stage 2 (F2), 5.7% had stage 3 (F3), and 2.2% had stage 4 (F4). By 2050, disease was predicted to be more advanced, with larger proportions having F2 to F4 compared with F0 or F1.

Further, with 5.8% of US adults (14.9 million people) diagnosed with MASH in 2020, the model predicted that would increase to 6.7% (18.4 million people) by 2030 and 7.9% (23.2 million people) by 2050. The population with MASH at stage of F2 or higher increased to 75%, and from 6.7 million in 2020 to 11.7 million in 2050. Additionally, the number of patients with MASH cirrhosis (F4) increased by 91.1% from 1,147,000 in 2020 to 2,192,000 in 2050.

With a mean of 11,483 new cases of HCC and 1717 liver transplants per year from 2020 through 2025, the model had predicted this increasing to 22,440 new cases of HCC and 6720 transplants per year from 2046 through 2050. By 2050, the number of HCC cases are predicted to almost double (22,440) and transplants are predicted to almost quadruple (6720).

Further, the authors noted the model predicted that cases of MASH would increase from approximately 5.8% (14.9 million) of US adults in 2020 to 7.9% (23.2 million) by 2050. The number of cases of MASH and clinically significant fibrosis (which was defined as F ≥ F2, centrilobular and periportal fibrosis, or more severe disease) were estimated to increase from 6.7 million to 11.7 million individuals. By 2046 to 2050, MASLD is predicted to cause 22,440 new cases of HCC and 6720 new cases of transplants per year compared with 11,483 new cases of HCC and 1717 new cases of transplants in 2020 to 2025. Finally, liver-related mortality was estimated to increase from 30,500 deaths in 2020 to 95,300 in 2050.

REFERENCE

Le P, Tatar M, Dasarathy S, et al. Estimated Burden of Metabolic Dysfunction–Associated Steatotic Liver Disease in US Adults, 2020 to 2050. JAMA Netw Open. 2025;8(1):e2454707. doi:10.1001/jamanetworkopen.2024.54707