The socioeconomic and environmental determinants of metabolic dysfunction-associated steatotic liver disease: understanding inequalities in prevalence and outcomes
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Metabolism-associated steatotic liver disease (MASLD) is the most prevalent chronic liver condition worldwide and affects nearly 30% of the global population. While traditionally associated with metabolic risk factors, such as obesity and insulin resistance, increasing attention is being directed toward socioeconomic and environmental determinants that contribute to disparities in MASLD prevalence and outcomes. Low-income populations often experience higher rates of MASLD owing to limited access to healthcare, poor diet quality, and reduced opportunities for physical activity. Conversely, high-income countries are witnessing a paradoxical rise in MASLD cases, driven by sedentary lifestyles and excessive consumption of ultra-processed foods. This review examined the effects of socioeconomic status, education, healthcare access, and environmental exposure on the epidemiology of MASLD. The findings revealed that individuals from lower socioeconomic backgrounds and migrant populations experience a disproportionately higher burden of MASLD due to systemic healthcare barriers, dietary transitions, and occupational exposure. Children and adolescents face increasing susceptibility owing to rising obesity rates, and geographic disparities highlight Europe as the most affected region, followed by Asia and North America. Given the growing public health impact of MASLD, addressing both socioeconomic and environmental determinants is essential. Future efforts should prioritize policy-driven interventions, including equitable healthcare access, lifestyle modifications, and research into novel therapeutic approaches to mitigate the disease burden and improve patient outcomes.
Metabolic-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, is the most common chronic liver condition worldwide, affecting approximately 30% of the global population [1].
A recent meta-analysis by Amini-Salehi et al. [2], which included data from over 78 million patients, reported a statistically significant difference in MASLD prevalence between men and women (36.6% and 25.5%, respectively). Its widespread occurrence has been strongly linked to the growing global burden of metabolic syndrome, including obesity, diabetes, and dyslipidemia [1]. Among obese individuals, MASLD prevalence ranges up to 57.5%, highlighting the substantial burden of this disease [2]. Although the pathophysiology of MASLD has been extensively studied, increasing attention is being paid to the socioeconomic and environmental factors that influence its distribution, progression, and outcomes across various populations. In low-income populations, the prevalence of obesity, which is a primary driver of MASLD, is steadily increasing. This trend is associated with lower education levels, higher unemployment rates, irregular meal patterns, and limited physical activity, which are often linked to a lack of financial resources for sports equipment [3]. These socioeconomic determinants significantly shape vulnerability to MASLD, creating disparities in the prevalence and outcomes of the disease [3]. Challenges such as food insecurity, reduced health literacy, and restricted access to quality medical care further exacerbate the risk of metabolic disorders, including MASLD [3]. Interestingly, high-income countries are experiencing a paradoxical rise in the prevalence of MASLD driven by the excessive consumption of ultra-processed foods. This underscores the intricate connection between economic development and health behaviors, emphasizing the urgent need for comprehensive strategies to raise awareness and address all aspects of MASLD [4]. Environmental factors amplify the socioeconomic burden of MASLD. Individuals with genetic predispositions who are exposed to adverse environmental conditions such as air pollution or smoking are particularly susceptible to MASLD, with lower socioeconomic groups disproportionately affected [5]. This review explored socioeconomic determinants influencing the prevalence, progression, and outcomes of MASLD. By examining factors such as education, income, healthcare access, urbanization, and environmental conditions, we highlighted the disparities that contribute to the MASLD burden. In addition, we identified patterns of inequality across vulnerable populations.
Methods
A comprehensive search was performed using National Institutes of Health, PubMed, World Health Organization (WHO), and European Association for the Study of the Liver (EASL) data. The literature search was conducted using the following keywords: (“MASLD” OR “Metabolic Associated Steatotic Liver Disease” OR “SLD” OR “Steatotic Liver Disease”) AND (“socioeconomic factors” OR “income disparities” OR “healthcare access” OR “environmental influences” OR “public health”). The search was restricted to studies published between 2019 and 2025. Additionally, national health reports and guidelines from the WHO and EASL were reviewed for policy perspectives.
In total, we reviewed 311 articles and the websites of WHO and EASL. The inclusion criterion for abstracts were those that addressed (1) socioeconomic determinants of MASLD, (2) treatment of hepatotropic viruses, (3) global prevalence and outcomes of MASLD in adult and children populations, (4) public health policies targeting MASLD, and (5) the impact of healthcare disparities on MASLD progression. Only studies published in English between 2019 and 2025 were considered.
Studies were excluded if they focused solely on metabolic risk factors without addressing socioeconomic or environmental determinants, included patients with liver diseases unrelated to MASLD, were non-peer-reviewed reports, editorials, or opinion pieces, or lacked sufficient data on socioeconomic or environmental influences on MASLD. Finally, we selected 49 (all of them in English) articles published between 2019 and 2024, with 27 published after 2023, one WHO report, and one EASL report.
Epidemiology of Metabolic-Associated Steatotic Liver Disease
The worldwide prevalence of MASLD in adults is estimated to be approximately 30%, and by 2019, it was projected that there were roughly 1.66 billion cases globally [6,7]. Latin America has the highest reported prevalence of MASLD, reaching 44.37%, whereas Western Europe has the lowest at 25.1% [1]. In contrast, Africa has a relatively low prevalence of MASLD compared with other regions [1]. Moreover, the prevalence of MASLD in the Middle East and North Africa rose significantly from 35.42% during the period of 2008–2016 to 46.20% between 2017 and 2020 [1] (Table 1).
A recent systematic review and meta-analysis of 63 studies, primarily conducted in Asian countries (China/Hong Kong, 26; South Korea, 22; Japan, 14; Sri Lanka, 1; Israel, 1) by Le et al. [8] found an incidence rate of 46.13 new cases of MASLD per 1,000 person-years. Notably, the incidence rate was higher in smokers than in non-smokers as well as in individuals who were obese or overweight than in those with normal weight. Among the regions studied, China exhibited the highest incidence rate, whereas Japan had the lowest. Furthermore, several recent reports have highlighted that China is experiencing a sharp rise in MASLD cases, with the aging population as a possible contributing factor [1]. The increasing prevalence of MASLD closely mirrors the growing rate of obesity and related health conditions [9]. Given its strong link to metabolic comorbidities, a modeling study by Estes et al. [10] projected a 21% increase in the global prevalence of MASLD between 2015 and 2030. Another modeling study focusing on four Asian regions provided additional insight into the potential adverse outcomes of MASLD by 2030 in the absence of intervention. Specifically, the study predicted that the prevalence of MASLD would increase by 6%–20%, and the prevalence of metabolic-associated steatohepatitis (MASH) would increase by 20%–35%.
Furthermore, new cases of hepatocellular carcinoma (HCC), decompensated cirrhosis, and related mortality could increase by 65%–100% [10]. Similarly, a comparable study conducted in Saudi Arabia, Kuwait, and the United Arab Emirates by Sanai et al. [11] reported significant increases in the prevalence of MASLD and MASH. This study highlighted a substantial growth in adverse outcomes, including advanced fibrosis, cirrhosis, decompensated cirrhosis, and liver-related mortality. The prevalence of MASLD in individuals with type 2 diabetes mellitus (T2DM) is both high and increasing. The highest prevalence of MASLD in T2DM patients was found in Eastern Europe (80.62%), followed by the Middle East (71.24%), while the lowest prevalence was recorded in Africa (53.10%).
Importantly, most T2DM patients with MASLD are diagnosed with MASH, and a significant proportion exhibit advanced fibrosis. Among those with liver biopsy data, the global prevalence rates of MASH, significant fibrosis, and advanced fibrosis were 66.44%, 40.78%, and 15.49%, respectively [1]. In addition, a higher incidence of MASLD has been observed among younger individuals (45 years or younger) in Asian populations. This trend is likely influenced by factors such as diets rich in carbohydrates, a high prevalence of central adiposity, and genetic susceptibility. MASLD is one of the fastest-growing medical conditions associated with the development of HCC and often leads to the need for liver transplantation in affected patients [12].
A study utilizing the Global Burden of Disease database 2019 estimated that in 2019, 170,000 new cases of liver cancer were linked to MASLD worldwide, representing 6.6% of all liver cancer cases arising from chronic liver diseases. In addition, there were 168,969 deaths attributed to MASLD-related liver cancer, accounting for 8.6% of all liver cancer-related deaths due to chronic liver disease. Regional analysis revealed that Asia accounted for 48.3% of the global MASLD-related liver cancer incidence and 46.2% of deaths, whereas the Middle East and North Africa regions accounted for 8.9% of MASLD-related liver cancer cases and 8.6% of related deaths. Asia, the Middle East, and North Africa experienced an increase in disability-adjusted life years from 2009 to 2019 owing to MASLD-related liver cancer. Notably, smoking is a significant predictor in Asia, while low levels of physical activity are associated with an increase in disability-adjusted life years in the Middle East and North Africa [13].
Socioeconomic Determinants of Metabolic-Associated Steatotic Liver Disease
The burden of MASLD is increasing worldwide, with low-income and lower-middle-income countries experiencing higher disability per prevalence [14]. Socioeconomic factors play a crucial role in the prevalence and progression of MASLD, as demonstrated in various studies worldwide. A study of 8,727 participants in Austria revealed that the prevalence of MASLD was 23% among participants with a high level of education, 33% among those with an intermediate level of education, and as high as 40% among those with a low level of education (P<0.01). This disparity was associated with higher levels of blood markers such as hemoglobin A1c (HbA1c) and triglycerides in the low-education group [15]. Additionally, subgroup analysis reported that higher liver stiffness measurements were independently associated with lower levels of education, indicating a strong influence of socioeconomic factors on the incidence of MASLD. Interestingly, this disparity is found not only for MASLD but also for ischemic heart disease and T2DM, which are more common in low- and middle-income countries [14]. Similarly, a study of the European population found that MASLD predominantly affected individuals with low incomes and educational attainment, which is consistent with previous research [16].
Food insecurity also contributes significantly to the risk of developing MASLD. Data from the 2005 to 2014 National Health and Nutrition Examination Survey reported that food-insecure adults were more likely to have MASLD and advanced fibrosis than food-secure adults. This insecurity is closely linked to high rates of obesity, diabetes, and hypertension [17].
Lifestyle factors also correlate with socioeconomic status (SES) and influence the risk of developing MASLD. Research on the US population has found that individuals with high-quality diets, regular physical activity, and higher education levels have a lower risk of developing MASLD. Interestingly, while a higher educational status was protective, family poverty income ratio did not show a direct relationship with MASLD risk [18]. Globally, disparities in the MASLD burden are clear. For example, Qatar experienced the highest increase in the incidence (761.8%) and prevalence (972.2%) of MASLD from 1990 to 2021, whereas the United Arab Emirates recorded the highest rise in mortality (1,028.3%) during the same period. Countries with a low Socioeconomic Development Index value showed the highest mortality rates related to MASLD liver complications, reflecting the disproportionate impact on economically disadvantaged regions [6]. Diet quality and food availability influenced the prevalence of MASLD differently across low-income regions. Paradoxically, high-income countries report a high prevalence of MASLD owing to diets rich in ultra-processed foods [1]. In contrast, in low-income countries, the prevalence of MASLD is associated with severe undernutrition and poverty [1].
Lifestyle factors also have an important effect. A US-based study examining the association of MASLD with Life’s Essential 8 (LE8), a framework encompassing blood glucose, blood pressure, body mass index (BMI), cholesterol, diet, physical activity, nicotine exposure, and sleep, found that higher LE8 scores correlated with lower MASLD risk. BMI and blood glucose levels are significant factors influencing this inverse relationship [19]. Collectively, these findings highlight the critical need to address socioeconomic inequalities and lifestyle factors in the prevention and management of MASLD.
Environmental Influences on Metabolic-Associated Steatotic Liver Disease
Environmental factors, including dietary habits, urbanization, and exposure to pollutants, play crucial roles in the onset and progression of MASLD. Specific diets, such as the Mediterranean diet, which is rich in vegetables, whole grains, nuts, olive oil, and fish, are associated with reduced hepatic inflammation and steatosis [20]. Interestingly, regular nut consumption (>4 times per week) was associated with a significantly lower prevalence of MASLD [20]. Conversely, a Western diet, which includes red and processed meats, has an adverse impact on liver health. Air pollution is an emerging risk factor for MASLD, particularly in urbanized and industrialized regions. Pollutants such as particulate matter (PM)2.5, PM10, NO 2, and NO x have been linked to an increased risk of MASLD, with PM2.5, especially harmful to liver metabolism [21]. These particles, which are primarily from fossil fuel combustion, disrupt glucose metabolism and induce oxidative stress in the liver [5]. Long-term exposure to PM2.5 activates Kupffer cells, promoting cytokine secretion and hepatic stellate cell activation, which enhances collagen production, a key mechanism in the development of fibrosis [5]. A nationwide inpatient study in the United States showed that MASLD prevalence was higher in regions with elevated PM2.5 levels, with stronger positive associations among patients who were aged ≥45 years, particularly in the Northeast, Midwest, and West, suggesting both geographic and socioeconomic influences on disease progression [22]. Similarly, a cohort study of 17,106 Chinese adults from 2005 to 2017 highlighted that individuals in the highest quartile of PM2.5 exposure had a 2.04-fold increased risk of MASLD compared with those in the lowest quartile [23]. Environmental influences contribute to MASLD development and progression. Identifying vulnerable populations and tailoring interventions to mitigate specific risks could help reduce the global burden of MASLD.
Related Comorbidities and Socioeconomic Context
MASLD is strongly associated with various extrahepatic complications, including cardiovascular disease (CVD), T2DM, chronic kidney disease (CKD), obesity, and hypertension (Table 2). These comorbidities are significantly influenced by socioeconomic factors that shape their prevalence, progression, and outcomes. CVD remains the leading cause of mortality among patients with MASLD and is an independent risk factor for cardiovascular death [24]. MASLD is associated with an increased risk of developing CVDs such as nonfatal coronary heart disease, stroke, and heart failure as well as death from cardiovascular causes [24]. Additionally, MASLD contributes to arterial stiffness, atherosclerosis, and impaired blood flow, and advanced fibrosis exacerbates these risks [24]. Socioeconomic conditions, environmental factors, and emotional well-being play critical roles in the development of CVD, with chronic inflammation, immune dysfunction, and hormonal imbalances driving the disease [25]. Low SES is a major determinant of CVD risk, and multiple studies have highlighted its profound impact on health outcomes. Factors such as smoking, obesity, and limited access to preventive care contribute to disproportionately worse outcomes in low-SES populations [26,27]. A computer simulation study involving 1.3 million 35-year-olds with low SES predicted that nearly 20% would develop coronary heart disease by the age of 65, almost double the rate of those with higher SES [26]. A subsequent multicenter study of 8,261 patients with coronary heart disease from 27 countries revealed that low-SES patients had less access to statin therapy and were less frequently advised to participate in cardiac rehabilitation programs, which were also less likely to be attended [27]. This underscores the critical role of SES in shaping CVD and MASLD risks, amplifying the need for public health strategies. Hypertension, a prevalent comorbidity of MASLD, significantly exacerbates the cardiovascular risk profile of the affected individuals. A Chinese cross-sectional study reported that lower household income increased the risk of hypertension by 35%, with lower education further contributing to heightened susceptibility [28]. The study also found that unemployed and retired individuals had higher odds of developing hypertension. Conversely, individuals in lower-income groups were not only more prone to hypertension but also less likely to maintain controlled hypertension [28]. T2DM is also strongly associated with MASLD, with over 90% of obese patients with diabetes being affected [24]. SES plays a key role in diabetes management; individuals with higher SES are more likely to achieve controlled HbA1c levels in urban areas, whereas those with lower SES show better fasting glucose control in rural settings [29]. Interestingly, Richards et al. [30] found that higher income correlates with an increased incidence of T2DM, while unemployment and lower education levels are also associated with a higher risk of T2DM; however, this is primarily influenced by a sedentary lifestyle and poor dietary choices. CKD is another comorbidity associated with MASLD. Socioeconomically deprived patients with CKD have faster disease progression, which appears to be the result of both socioeconomic and individual lifestyle factors [31]. Obesity, a central driver of MASLD, is highly prevalent among patients with MASLD and increases the risk of metabolic disorders. Global studies highlight regional differences with a lower prevalence of MASLD among overweight and obese populations in Asian and Middle Eastern countries than in Western nations [32].
Metabolic-Associated Steatotic Liver Disease in Vulnerable Populations
The increasing prevalence of MASLD in vulnerable populations, including children, adolescents, and migrants, poses a significant public health challenge.
Pediatric populations
In pediatric populations, MASLD primarily results from poor dietary habits, insulin resistance, dyslipidemia, and sedentary lifestyles, with obesity being the primary risk factor [33]. Recent studies indicate a surprisingly high rate of MASLD in children and adolescents, ranging from 7% to 14%, which makes the early identification and development of intervention strategies aimed at limiting the progression of liver damage in children and adolescents key [34]. A large multicenter study involving 16,390 overweight or obese children (58% men) confirmed the sex-dependent nature of MASLD, with a higher prevalence among men during early puberty (men 14.4% versus women 7.4%, P<0.001) and an increased percentage of girls in advanced puberty (P=0.001) [33]. A summary of the key points of the MASLD in children and adolescents is presented in Table 3.
Ethnic differences
Ethnic differences are also notable, with Hispanic origin increasing the risk of MASLD up to four-fold. In the United States, prevalence varies by ethnicity, with rates of 37% in the Hispanic population, 24.7% in the Black population, and 29.3% in the White population [35]. The Western dietary pattern, characterized by high consumption of sweets and red meat and low fiber intake, has played a crucial role in the growing MASLD burden [36]. A meta-analysis by Hassani Zadeh et al. [37] found that adherence to a Western diet increased MASLD risk by 56%, whereas a healthier diet rich in fiber, lean meat, and fish reduced the risk by 22%. The Mediterranean diet, rich in legumes and unprocessed grains, also offers protective benefits [37]. Asian ancestry similarly predisposes individuals to the disease, while African ancestry appears to confer some protection [38]. Genetic predisposition is a critical factor, as demonstrated by studies on the PNPLA3 I148M allele in homozygotes, which has been associated with up to 27-fold higher hepatic fat content [39]. Advanced cases may present with hepatomegaly, splenomegaly, or signs of liver failure; however, cirrhosis is rare in children [1].
Migrant populations
Among migrant populations, MASLD is increasingly prevalent and is driven by post-migration dietary changes and socioeconomic challenges [40]. Limited healthcare access combined with prevalent risk factors such as obesity and insulin resistance exacerbate the disease burden [40]. A meta-analysis by Lim et al. [41] found that Europe had the highest prevalence of MASLD (54.33%), followed by Asia (38.89%) and North America (29.08%), with migrant populations from high-prevalence regions contributing to the growing burden of MASLD.
MASLD disproportionately affects vulnerable populations, including children, adolescents, and migrants, due to factors such as obesity, insulin resistance, and socioeconomic challenges. However, early detection of the disease and implementation of treatment can lead to better health outcomes and reduce the risk of severe liver damage and cardiovascular complications.
Public Health Strategies
Despite its increasing prevalence and profound public health implications, MASLD is often overlooked by national health strategies. Surveys conducted globally have highlighted a striking lack of preparedness, with no nation implementing comprehensive strategies or action plans. A 2018–2019 survey across 29 European countries and a global study covering 102 countries revealed the absence of national policies, clinical guidelines, and organized health system approaches for MASLD [42,43]. None of the 29 European countries surveyed developed written strategies or action plans for MASLD [42]. Globally, assessment scores for MASLD-related preparedness vary significantly. India and the United Kingdom were the highest-ranking countries, yet these scores reflected only modest progress. Notably, 32 countries (31%) scored zero out of 100, indicating a complete lack of action [43]. Additionally, national MASLD clinical guidelines were available in only 32 countries, underscoring the urgent need for coordinated global efforts to address MASLD effectively. This gap is alarming as the burden of MASLD, including advanced liver disease, is expected to more than double by 2030 [44], with projected economic costs exceeding €334 billion in Europe and $1 trillion in the United States [45]. In 2020, the EASL-Lancet Commission issued a report on liver health and care in Europe stressing the urgency to incorporate MASLD into public health policies to mitigate its impact [45]. The Commission recommended that MASLD be included in national healthcare policies and guidelines, which are currently absent in most countries. The European Association for the Study of Diabetes and the European Association for the Study of Obesity recently developed guidelines reflecting advances in MASLD diagnosis, treatment, and monitoring. These guidelines emphasize a holistic approach that integrates early detection, hepatitis screening, and primary care hepatology training [45,46]. These initiatives align with the WHO’s global call for action to curb obesity and T2DM and aim to reduce premature mortality from noncommunicable diseases by one-third by 2030 [47]. Currently, MASLD management relies heavily on lifestyle interventions such as diet and exercise, which benefit liver health and microbiome balance. However, no pharmacological treatments have yet been approved. Emerging research highlights the promise of microbiome-targeting therapies such as probiotics and fecal microbiota transplantation. Advances in genetic assessments and next-generation sequencing may enable personalized treatments in the future, accounting for individual differences in microbiome composition [48]. A summary of the strategies used to counteract MASLD is presented in Table 4.
Conclusion
MASLD has emerged as a growing global public health concern, and socioeconomic and environmental factors play critical roles in its prevalence and outcomes. This evidence highlights significant disparities in MASLD burden across different regions and populations, particularly those with lower SES, limited healthcare access, and unhealthy lifestyle patterns. Migrant populations and children are particularly vulnerable, emphasizing the urgent need for targeted interventions. Despite advances in understanding the pathophysiology of MASLD and its associated comorbidities, substantial gaps remain in effective management strategies. From a primary care perspective, early identification and risk stratification of patients with MASLD are essential in mitigating disease progression. Primary care providers play a critical role in screening high-risk individuals, particularly those from underserved communities, who may face barriers to specialist care [49]. Integrating MASLD assessment into routine checkups through non-invasive diagnostic tools, such as the Fibrosis-4 index or transient elastography, could improve early detection and allow for timely lifestyle interventions. In addition, addressing modifiable risk factors, including diet, physical inactivity, and metabolic comorbidities, should be prioritized in primary care settings [49]. Strengthening patient education regarding MASLD and expanding access to multidisciplinary care, including dietitians and hepatologists, may enhance long-term disease management. Implementing community-based interventions and promoting health literacy initiatives in low-income populations could further reduce disparities in MASLD outcomes [49].
Article Information
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Increases MASLD risk via poor diet, lack of preventive care, and higher prevalence of metabolic syndrome. Leads to higher rates of CVD in MASLD patients.
MASLD patients with CKD are more likely to experience worsened outcomes due to lack of early intervention and monitoring.
Hypertension
Low income, unemployment, limited access to medication
Contributes to metabolic stress and fibrosis progression in MASLD patients, worsening liver and cardiovascular outcomes.
Obesity
Low SES, food insecurity, lack of access to healthy food
Strongly linked to MASLD development. Poor dietary habits and sedentary lifestyle increase liver fat accumulation and disease severity.
Dyslipidemia
Low SES–higher LDL and hypercholesterolemia
Limited access to lipid-lowering medications and lack of preventive measures worsen lipid profiles, increasing the risk of MASLD-related complications.
Neoplasms
Low SES, limited access to diagnosis and treatment
Late detection of MASLD-associated liver cancer leads to poorer prognoses, with disparities in healthcare access further exacerbating mortality risks.
• Use artificial intelligence-driven risk prediction models in primary care to stratify MASLD patients.
Medical and multidisciplinary approaches
• Expand training for primary care physicians in MASLD early detection and metabolic disease management.
• Promote collaborative care models, integrating hepatologists and nutritionists.
• Advocate for the classification of MASLD as a NCD to align with chronic disease care frameworks.
Policy and legislative actions
• Align with WHO’s global strategy to curb obesity and T2DM by 2030.
• Integrate MASLD into national healthcare guidelines to improve early detection and intervention.
• Implement employer-led wellness programs that encourage physical activity and healthy eating through workplace incentives.
MASLD, metabolic dysfunction-associated steatotic liver disease; DASH, dietary approaches to stop hypertension; SSB, sugar-sweetened beverage; HFSS, high-fat sugar and salt; GLP-1, glucagon-like peptide-1; NCD, non-communicable disease; WHO, World Health Organization; T2DM, type 2 diabetes mellitus.
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The socioeconomic and environmental determinants of metabolic dysfunction-associated steatotic liver disease: understanding inequalities in prevalence and outcomes
The socioeconomic and environmental determinants of metabolic dysfunction-associated steatotic liver disease: understanding inequalities in prevalence and outcomes
Region
Prevalence (%)
Incidence (%)
Central Europe
1.63
1.18
Eastern Europe
2.74
2.14
Western Europe
5.23
3.87
Andean Latin America
0.77
0.83
Central Latin America
3.53
3.69
Southern Latin America
0.64
0.59
Tropical Latin America
3.38
3.28
Central Asia
1.20
1.21
East Asia
23.78
20.49
South Asia
19.70
22.26
Southeast Asia
9.08
9.53
High-income Asia Pacific
1.95
1.51
Australasia
0.30
0.24
Oceania
0.13
0.16
Caribbean
0.64
0.60
Central Sub-Saharan Africa
0.86
1.14
Eastern Sub-Saharan Africa
2.94
4.04
North Africa and Middle East
12.96
13.61
Southern Sub-Saharan Africa
0.93
1.10
Western Sub-Saharan Africa
3.78
5.17
High-income North America
3.86
3.38
Diseases associated with MASLD
Socioeconomic factors affecting MASLD and its related diseases
Increases MASLD risk via poor diet, lack of preventive care, and higher prevalence of metabolic syndrome. Leads to higher rates of CVD in MASLD patients.
MASLD patients with CKD are more likely to experience worsened outcomes due to lack of early intervention and monitoring.
Hypertension
Low income, unemployment, limited access to medication
Contributes to metabolic stress and fibrosis progression in MASLD patients, worsening liver and cardiovascular outcomes.
Obesity
Low SES, food insecurity, lack of access to healthy food
Strongly linked to MASLD development. Poor dietary habits and sedentary lifestyle increase liver fat accumulation and disease severity.
Dyslipidemia
Low SES–higher LDL and hypercholesterolemia
Limited access to lipid-lowering medications and lack of preventive measures worsen lipid profiles, increasing the risk of MASLD-related complications.
Neoplasms
Low SES, limited access to diagnosis and treatment
Late detection of MASLD-associated liver cancer leads to poorer prognoses, with disparities in healthcare access further exacerbating mortality risks.
, Krzysztof Łupina1
