The Rising Tide of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in the US
Metabolic dysfunction-associated steatotic liver disease, commonly known as MASLD, is emerging as a significant health concern in the United States. With fat accumulation in the liver due to metabolic stressors such as obesity, high cholesterol, and elevated blood sugar, this condition is poised to affect millions in the coming decades.
Phuc Le, PhD, MPH
Credit: Cleveland Clinic
The Growing Burden of MASLD
Recent studies predict that by 2050, MASLD will impact nearly 41.4% of the US population, translating to approximately 122 million individuals. This alarming projection also highlights a sharp rise in related complications such as liver cancer, decompensated cirrhosis, and the need for liver transplants.
“Understanding the clinical burden of MASLD, especially the number of patients eligible for pharmacologic treatment, could enable health systems and pharmaceutical companies to prepare to meet imminent demand, but estimates vary widely, posing planning challenges,” says Phuc Le, PhD, MPH, a leading researcher in the field.
Breakthroughs in Treatment
On March 14, 2024, a significant milestone was achieved with the FDA approval of resmetirom (Rezdiffra), the first-ever liver-directed therapy for MASLD. While this marks a step forward, it remains the only FDA-approved treatment, underscoring the urgent need for more therapeutic advancements.
Projecting the Future: A Model-Based Approach
To understand the trajectory of MASLD, researchers employed a decision analytical modeling study. This innovative approach simulated the natural progression of the disease in a hypothetical US population starting from 2000 and projected forward to 2050. The model incorporated data on births, immigration, mortality, and MASLD epidemiology to provide a comprehensive outlook.
the study revealed a steady increase in MASLD prevalence, rising from 33.7% (86.3 million people) in 2020 to 41.4% (121.9 million people) by 2050. Additionally, cases of metabolic-associated steatohepatitis (MASH), a severe form of MASLD, are expected to climb from 5.8% to 7.9% over the same period.
The Escalation of Fibrosis Stages
Fibrosis, a critical aspect of MASLD progression, is also becoming more severe. In 2020, 48.4% of MASLD patients had no fibrosis, but by 2050, the disease is projected to advance, with larger proportions of individuals experiencing F2 (17.4%), F3 (8.4%), and F4 (4.0%) fibrosis stages. The population with MASH and significant fibrosis (≥ F2) is expected to surge by 75%, from 6.7 million in 2020 to 11.7 million by 2050.
Call to Action
“This decision analytical modeling study estimates a ample burden of MASLD in the next 30 years in the US,” researchers concluded. “By implementing preventive strategies,investing in research,and preparing health care systems,we can minimize the impact of MASLD and improve the lives of millions of individuals affected by this disease.”
References
- Le P, Tatar M, Dasarathy S, et al. Estimated Burden of Metabolic Dysfunction–Associated Steatotic Liver Disease in US Adults, 2020 to 2050.JAMA Network Open. 2025;8(1):e2454707. doi:10.1001/jamanetworkopen.2024.54707
- Brooks A. Resmetirom (Rezdiffra) Receives Historic FDA Approval for Noncirrhotic NASH. hcplive. March 14, 2024. Accessed January 16, 2025. https://www.hcplive.com/view/resmetirom-rezdiffra-receives-historic-fda-approval-for-noncirrhotic-nash
