Global, Regional and National Burden of Metabolic Dysfunction-Associated Steatotic Liver Disease in Adolescents and Adults Aged 15-49 Years from 1990 to 2021: Results from the 2021 Global Burden of Disease Study

Biwu Xu¹Hailong Li^2,3Yijie Pi⁴Kaiyuan Li^5*

• ¹Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
• ²Nanchang University, Nanchang, China
• ³Department of Cardiovascular Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
• ⁴Department of ophthalmology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
• ⁵Department of Cardiology, The Affiliated Taizhou People's Hospital, Nanjing Medical University, Taizhou, China

Background: With rising obesity and diabetes rates, the incidence of Metabolic dysfunctionassociated steatotic liver disease (MASLD) among individuals aged 15-49 is increasing, affecting their productivity, health, and quality of life. However, a comprehensive global assessment of MASLD burden and long-term trends in this age group remains lacking.The study analyzed prevalence, incidence, mortality, and disability-adjusted life years (DALYs) for individuals aged 15-49 using data from the Global Burden of Disease (GBD) 2021 study. Trends from 1990 to 2021 were assessed using Estimated Annual Percentage Change (EAPC), with data stratified by Socio-Demographic Index (SDI), sex, and age. Results: Between 1990 and 2021, the number of individuals with MASLD increased from 343 million to 666 million, reflecting an average annual growth rate of 0.95%. The number of MASLD-related deaths increased from 7,920 to 15,110, corresponding to an average annual growth rate of 0.8%. Over the same period, DALYs climbed from 399,000 to 751,000, indicating an increase of approximately 0.77%. Low-SDI regions showed the fastest growth in mortality and DALYs, whereas some high-SDI areas, notably high-income Asia Pacific, demonstrated a decline in these measures. Regarding sexbased differences, males exhibited a higher growth rate of MASLD-related deaths and DALYs compared to females, although the increase in prevalence was more pronounced among females. Age-group analysis revealed that the 45-49-year group experienced the most significant surge in MASLD burden.Conclusions: Over the past three decades, the global burden of MASLD has risen significantly, especially in regions with rapidly increasing obesity rates. Despite progress in some high-income countries, the persistent escalation in low-income regions underscores the urgency for targeted interventions.