Epidemiologic data underscore metabolic liver disease as a major contributor to global disease burden. There is growing recognition that MASLD and MASH are a hepatic manifestation of metabolic disfunction. 1 They are often clustered with other cardiometabolic risk factors associated with metabolic syndrome (MetS), such as type 2 diabetes and hypertension. “The term metabolic was introduced to steatotic liver disease to emphasize the underlying pathophysiologic drivers of this liver disease, particularly obesity, insulin resistance, and type 2 diabetes, says Zobair Younossi, MD, MPH, a gastroenterologist and hepatologist and Chairman of the Global NASH/MASH Council and Professor for Liver Outcomes & Policy Research at Georgetown University School of Medicine, in Washington, DC. Insulin resistance is a key metabolic driver. Obesity and type 2 diabetes, both implicated in insulin resistance, remain important risk factors for progressive liver disease. To be diagnosed with MASLD, one has to have liver steatosis (at least 5 percent fat) along with at least one cardiometabolic risk factor. 2,3 “Fat in the liver is a marker of metabolic health,” notes Fernando Bril, MD, an endocrinologist and assistant professor at the University of Alabama at Birmingham, and a co-author of the recent 2026 Clinical Care Pathway for MASLD from the American Gastroenterological Association (AGA). Hepatic fat accumulation is a marker of underlying metabolic dysfunction, often reflecting insulin resistance, explains Bril, adding that insulin resistance is typically present across multiple tissues, including blood vessels and kidneys, by the time hepatic steatosis develops. MASH represents the progressive, inflammatory form of MASLD, characterized by hepatocellular injury and structural liver damage. 2 MASH affects The Growing Burden of Metabolic Liver Disease EPIDEMIOLOGY, METABOLIC DRIVERS, AND IMPLICATIONS FOR PATIENT CARE
METABOLIC LIVER DISEASE BY THE NUMBERS
Rising rates of obesity and type 2 diabetes are driving parallel increases in metabolic liver disease prevalence. Key epidemiologic data highlight the scale of the burden. 1,2,4,5
in U.S. & 38% of all adults globally are estimated to have metabolic dysfunction–associated steatotic liver disease (MASLD). 1,6 42% OF ADULTS
One 2020 study found that worldwide cases rose from 391M in 1990 to 882M in 2017. 7 391M 882M+
1990
2017
CHILDREN/ADOLESCENTS
Up to 20% globally are estimated to have MASLD. An estimated 47% of children with obesity have MASLD. 8
OVERWEIGHT
70% of people who are overweight and 75% of those who have obesity have MASLD. 8
TYPE 2 DIABETES
Up to 70% of people with T2D have MASLD. 4
UP TO 90% of people with advanced obesity (BMI of 40 kg/m2 or above) have MASLD. 6
approximately 5 percent of adults globally and up to 7 percent in the U.S.—or roughly 22 million adults. 4 Prevalence is substantially higher among high-risk populations, including approximately 35 percent of those with obesity and more than 60 percent of individuals with type 2 diabetes. 3,4 “Among those people who already have MASLD,
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