US cases of MASLD projected to top 121 million by 2050 alongside 55% spike in MASH
Key takeaways:
- The model predicted an increase in MASLD prevalence from 33.7% in 2020 to 41.4% by 2050.
- It also projected a rise in cases of MASH, decompensated cirrhosis, HCC and liver transplantation.
A new model has projected a substantial rise in the burden of metabolic dysfunction-associated steatotic liver disease in the U.S. by 2050, which could be minimized by effective preventive and management strategies, researchers wrote.
“People with MASLD or [metabolic dysfunction–associated steatohepatitis] are at increased risk of adverse liver-related health outcomes, and MASH is projected to soon become the leading indication for liver transplant in the U.S.,” Phuc Le, PhD, MPH, associate staff at Cleveland Clinic Community Care and assistant professor of medicine at Cleveland Clinic Lerner College of Medicine, and colleagues wrote in JAMA Network Open.
“Understanding the clinical burden of MASLD, especially the number of patients eligible for pharmacologic treatment (ie, patients with MASH and fibrosis stage ≥ F2), could enable health systems and pharmaceutical companies to prepare to meet imminent demand, but estimates vary widely, posing planning challenges.”
To project the disease burden of MASLD from 2020 to 2050 among U.S. adults, Le and colleagues created an agent-based state transition model of a hypothetical population of 2,821,624 adults (mean age, 35.8 years; 50.9% women) with similar age and sex distribution to that of the U.S. population in 2000, simulated through 2050. The model also tracked the natural history of MASLD progression.
The main outcomes were MASLD, MASH, fibrosis, hepatocellular carcinoma, liver transplant and liver-related death.
According to results, the model forecasted a rise in MASLD prevalence among U.S. adults between 2020 and 2050, from 33.7% to 41.4%, with “approximately 122 million U.S. adults having MASLD in 2050.” The model also predicted MASH incidence would increase from 14.9 million (5.8%) to 23.2 million (7.9%).
In addition, cases of decompensated cirrhosis would “more than triple,” from 289,200 in 2020 to 1,027,400 in 2050, while cases of MASH with fibrosis stage 2 or higher would increase 75%, from 6.7 million to 11.7 million.
The researchers also reported that HCC cases “almost doubled” by 2050, from a mean 11,483 new cases from 2020 to 2025 to 22,440 new cases from 2046 to 2050 — a cumulative total of 527,900 cases over 30 years. In addition, liver transplantation “almost quadrupled” during those years, from 1,717 per year to 6,720 per year — a cumulative total of 132,600 liver transplants.
MASLD-related deaths were also projected to increase from 30,500 in 2020 to 95,300 in 2050.
“This decision analytical modeling study estimates a substantial burden of MASLD in the next 30 years in the U.S.,” Le and colleagues wrote. “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.”
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