Global incidence of non-alcoholic fatty liver disease: a systematic review and meta-analysis of 63 studies and 1,201,807 persons

Le, Michael H.; Le, David M.; Baez, Thomas C.; Wu, Yuankai; Ito, Takanori; Lee, Eunice Y.; Lee, KeeSeok; Stave, Christopher D.; Henry, Linda; Barnett, Scott D.; Cheung, Ramsey; Nguyen, Mindie H.

doi:10.1016/j.jhep.2023.03.040

Cited by 303Liver Disease Diagnosis and TreatmentDiabetes, Cardiovascular Risks, and LipoproteinsAlcohol Consumption and Health Effects

Global incidence of non-alcoholic fatty liver disease: a systematic review and meta-analysis of 63 studies and 1,201,807 persons

Le, Michael H., Le, David M., Baez, Thomas C., Wu, Yuankai, Ito, Takanori, Lee, Eunice Y., Lee, KeeSeok, Stave, Christopher D. +4 more·2023·Journal of Hepatology

DOI 10.1016/j.jhep.2023.03.040

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Abstract

Background & aims The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing. We aimed to estimate the pooled global NAFLD incidence.Methods We performed a systematic review and meta-analysis of cohort studies of adults without NAFLD at baseline to evaluate the global incidence of ultrasound-diagnosed NAFLD.Results A total of 63 eligible studies (1,201,807 persons) were analyzed. Studies were from Mainland China/Hong Kong (n = 26), South Korea (n = 22), Japan (n = 14), other (n = 2, Sri Lanka, Israel); 63.8% were clinical center studies; median study year 2000 to 2016; 87% were good quality. Among the 1,201,807 persons at risk, 242,568 persons developed NAFLD, with an incidence rate of 4,612.8 (95% CI 3,931.5-5,294.2) per 100,000 person-years and no statistically significant differences by study sample size (p = 0.90) or study setting (p = 0.055). Males had higher incidence vs. females (5,943.8 vs. 3,671.7, p = 0.0013). Both the obese (vs. non-obese) and the overweight/obese groups (vs. normal weight) were about threefold more likely to develop NAFLD (8,669.6 vs. 2,963.9 and 8,416.6 vs. 3,358.2, respectively) (both p <0.0001). Smokers had higher incidence than non-smokers (8,043.2 vs. 4,689.7, p = 0.046). By meta-regression, adjusting for study year, study setting, and study location, study period of 2010 or after and study setting were associated with increased incidence (p = 0.010 and p = 0.055, respectively). By country, China had a higher NAFLD incidence compared to non-China regions (p = 0.012) and Japan a lower incidence compared to non-Japan regions (p = 0.005).Conclusions NAFLD incidence is increasing with a current estimate of 4,613 new cases per 100,000 person-years. Males and overweight/obese individuals had significantly higher incidence rates compared to females and those of normal weight. Public health interventions for prevention of NAFLD are needed with a special emphasis on males, overweight/obese individuals, and higher risk regions.Impact and implications Non-alcoholic fatty liver disease (NAFLD) affects approximately 30% of people worldwide and appears to be increasing, but data to estimate the incidence rate are limited. In this meta-analytic study of over 1.2 million people, we estimated an incidence rate of NAFLD of 46.13 per 1,000 person-years with significant differences by sex, BMI, geography, and time-period. As treatment options for NAFLD remain limited, prevention of NAFLD should remain the focus of public health strategies. Studies such as these can help policy makers in determining which and whether their interventions are impactful.

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The estimated global prevalence of MASLD in the general population has risen from 25% in 2016 to currently more than 30%, and the incidence is continually increasing.
“The estimated global prevalence of MASLD in the general population has risen from 25% in 2016 12 to currently more than 30%, and the incidence is continually increasing. 12 -14”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [14]

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The global burden of fatty liver disease: the major impact of China
Lou, T.-W., Yang, R., & Fan, J. (2024) · HepatoBiliary Surgery and Nutrition · doi:10.21037/hbsn-23-556 · Cited by 84 · see citing works
“A systematic review and meta-analysis by Le et al. (6) reported that the pooled incidence of NAFLD in Asian adults was 46.13/1,000 person-years (95% CI: 39.32–52.94); the incidence of NAFLD in men was significantly higher than that in women (53.10 vs. 33.70/1,000 person-years); the risk of NAFLD in…”
BackgroundInfluential
Guideline for the Prevention and Treatment of Metabolic Dysfunction-associated Fatty Liver Disease (Version 2024)
Fan, J., Xu, X., Yang, R.-X., Nan, Y., Wei, L., Jia, J., Zhuang, H., Shi, J., Li, X., Cm, S., et al. (2024) · Journal of Clinical and Translational Hepatology · doi:10.14218/jcth.2024.00311 · Cited by 85 · see citing works
Natural products in non-alcoholic fatty liver disease (NAFLD): Novel lead discovery for drug development
Wang, L., Yan, Y., Wu, L., & Peng, J. (2023) · Pharmacological Research · doi:10.1016/j.phrs.2023.106925 · Cited by 74 · see citing works
Addressing the High and Rising Global Burden of Metabolic Dysfunction‐Associated Steatotic Liver Disease ( MASLD ) and Metabolic Dysfunction‐Associated Steatohepatitis ( MASH ): From the Growing Prevalence to Payors' Perspective
Younossi, Z. M., Razavi, H. A., Sherman, M., Allen, A. M., Anstee, Q. M., Cusi, K. J., Friedman, S. L., Lawitz, E., Lazarus, J. V., Schuppan, D., et al. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70020 · Cited by 65 · see citing works
“The prevalence is continuing to increase at an alarming rate [14, 16] leading to a growing overall burden of disease.”
Gastrointestinal cancers in lean individuals with non‐alcoholic fatty liver disease: A systematic review and meta‐analysis
de Souza, M. H. G., Diaz, I., Barchetta, I., & Mantovani, A. (2023) · Liver International · doi:10.1111/liv.15763 · Cited by 60 · see citing works
MASLD treatment—a shift in the paradigm is imminent
Machado, M. V. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1316284 · Cited by 51 · see citing works
Metabolic Dysfunction-Associated Steatohepatitis and Progression to Hepatocellular Carcinoma: A Literature Review
Ghazanfar, H., Javed, N., Qasim, A., Zacharia, G. S., Ghazanfar, A., Jyala, A., Shehi, E., & Patel, H. (2024) · Cancers · doi:10.3390/cancers16061214 · Cited by 50 · see citing works
The Expanding Role of GLP-1 Receptor Agonists: Advancing Clinical Outcomes in Metabolic and Mental Health
Qassab, M. A., Mneimneh, M., Jradi, A., Derbas, B., Dabboussi, D., Baini, J. K., Katrib, N., Chaarani, N., Attieh, P., Kanaan, A., et al. (2025) · Current Issues in Molecular Biology · doi:10.3390/cimb47040285 · Cited by 52 · see citing works
“It is characterized by the presence of steatosis in no less than 5% of hepatocytes which can progress to inflammation and fibrosis leading to metabolic dysfunction-associated steatohepatitis (MASH) and liver cirrhosis [3,4,23,24].”
Synergistic association of sodium-glucose cotransporter-2 inhibitor and metformin on liver and non-liver complications in patients with type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease
Mao, X., Zhang, X., Kam, L. Y., Chien, N., Lai, R., Cheung, K. S., Yuen, M., Cheung, R. C., Seto, W., & Nguyen, M. H. (2024) · Gut · doi:10.1136/gutjnl-2024-332481 · Cited by 44 · see citing works
A public health perspective on mitigating the global burden of chronic liver disease
Balakrishnan, M., & Rehm, J. T. (2023) · Hepatology · doi:10.1097/hep.0000000000000679 · Cited by 41 · see citing works
“The risk of developing MASLD increases 3-fold among adults with a body mass index of 25 kg/m 2 (23 kg/m 2 among Asian populations) and above, [9] with dose-dependent increases seen with every per unit increase in waist circumference and body mass index.”
Background
Inappropriate Diet Exacerbates Metabolic Dysfunction-Associated Steatotic Liver Disease via Abdominal Obesity
Xiang, M., Tian, X., Wang, H., Gan, P., & Zhang, Q. (2024) · Nutrients · doi:10.3390/nu16234208 · Cited by 40 · see citing works
Global burden of adult non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) has been steadily increasing over the past decades and is expected to persist in the future
Dong, X., Li, J.-M., Lü, X., Lin, X.-Y., Hong, M., Weng, S., & Pan, J. (2024) · Translational Gastroenterology and Hepatology · doi:10.21037/tgh-23-118 · Cited by 38 · see citing works
Fucoidan ameliorates lipid accumulation, oxidative stress, and NF-κB-mediated inflammation by regulating the PI3K/AKT/Nrf2 signaling pathway in a free fatty acid-induced NAFLD spheroid model
Chu, X., Wang, X., Feng, K., Bi, Y., Xin, Y., & Liu, S. (2025) · Lipids in Health and Disease · doi:10.1186/s12944-025-02483-z · Cited by 38 · see citing works
“The prevalence of non-alcoholic fatty liver disease (NAFLD) has increased from 25 to 38% over the past 30 years [1–3].”
The burden of liver disease in Latin America
Díaz, L. A., Villota‐Rivas, M., Francisco Barrera, M., Lazarus, J. V., & Arrese, M. A. (2023) · Annals of Hepatology · doi:10.1016/j.aohep.2023.101175 · Cited by 37 · see citing works
Trimethylamine N-oxide, choline and its metabolites are associated with the risk of non-alcoholic fatty liver disease
Ma, R., Shi, G.-Y., Li, Y., & Shi, H. (2024) · British Journal Of Nutrition · doi:10.1017/s0007114524000631 · Cited by 37 · see citing works
“Non-alcoholic fatty liver disease (NAFLD) has emerged as the most prevalent hepatic disorder worldwide and is estimated to afflict approximately 38 % of the world ’ s population, with an annual incidence of 46 · 13 new cases per 1000 person-years (1,2) .”
Background
Liver and cardiovascular outcomes in lean non-alcoholic fatty liver disease: an updated systematic review and meta-analysis of about 1 million individuals
de Souza, M. H. G., Diaz, I., & Al‐Sharif, L. (2024) · Hepatology International · doi:10.1007/s12072-024-10716-z · Cited by 37 · see citing works
“Its prevalence is increasing in parallel with the global obesity epidemic, resulting in a significant social and economic burden [2].”
Comparing similarities and differences between NAFLD, MAFLD, and MASLD in the general U.S. population
Zou, H., Ma, X., Pan, W. Q., & Xie, Y. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1411802 · Cited by 35 · see citing works
Endpoints in NASH Clinical Trials: Are We Blind in One Eye?
Lonardo, A., Ballestri, S., Mantovani, A., Targher, G., & Bril, F. (2024) · Metabolites · doi:10.3390/metabo14010040 · Cited by 34 · see citing works
“The prevalence of NASH ranges from ~2% to 6.5% globally, with a nearly two-fold increase among high-risk individuals such as middle-aged individuals in the USA [25].”
BackgroundInfluential
A global survey on the use of the international classification of diseases codes for metabolic dysfunction-associated fatty liver disease
Zhang, H., Targher, G., Byrne, C. D., Kim, S., Wong, V. W.-S., Valenti, L., Glickman, M., Ponce, J., Mantzoros, C. S., Crespo, J., et al. (2024) · Hepatology International · doi:10.1007/s12072-024-10702-5 · Cited by 34 · see citing works
MASLD and MASH at the crossroads of hepatology trials and cardiorenal metabolic trials
Zannad, F. M., Sanyal, A. J., Butler, J., Ferreira, J. P., Girerd, N., Miller, V., Pandey, A., Parikh, C. R., Ratziu, V., Younossi, Z. M., et al. (2024) · Journal of Internal Medicine · doi:10.1111/joim.13793 · Cited by 35 · see citing works
“Prospective data indicated a 14% prevalence of advanced ﬁbrosis and a 6% prevalence of cirrhosis in patients with T2DM [8].”
Background
Projected Trends in Metabolic Dysfunction–Associated Steatotic Liver Disease Mortality Through 2040
Zhang, X., Linden, S., Levesley, C. R., He, X., Yang, Z., Barnet, S., Cheung, R. C., Ji, F., & Nguyen, M. H. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.16367 · Cited by 33 · see citing works
The newly proposed Metabolic Score for Visceral Fat is a reliable tool for identifying non-alcoholic fatty liver disease, requiring attention to age-specific effects in both sexes
Kuang, M., Qiu, J., Li, D., Hu, C., Zhang, S., Sheng, G., & Zou, Y. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1281524 · Cited by 31 · see citing works
The heterogeneity of metabolic syndrome presentation and challenges this causes in its pharmacological management: a narrative review focusing on principal risk modifiers
Lonardo, A. (2023) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2023.2259306 · Cited by 29 · see citing works
“…persons and 63 eligible studies found that NAFLD incidence is increasing, with a current estimate of 4,613 new cases per 100,000 person-years; however, compared to women and to normal weight individuals, men and overweight/obese individuals had significantly higher disease incidence rates [48].”
Result
Systematic Review and Meta-Analysis: Prevalence of Non-Alcoholic Fatty Liver Disease and Liver Fibrosis in Patients with Inflammatory Bowel Disease
Navarro, P., Gutiérrez‐Ramírez, L., Tejera‐Muñoz, A., Arias, Á., & Lucendo, A. J. (2023) · Nutrients · doi:10.3390/nu15214507 · Cited by 28 · see citing works
Non-invasive diagnosis of non-alcoholic fatty liver disease: Current status and future perspective
Wang, J., Jiang, S., Hu, A., Zhou, A.-W., Hu, T., Li, H., Fan, Y., & Lin, K. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e27325 · Cited by 27 · see citing works
“Of note, the aging of the population, as well as the growing obesity and diabetes epidemic, will probably have a significant impact on its prevalence in the years to come [11 – 13].”
Background
Therapeutic siRNA targeting PLIN2 ameliorates steatosis, inflammation, and fibrosis in steatotic liver disease models
Wang, Y., Zhou, J., Yang, Q., Li, X., Qiu, Y., Zhang, Y., Liu, M., & Zhu, A. J. (2024) · Journal of Lipid Research · doi:10.1016/j.jlr.2024.100635 · Cited by 27 · see citing works
Differential prevalence and prognostic value of metabolic syndrome components among patients with MASLD
Pustjens, J., van Kleef, L. A., Janssen, H. L. A., de Knegt, R. J., & Brouwer, W. P. (2024) · JHEP Reports · doi:10.1016/j.jhepr.2024.101193 · Cited by 27 · see citing works
Efficacy of the Mediterranean diet in treating metabolic dysfunction-associated steatotic liver disease (MASLD) in children and adolescents: a systematic review and meta-analysis
Jamil, A., Chivese, T., Elshaikh, U. A. M., & Sendall, M. C. (2024) · BMC Public Health · doi:10.1186/s12889-024-19378-w · Cited by 26 · see citing works
“The prevalence of MASLD has increased over recent years from 2000 per 100,000 person-years in the year 2000 to 7000 per 100,000 in the year 2015 [2].”
Background
Regular exercise alleviates metabolic dysfunction-associated steatohepatitis through rescuing mitochondrial oxidative stress and dysfunction in liver
Lin, B., Wu, T., Nasb, M., Li, Z., & Chen, N. (2025) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2025.02.017 · Cited by 26 · see citing works
Metabolic dysfunction-associated steatotic liver disease (MASLD): Exploring systemic impacts and innovative therapies
Jain, P., Jain, A., Deshmukh, R., Samal, P. K., Satapathy, T., & Ajazuddin, M. (2025) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clinre.2025.102584 · Cited by 25 · see citing works
TM6SF2 E167K variant decreases PNPLA3-mediated PUFA transfer to promote hepatic steatosis and injury in MASLD
Sun, B., Ding, X., Tan, J., Zhang, J., Chu, X., Zhang, S., Liu, S., Zhao, Z., Xuan, S., Xin, Y., et al. (2024) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2024.0268 · Cited by 25 · see citing works
Towards precision medicine in non-alcoholic fatty liver disease
Francque, S. (2023) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-023-09820-6 · Cited by 24 · see citing works
“NAFLD also shows marked sex-related differences [37], attributed mainly to the protective actions of oestrogens [38, 39].”
Background
The association between endocrine disrupting chemicals and nonalcoholic fatty liver disease: A systematic review and meta-analysis
Pan, K., Xu, J., Xu, Y., Wang, C., & Yu, J. (2024) · Pharmacological Research · doi:10.1016/j.phrs.2024.107251 · Cited by 23 · see citing works
Exploring Varied Treatment Strategies for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
Elshaer, A., Chascsa, D. M. H., & Lizaola‐Mayo, B. (2024) · Life · doi:10.3390/life14070844 · Cited by 22 · see citing works
Association between nonalcoholic fatty liver disease and increased glucose-to-albumin ratio in adults without diabetes
Wang, S., Lin, X., Zhu, C., Dong, Y., Guo, Y., Xie, Z., He, X., Ju, W., & Chen, M. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1287916 · Cited by 23 · see citing works
Elevated GGT to HDL ratio as a marker for the risk of NAFLD and liver fibrosis
Xuan, Y., He, F., Liu, Q. F., Dai, D., Wu, D., Shi, Y., & Yao, Q. Z. (2025) · Scientific Reports · doi:10.1038/s41598-024-84649-w · Cited by 25 · see citing works
ZSP1601, a novel pan-phosphodiesterase inhibitor for the treatment of NAFLD, A randomized, placebo-controlled phase Ib/IIa trial
Hu, Y., Li, H., Zhang, H., Chen, X., Chen, J., Xu, Z., You, H., Dong, R., Peng, Y., Li, J., et al. (2023) · Nature Communications · doi:10.1038/s41467-023-42162-0 · Cited by 20 · see citing works
Sex and gender differences in metabolic dysfunction-associated liver disease
Penmetsa, R., Kapil, S. R., & VanWagner, L. B. (2025) · Indian Journal of Gastroenterology · doi:10.1007/s12664-025-01833-0 · Cited by 21 · see citing works
Adrenic acid: A promising biomarker and therapeutic target (Review)
Wang, Z., Gao, H., Ma, X., Zhu, D., Zhao, L., & Xiao, W. (2024) · International Journal of Molecular Medicine · doi:10.3892/ijmm.2024.5461 · Cited by 19 · see citing works
“Approximately 30% of the global population is estimated to suffer from NAFLd, and this percentage is increasing (42).”
Projected Global Clinical, Humanistic, and Economic Impact of Metabolic Dysfunction-Associated Steatohepatitis (MASH): The Cost of Inaction Based on Data From Nine Countries
Younossi, Z. M., Paik, J. M., Lazarus, J. V., Burra, P., Eguchi, Y., Tacke, F., Crespo, J., Villela‐Nogueira, C. A., Brennan, P., Al‐Omar, H. A., et al. (2025) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2025.09.002 · Cited by 19 · see citing works
State of CD8+ T cells in progression from nonalcoholic steatohepatitis to hepatocellular carcinoma: From pathogenesis to immunotherapy.
Zhong, X., Lv, M.-L., Ma, M.-Q., Huang, Q., Hu, R., Li, J., Yi, J., Sun, J.-L., & Zhou, X.-Z. (2023) · Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie · doi:10.1016/j.biopha.2023.115131 · Cited by 20 · see citing works
Associations between exposure to ambient particulate matter and advanced liver fibrosis in Chinese MAFLD patients
Xing, Y., Gao, X., Li, Q., Li, X., Wang, Y., Yang, Y., Yang, S., Lau, P. W. C., Zeng, Q., & Wang, H. (2023) · Journal of Hazardous Materials · doi:10.1016/j.jhazmat.2023.132501 · Cited by 17 · see citing works
The socioeconomic and environmental determinants of metabolic dysfunction-associated steatotic liver disease: understanding inequalities in prevalence and outcomes
Lorek, D., Łupina, K., Bisaga, W., Malicki, D., Stępień, W., Kumor, L., & Janczura, J. (2025) · Korean Journal of Family Medicine · doi:10.4082/kjfm.25.0027 · Cited by 17 · see citing works
“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.”
Influential
Preclinical evidence construction for epigallocatechin-3-gallate against non-alcoholic fatty liver disease: a meta-analysis and machine learning study
Zhang, Y., Li, J., Wang, Z., Chen, J., Zhao, M., Guo, C. X., Wang, T., Li, R., Zhang, H., Ma, X., et al. (2025) · Phytomedicine · doi:10.1016/j.phymed.2025.156651 · Cited by 16 · see citing works
Thyroid function, adipokines and mitokines in metabolic dysfunction‐associated steatohepatitis: A multi‐centre biopsy‐based observational study
Kouvari, M., Valenzuela‐Vallejo, L., Axarloglou, E., Verrastro, O., Papatheodoridis, G., Mingrone, G., George, J., & Mantzoros, C. S. (2024) · Liver International · doi:10.1111/liv.15847 · Cited by 16 · see citing works
Lipoprotein Combine Index as a Better Marker for NAFLD Identification Than Traditional Lipid Parameters
Qiu, J., Huang, X., Kuang, M., Yang, R., Li, J., Sheng, G., & Zou, Y. (2024) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s462181 · Cited by 16 · see citing works
“3,4 Currently, there are no clinically approved medications specifically for treating NAFLD; However, compelling evidence suggests that changes in diet and lifestyle can effectively prevent NAFLD.”
Background
Hepatocellular Interactions of Potential Nutraceuticals in the Management of Inflammatory NAFLD
Ezhilarasan, D., & Kulanthaivel, L. (2024) · Cell Biochemistry and Function · doi:10.1002/cbf.4112 · Cited by 17 · see citing works
“The global prevalence of NAFLD was estimated to be 24% in 2018 [9] and current estimates indicate that it has risen to 29% [10].”
Two-Year Mediterranean Diet Intervention Improves Hepatic Health in MASLD Patients
Monserrat-Mesquida, M., Bouzas, C., García, S., Mateos, D., Casares, M., Ugarriza, L., Gómez, C., Sureda, A., & Tur, J. A. (2025) · Foods · doi:10.3390/foods14101736 · Cited by 16 · see citing works
“MASLD is a major cause of chronic liver disease (CLD), impacting approximately 30% of the global adult population, with its prevalence continuing to increase [2].”
Insights into the Activities and Usefulness of Deoxynojirimycin and Morus alba: A Comprehensive Review
Tricase, A. F., Cavalluzzi, M. M., Catalano, A. A., Bellis, M. D., Palma, A. D., Basile, G., Sinicropi, M. S., & Lentini, G. (2025) · Molecules · doi:10.3390/molecules30153213 · Cited by 15 · see citing works
“Non-alcoholic fatty liver disease is one of the most common liver diseases affecting about 25% of the population worldwide [151,152].”
Sex Differences in MASLD After Age 50: Presentation, Diagnosis, and Clinical Implications
Milani, I., Parrotta, M. E., Colangeli, L., Chinucci, M., Palleschi, S., Rossi, B., Sbraccia, P., Mantovani, A., Leonetti, F., Guglielmi, V., et al. (2025) · Biomedicines · doi:10.3390/biomedicines13092292 · Cited by 15 · see citing works
“Men consistently exhibit a higher prevalence of MASLD [20–22] across all age groups, whereas in women, the risk increases with age [23], reaching or surpassing that of men after menopause [19,22,24–26].”
Meeting at the Crossroad between Obesity and Hepatic Carcinogenesis: Unique Pathophysiological Pathways Raise Expectations for Innovative Therapeutic Approaches
Arvanitakis, K., Papadakos, S. P., Lekakis, V., Koufakis, T., Lempesis, I. G., Papantoniou, E., Kalopitas, G., GEORGAKOPOULOU, V. E., Stergiou, I. Ε., Theocharis, S. E., et al. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms241914704 · Cited by 15 · see citing works
“The incidence rate has tripled between 2000 and 2015, with higher rates in men and those who are overweight/obese, emphasizing the need for public health interventions targeting at-risk populations as the prevalence of MAFLD continues to rise [10].”
Background
Metabolic Dysfunction-Associated Steatotic Liver Disease: The Associations between Inflammatory Markers, TLR4, and Cytokines IL-17A/F, and Their Connections to the Degree of Steatosis and the Risk of Fibrosis
Coste, S. C., Orasan, O. H., Cozma, A., Negrean, V., Sitar-Tăut, A., Filip, G. A., Hangan, A. C., Lucaciu, R. L., Iancu, M., & Procopciuc, L. M. (2024) · Biomedicines · doi:10.3390/biomedicines12092144 · Cited by 15 · see citing works
Sex Differences in Adverse Liver and Nonliver Outcomes in Steatotic Liver Disease
Yan, T., Zhang, X., Wong, T., Cheung, R. C., & Nguyen, M. H. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.48946 · Cited by 15 · see citing works
Chinese herbal formula in the treatment of metabolic dysfunction-associated steatotic liver disease: current evidence and practice
Tao, S.-H., Lei, Y., Tan, Y., Yang, Y.-B., & Xie, W. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1476419 · Cited by 16 · see citing works
Ideal dietary fiber model: Personalized gut microbiota modulation based on structure-function relationships
Wang, C., Qin, S., Shi, J., Zhu, J., Ju, X., Wang, W., & Yang, L. (2025) · Carbohydrate Polymers · doi:10.1016/j.carbpol.2025.124097 · Cited by 14 · see citing works
Targeting Metabolism: Innovative Therapies for MASLD Unveiled
Wang, W., Gao, X., Niu, W., Yin, J., & He, K. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26094077 · Cited by 14 · see citing works
Functional foods and dietary matrices for metabolic improvement: an integrative review of mechanisms, evidence, and future directions
Rahimah, S., Tallei, T. E., Savitri, M., Yamada, C., Kim, H. J., Choi, M., Park, M. N., Ophinni, Y., & Kim, B. (2026) · Journal of Functional Foods · doi:10.1016/j.jff.2026.107240 · Cited by 14 · see citing works
Hepatic transcriptome signatures in mice and humans with nonalcoholic fatty liver disease
Ding, Y., Dai, X., Bao, M., Xing, Y., Liu, J., Zhao, S., Liu, E., Yuan, Z., & Bai, L. (2023) · Animal Models and Experimental Medicine · doi:10.1002/ame2.12338 · Cited by 12 · see citing works
Gender perspective on the association between liver enzyme markers and non-alcoholic fatty liver disease: insights from the general population
Qiu, J., Kuang, M., He, S., Yu, C., Wang, C., Huang, X., Sheng, G., & Zou, Y. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1302322 · Cited by 13 · see citing works
Normal weight and central obesity as predictors of increased all-cause mortality in metabolic dysfunction associated steatotic liver disease
Chen, J., Zhou, H., & Liu, K. (2023) · Journal of Hepatology · doi:10.1016/j.jhep.2023.11.024 · Cited by 13 · see citing works
The association of exposure to polychlorinated biphenyls with lipid profile and liver enzymes in umbilical cord blood samples
Hjazi, A. M., Hsu, C., Al-Attar, W. M., Almajidi, Y. Q., Hussien, B. M., Alzahrani, A. A., Kareem, A. K., Alazbjee, A. A. A., & Meng, X. (2024) · Chemosphere · doi:10.1016/j.chemosphere.2023.141096 · Cited by 13 · see citing works
The newly proposed plasma-glycosylated hemoglobin A1c/High-Density lipoprotein cholesterol ratio serves as a simple and practical indicator for screening metabolic associated fatty liver disease: an observational study based on a physical examination population
He, S., Lu, S., Yu, C., Kuang, M., Qiu, J., Sheng, G., & Zou, Y. (2024) · BMC Gastroenterology · doi:10.1186/s12876-024-03362-0 · Cited by 13 · see citing works
“According to the latest epidemiological data, the global prevalence of MAFLD is estimated to be around 30% [6], and it appears to be on the rise.”
Background
Lactucin ameliorates FFA-induced steatosis in HepG2 cells by modulating mitochondrial homeostasis through the SIRT1/PGC-1α signaling axis
Lei, Y., Ma, X., Liu, T., Wang, M., Kang, J., Yang, J. Q., & Mi, N. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e39890 · Cited by 13 · see citing works
Semaglutide on liver fibrosis and heart outcomes in patients at high risk of liver fibrosis: a prespecified analysis of the SELECT randomized trial
Meyhöfer, S. M., Cariou, B., Cercato, C., Colhoun, H. M., Deanfield, J. E., Long, M. T., Jeppesen, O. K., Lincoff, A. M., Lingvay, I., Plutzky, J., et al. (2026) · Nature Medicine · doi:10.1038/s41591-026-04281-1 · Cited by 12 · see citing works
“The global prevalence of MASLD is estimated to be ~30% and has risen in parallel with the global surge in obesity, making it an increasingly recognized health concern 4,5 .”
Farnesoid X receptor is an important target for the treatment of disorders of bile acid and fatty acid metabolism in mice with nonalcoholic fatty liver disease combined with cholestasis
Liu, X., Wang, J., Li, M., Qiu, J., Li, X., Qi, L., Liu, J., Liu, P., Xie, G., & Wang, X. (2023) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.16279 · Cited by 12 · see citing works
High Plant Protein Diet Ameliorated Hepatic Lipid Accumulation Through the Modulation of Gut Microbiota
Zhu, S., Zhao, Y., Liu, L., Xu, Y., Zhu, J., Li, W., Liu, Y., & Xia, M. (2023) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.202300515 · Cited by 12 · see citing works
Exposure to per- and polyfluoroalkyl substances, neonicotinoid insecticides, benzotriazoles and benzothiazoles: Associations with human non-alcoholic fatty liver disease
Qin, R., Zhang, B., Zhu, H., Chen, Y., Song, S., & Zhang, B. (2024) · Environmental Chemistry and Ecotoxicology · doi:10.1016/j.enceco.2024.07.005 · Cited by 12 · see citing works
Assessment of the diagnostic efficacy of five non-invasive tests for MASLD: external validation utilizing data from two cohorts
Zou, H., Wen, P., & Sun, X. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1571487 · Cited by 12 · see citing works
The effects of time-restricted eating for patients with nonalcoholic fatty liver disease: a systematic review
Lin, X., Wang, S., & Huang, J. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1307736 · Cited by 12 · see citing works
The impacts of Ramadan fasting for patients with non-alcoholic fatty liver disease (NAFLD): a systematic review
Lin, X., Wu, G., & Huang, J. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1315408 · Cited by 11 · see citing works
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“MASLD affects approximately 30% of the global population, with its prevalence steadily increasing [42], which has a broader impact than ALD.”
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“NAFLD incidence is continuously increasing, and epidemiological evidence has indicated the contributing roles of excess carbohydrate consumption in metabolic diseases including type 2 diabetes (T2DM) and NAFLD via increasing lipogenesis (Le et al. 2023).”

The Worldwide Burden of NAFLD: A Systematic Review and Meta-Analysis of Prevalence and IncidencePreprint
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Estimating global prevalence, incidence, and outcomes of non-alcoholic fatty liver disease from 2000 to 2021: systematic review and meta-analysis
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Global Prevalence, Incidence and Outcome of Non-Obese or Lean NAFLD: A Meta-Analysis of 134 Studies and 11,947,163 PersonsPreprint
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Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019: a systematic review and meta-analysis
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Authors: Le, M. H., Le, D. M., Baez, T. C., Wu, Y., Ito, T., Lee, E. Y., Lee, K., Stave, C. D., Henry, L., Barnett, S. D., Cheung, R., & Nguyen, M. H.
Affiliations: University of Vermont (US)
Burrell College of Osteopathic Medicine (US)
Third Affiliated Hospital of Sun Yat-sen University (CN)
Nagoya University (JP)
Stanford Medicine (US)
Stanford University (US)
VA Palo Alto Health Care System (US)
Corresponding author: Nguyen, Mindie H.
ORCID: Le, Michael H.
Wu, Yuankai
Ito, Takanori
Lee, KeeSeok
Stave, Christopher D.
Henry, Linda
Barnett, Scott D.
Cheung, Ramsey
Nguyen, Mindie H.
Venue: Journal of Hepatology
Publisher: Elsevier BV
Published: 2023-08
Volume: 79
Issue: 2
Pages: 287-295
ISSN: 0168-8278 (ISSN-L)
DOI: 10.1016/j.jhep.2023.03.040
OpenAlex: W4362719751
Cited by: 303
References: 51
Citations by year: 2026: 71 · 2025: 98 · 2024: 98 · 2023: 35 · 2012: 1
FWCI: 11.80
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of Hepatology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
Keywords: NAFLD incidence, global prevalence, ultrasonography, obesity, overweight, smoking, sex differences, China, South Korea, Japan, cohort studies, risk factors, study quality bias, study design bias, publication bias
MeSH terms: Adult, Female, Humans, Male, Obesity, Cohort Studies, Incidence, Overweight, Non-alcoholic Fatty Liver Disease

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Global incidence of non-alcoholic fatty liver disease: a systematic review and meta-analysis of 63 studies and 1,201,807 persons

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