Prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease: Mapping Across Different Indian Populations...

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern. MASLD is strongly linked to obesity, sedentary lifestyles, and metabolic syndrome. In India, the prevalence of MASLD exhibits regional variations because of genetic, dietary, and socioeconomic factors. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) are standardized non-invasive tools for assessing fibrosis and steatosis in MASLD. This study aimed to determine the prevalence and severity of MASLD across different Indian regions and examine regional disparities in MASLD burden.

This retrospective, multicenter, cross-sectional study analyzed the data of 13,750 adults from 105 diabetes and endocrine clinics across six geographic zones in India between May 2023 and February 2024. Participants underwent LSM and CAP assessment using FibroScan™. Based on LSM, liver fibrosis was categorized as F0-F1 (2-7 kPa), F2 (7-10 kPa), F3 (10-14 kPa), and F4 (≥ 14 kPa). Based on CAP, MASLD was classified as mild (238-260 dB/m), moderate (261-292 dB/m), and severe (≥ 293 dB/m).

The prevalence of MASLD was 68.2% (CAP ≥ 238 dB/m), and the prevalence of fibrosis was 33.7% (LSM ≥ 7 kPa). The highest MASLD burden was observed in North India (73.3%), particularly in Uttarakhand (80.0%). Severe fibrosis (F4) was highly prevalent in Kerala (20.0%), whereas severe steatosis (S3) was highly prevalent in Jammu and Kashmir (50.3%). The prevalence of MASLD was significantly associated with regional variations (P < 0.001) but not with age.

This study highlights significant regional disparities in MASLD burden. The high burden in North India calls for region-specific public health interventions, standardized screening, and preventive strategies.