Two-Decade Trends in MASLD and Its Complications in the Middle East and North Africa (2010-2021)

The Middle East and North Africa (MENA) region is undergoing demographic shifts potentially increasing metabolic dysfunction-associated steatotic liver disease (MASLD) and its complications. We assessed MASLD prevalence and liver disease burden from 2010 to 2021.

Data from Global Burden of Disease (GBD), United Nations Population Division and NCD Risk Factor Collaboration covering 21 MENA countries were used for annual percent change (APC) trends per Joinpoint regression. Regression modelling determined MASLD cirrhosis prevalence (compensated [CC]/decompensated cirrhosis [DCC]). Prevalence and mortality estimates were age-standardised (children and adults).

MENA region's population: progressively aged, increased (518-623 million), and experienced prevalence increases in adult diabetes (7.4%-12.1%), obesity (25.4%-31.3%) and MASLD (26.3% [117.97 million] to 27.7% [164.31 million]; APC = 0.47%; 95% CI, 0.35-0.59); steeper increase in adults ≥ 20 years (37.1%-41.0%; APC = 0.90%; 0.79-1.01). MASLD cirrhosis (0.22% [1.13 million] to 0.28% [1.73 million]; APC = 2.18%; 2.05-2.31), CC (0.20%-0.25%; APC = 2.24%) and DCC (0.020%-0.025%; APC = 2.23%) increased. Algeria, Iraq, Morocco and Turkey had the highest increases (APCs > 2.8% for both CC and DCC). MASH cirrhosis mortality (APC = 0.60%), and DALYs (APC = 0.47%) increased. MASH liver cancer prevalence (APC = 2.90%), incidence (APC = 2.90%), mortality (0.50-0.69 per 100 000; APC = 2.87%) and DALYs (APC = 2.51%) increased. Iran had the most rapid increases (APC > 6%) for all liver cancer outcomes; Egypt accounted for ≥ 50% liver cancer DALYs in 2021. Kuwait, West-Bank/Gaza and United Arab Emirates showed stable/declining trends.

The prevalence of MASLD and associated complications (cirrhosis and liver cancer) increased substantially across the MENA region from 2010 to 2021, with variation across countries.