Global burden of MASLD-IBD comorbidity from 1990 to 2021 and trend prediction to 2050

Metabolic dysfunction-associated steatotic liver disease (MASLD), a prevalent chronic liver disorder, imposes a substantial global clinical and economic burden. Emerging evidence underscores inflammatory bowel disease (IBD) as a significant independent risk factor for MASLD. However, the global burden and trends of MASLD-IBD comorbidity remain largely obscured. This study aims to evaluate the global burden of MASLD-IBD from 1990 to 2021 and to project its trajectory to 2050. The findings will inform the development of proactive public health strategies.

Leveraging the Global Burden of Disease (GBD) 2021 database, we quantified IBD's contribution to MASLD via population-attributable fractions. We analyzed the global prevalence, mortality, and disability-adjusted life years (DALYs), stratifying by socio-demographic index (SDI), sex, and age. Estimated annual percentage change (EAPC) assessed 1990-2021 trends; Bayesian age-period-cohort modeling projected 2050 trajectories.

In 2021, the global age-standardized prevalence of MASLD-IBD comorbidity reached 171.7 cases (95% uncertainty interval [UI], 157.3-187.1), with a corresponding DALY rate of 0.5 cases (95% UI, 0.4-0.6) per 10 million population. High-income regions, including North America, Australia, and Western Europe, bore the highest burden. From 1990 to 2021, 20 out of 21 GBD regions exhibited escalating age-standardized prevalence and DALY rates, most markedly in East Asia (prevalence EAPC = 3.18; 95% confidence interval [CI], 2.59-3.77) and East Europe (DALY EAPC = 4.05; 95% CI, 3.32-4.79). Middle SDI regions saw the largest absolute increases, with mortality mirroring DALY trends. Adults ≥ 60 years bore disproportionately higher burdens. By 2050, projections suggest divergent gender trends of rising female burden versus declining male rates.

MASLD-IBD comorbidity burdens have risen globally over three decades, necessitating targeted interventions, particularly for ageing populations and high-risk regions. Gender-specific strategies will be critical for mitigating future impacts.