Epidemiological Trajectories and Quality of Care Disparities of MASLD in Asia, 1990-2023

To characterize temporal and geographic patterns of metabolic dysfunction-associated steatotic liver disease (MASLD) across Asia from 1990 to 2023, assess disparities in disease burden and care quality, and identify key demographic and metabolic determinants shaping its trajectory.

We analyzed Global Burden of Disease (GBD) 2023 data for 47 Asian countries (1990-2023). Age-standardized incidence (ASIR), mortality (ASMR), and disability-adjusted life-years (ASDR) were examined using Joinpoint regression. A Quality-of-Care Index (QCI) was derived through principal component analysis. Explainable machine learning (SHAP models) evaluated demographic and metabolic determinants and projected future trends to 2050.

MASLD burden rose substantially across Asia. East Asia exhibited the fastest incidence growth (AAPC 0.61%), whereas Central Asia experienced the sharpest increases in ASMR (1.04%) and ASDR (1.09%). In 2023, ASIR peaked in Malaysia (763.5 per 100,000), ASMR in Mongolia (7.08), and ASDR in Turkmenistan (184.9). A shift toward metabolic risk dominance was evident, with hyperglycemia and obesity surpassing smoking as primary contributors to mortality and disability burden. QCI was highest in East and Western Asia and lowest in South and Central Asia. SHAP analysis identified aging and hyperglycemia as dominant predictors of future burden.

MASLD is accelerating across Asia, driven by metabolic risk accumulation, demographic aging, and unequal care capacity. Strengthening weight and glycemic control, expanding metabolic liver disease surveillance, and improving equitable hepatometabolic care are urgent priorities to curb future disease burden.