Burden and Health System Challenges in MASLD Across East and Southeast Asia: A Narrative Review

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an escalating public health concern in East and Southeast Asia, driven by rapid urbanization, dietary transitions, and rising rates of obesity, diabetes, and hypertension. Unique metabolic and phenotypic characteristics among Asian populations, coupled with resource constraints, contribute to underdiagnosis and delayed management. This narrative review aims to examine the burden, risk factors, population-specific challenges, and public health gaps related to MASLD across East and Southeast Asian countries.

A comprehensive literature search was conducted using PubMed, ScienceDirect, and Google Scholar for studies published from 2010 to 2024. Search terms included "MASLD," "MAFLD," "NAFLD," "fatty liver disease," "East Asia," "Southeast Asia," "risk factors," and "public health." Eligible studies included original research, cohort studies, reviews, and meta-analyses focused on MASLD or NAFLD in the specified regions. Data were synthesized thematically, emphasizing prevalence patterns, lifestyle determinants, vulnerable populations, and health-system challenges.

MASLD prevalence varies widely across East and Southeast Asia, with higher rates observed in urban and high-income settings. Beyond metabolic drivers, environmental factors, dietary shifts, and socioeconomic disparities strongly influence disease patterns. Distinct subpopulations-including children, older adults, individuals with lean MASLD, and those with chronic comorbidities-experience unique vulnerabilities, often compounded by limited region-specific data. Major health-system gaps include inadequate integration of MASLD into primary care, variability in diagnostic access, insufficient public health surveillance, and low provider awareness.

MASLD represents a growing yet underrecognized public health issue in East and Southeast Asia. Addressing diagnostic gaps, enhancing primary care capacity, and integrating MASLD within existing metabolic disease programs are essential for improving early detection and long-term outcomes. Region-specific strategies and strengthened health systems are critical to mitigating the future burden of MASLD across diverse Asian populations.