Prevalence and associated factors of metabolic dysfunction-associated steatotic liver disease in Taiwan, 2001-2021

Metabolic dysfunction-associated steatotic liver disease (MASLD) was the most rapidly growing liver disease worldwide. We aimed to investigate the temporal trends in prevalence and risks of MASLD in Taiwan, 2001-2021.

We enrolled participants from two large cohorts. Steatotic liver disease (SLD) was defined by either abdominal ultrasound, or serum panels. MASLD was defined as SLD with at least one cardiometabolic risk factor (CMRF). The endpoints were the changes in prevalence and risks of SLD, MASLD and CMRF.

A total of 426,478 participants (mean age, 42.0 ± 13.3 years; 57.2% females) were enrolled. The overall prevalence of SLD, MASLD and having one CMRF was 36.3%, 35.1% and 72.4%, respectively, with increased prevalence from 32.4%, 31.1% and 66.7% in 2001-2005, to 38.3%, 37.9% and 81.1% in 2016-2021, by 18.2%, 21.9%, and 21.6% increase, respectively. Overweight was the most prevalent and growing CMRF, especially in younger population. pre-DM/DM was the second prevalent CMRF with a greater increase mainly in older populations. Notably, MASLD prevalence rose in individuals under 50 years but declined in older groups after 2010. Gender analysis showed males had consistently higher MASLD rates, while females experienced greater increases in pre-DM/DM.

The prevalence of MASLD and CMRFs in Taiwan had increased markedly among younger populations in past two decades. Overweight and pre-DM/DM were two major CMRFs contributed to the increased prevalence of MASLD. These findings highlight the urgent need for targeted public health strategies to address the growing burden of MASLD and associated CMRFs.