HOUSTON — As a liver cancer risk factor, metabolic dysfunction-associated steatotic liver disease (MASLD) has become a critical public health issue. A new study suggested that measuring the burden of cirrhosis and its complications in people with MASLD patients is important information to improve healthcare delivery.
Researchers from the Baylor College of Medicine, the Michael E. DeBakey VAMC and The University of Texas MD Anderson Cancer Center, all in Houston, sought to quantify the changes in the burden of MASLD-related cirrhosis and hepatocellular carcinoma (HCC) in a nationwide U.S. healthcare system. To do that, they used data from the VHA to examine temporal trends between 2010 and 2021 in the annual incidence and prevalence of cirrhosis and HCC in a large cohort of patients with MASLD and to compare them to patients with hepatitis C virus infection (HCV) and alcohol-associated liver disease (ALD).
Results published in Hepatology Communications indicated that the MASLD cohort grew from 78,082 in 2010 to 621,400 patients in 2021. At the same time, the annual age-standardized incidence rates of MASLD-related cirrhosis rose from 1.39 (95% CI, 1.13, 1.65) to 1.91 (95% CI, 1.80, 2.02) per 1000 patients (37.4% increase).1
“HCC incidence increased from 0.08 (95% CI, 0.02, 0.14) to 0.22 (0.18, 0.26) per 1,000 patients (175% increase),” the researchers advised. “Cirrhosis and HCC prevalence also increased, particularly among adults older than age 65, whites, Hispanics, and individuals with diabetes. Temporal trends in the incidence and prevalence of cirrhosis and HCC among patients with ALD were similar to those in MASLD. In contrast, patients with HCV experienced a sharp decline in the incidence of cirrhosis and HCC in this time frame.”
The authors concluded that the burden of MASLD-related cirrhosis and HCC is growing, explaining, “While the burden of liver complications is similar between MASLD and ALD, the substantially larger size of the MASLD population means that the modest increases in incidence of cirrhosis and HCC could translate into a large absolute burden.”
“Metabolic dysfunction–associated steatotic liver disease (MASLD) is a common and growing problem,” the authors wrote. “With the rise in obesity, Type 2 diabetes mellitus (T2DM), and metabolic syndrome, the prevalence of MASLD will continue to increase. MASLD encompasses a spectrum of liver conditions, starting from hepatic steatosis to more severe forms such as metabolic dysfunction–associated steatohepatitis (MASH), which can further progress to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). MASLD is a chronic condition characterized by prolonged lipotoxicity, hepatocellular injury, and fibrosis. As a result, especially within an aging population, an increase in MASLD-related cirrhosis and HCC is expected. Indeed, MASLD is currently the fastest-growing indication for liver transplantation in the U.S. In addition, mathematical modeling studies forecast that MASLD-related HCC would overtake HCC from other etiological risk factors by 2030.
They added, however, that strategies now exist to mitigate the impact of MASLD. Those include limiting the risk factors, increasing access to anti-obesity and liver directed treatments and enhancing the healthcare-system infrastructure.
“Measuring the burden of cirrhosis and its complications in MASLD is crucial, as these data can provide a critical insight into the magnitude of the problem and inform changes in the pattern of care delivery to patients with MASLD,” the study concluded. “It is also important to identify and characterize the populations at the highest risk—defined by their demographic features and exposure to key risk factors.”
- Ali B, Samuel R, Kramer JR, Li L, Yu X, Cao Y, Desiderio R, Cholankeril G, Asch SM, El-Serag HB, Kanwal F. Evolving burden of metabolic dysfunction-associated steatotic liver disease and its complications in a US nationwide healthcare system. Hepatol Commun. 2026 Jan 5;10(1):e0878. doi: 10.1097/HC9.0000000000000878. PMID: 41493837; PMCID: PMC12772495.