This Metabolic Disease Has Increased 143% Since 1990 & It's Not Diabetes

When we talk about metabolic health, most of the focus lands on blood sugar or heart disease. But there's another condition quietly affecting more than 1 in 6 people worldwide: metabolic dysfunction–associated steatotic liver disease (MASLD).

A new global analysis published in The Lancet Gastroenterology & Hepatology finds that cases of MASLD have surged by 143% since 1990, reaching an estimated 1.3 billion people in 2023. These numbers are expected to increase even more by 2050. Here's what you need to know about MASLD, the key findings of this new report, and ways to improve your liver and metabolic health.

What is MASLD

MASLD is the updated term for what was previously called nonalcoholic fatty liver disease (NAFLD). The name change, adopted in 2023, reflects a shift toward defining the condition by what it is (a metabolic disorder).

The condition occurs when excess fat accumulates in the liver, typically driven by metabolic factors like insulin resistance, elevated blood sugar, and obesity. Alcohol-associated liver disease refers to the buildup of fat in the liver driven by excess alcohol consumption.

Why are cases rising so quickly

The review points to three metabolic risk factors driving the surge in new diagnoses: high fasting plasma glucose, high body mass index, and smoking.

According to the study, high fasting plasma glucose accounted for the largest share of MASLD-related deaths and disability globally. High BMI followed closely behind (a metric that is commonly used, although imperfect, to estimate excess weight). These risk factors have become increasingly prevalent over the past three decades as rates of obesity, type 2 diabetes, and metabolic syndrome have climbed worldwide.

The researchers note that dietary shifts, sedentary lifestyles, and the global rise in metabolic conditions have created what they call a "perfect storm" for liver disease.

A hidden, slow-building risk

One of the most concerning aspects of MASLD is that there aren't any clearcut signs. Most people with the condition experience no symptoms in the early stages, which means it often goes undetected until significant damage has occurred.

Left unchecked, MASLD can progress to more serious conditions like steatohepatitis (inflammation of the liver), fibrosis (scarring), cirrhosis, and even liver cancer. The study found that MASLD-related deaths increased by 83% between 1990 and 2021, with liver cancer and cirrhosis accounting for the majority of fatalities. In these more severe cases, a liver transplant may be warranted.

The global picture

This isn't just a condition affecting older adults. The study found that MASLD prevalence peaks between ages 55 and 59 for women and 50 and 54 for men, but cases are rising across all age groups, including younger populations.

By 2050, researchers project that 1.8 billion people will be living with MASLD, a 42% increase from current levels. The largest growth is expected in regions already grappling with rising rates of obesity and diabetes.

Why screening matters

Because MASLD rarely causes symptoms until it's advanced, screening becomes critical, especially for people with known metabolic risk factors.

Current screening options include blood tests that measure liver enzymes (like ALT and AST) and imaging techniques such as ultrasound or FibroScan, which can detect fat accumulation. If you have type 2 diabetes, obesity, or metabolic syndrome, talking to your doctor about liver health screening is worth considering.

Improving metabolic health

The same lifestyle factors that drive MASLD are also the levers for managing it. Prioritizing blood sugar balance through diet and movement, maintaining a healthy weight, and avoiding smoking can all help reduce liver fat and slow disease progression.

There's no specific medication approved for MASLD, which makes lifestyle interventions the primary line of defense. Regular physical activity, a diet rich in whole foods and low in ultra-processed options, and limiting alcohol (even though MASLD isn't caused by alcohol, drinking can still worsen liver health) are the foundational strategies.

The takeaway

MASLD has quietly become one of the most common chronic conditions worldwide, and it's projected to keep growing. Because it develops silently, awareness and proactive screening are key, especially for anyone with metabolic risk factors.

And implementing daily and weekly habits that support metabolic health (like eating a high-protein and high-fiber diet, lifting weights, doing cardio, and prioritizing sleep) can help lower your risk for this condition (and even reverse early stages of the disease).