Author information

¹The Global NASH Council, Washington DC, USA; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA. Electronic address: zobair.younossi@inova.org.

²The Global NASH Council, Washington DC, USA; School of Public Health, University of Haifa, Haifa, Israel.

³The Global NASH Council, Washington DC, USA; Denver Health Medical Center, Denver, CO, USA.

⁴The Global NASH Council, Washington DC, USA; Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA.

⁵The Global NASH Council, Washington DC, USA; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA.

⁶The Global NASH Council, Washington DC, USA; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA; Center for Outcomes Research in Liver Diseases, Washington DC, USA.

Abstract

Background: The burden of MASLD is growing across the globe. This study explores association of food insecurity with MASLD prevalence and liver-related mortality (LRM) across the globe.

Methods: The study combines United Nations' country-level food security data with the MASLD data from Global Burden of Disease-2021. Mixed-effects linear regression (MELR) models, accounting for country-level random effects, were used to assess associations of food security indicators with MASLD prevalence and LRM. The analyses were performed according to each country's Socioeconomic Development Index (SDI) status.

Results: In 2021, the median prevalence and LRM of MASLD across 204 countries was 21.77% (14.14%-48.18%) and 2.92 per 100,000 (0.42-10.79) with the highest MASLD prevalence located in North Africa & Middle East (41.70%) and the lowest prevalence in high-income countries (17.31%). After adjustments for age, gender and SDI, higher MASLD prevalence was associated with increasing rates of obesity, type 2 diabetes (T2D) and low physical activity (p<0.001). When analyses were performed based on SDI status, divergent patterns of MASLD prevalence were observed. In high SDI countries (socioeconomically more developed), MASLD prevalence was significantly higher in those in the top tertile of food insecurity as compared to the bottom tertile (mean, 26.73% vs. 18.87%, p=0.0001). In contrast, in low SDI countries (socioeconomically less developed), the opposite was true (19.45% vs. 24.96%, p=0.0008). MASLD-LRM was associated with older age, obesity, and metabolic risks (p<0.001).

Conclusions: And Relevance: MASLD prevalence and LRM exhibit significant geographical variability across the globe which can be influenced by clinic-demographic, and food insecurity. Targeted public health strategies which considers socio-economic realities of each region are essential for mitigating the global burden of MASLD.