Prevalence of MASLD, Met-ALD, and ALD and Associated Fibrosis Among US Adults

Background and Aim: Steatotic liver diseases (SLD) encompasses metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD). Our aim was to determine the age-standardized prevalence of fibrosis stages and cirrhosis in US adults with different subtypes of SLD. Methods: We utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 2017 to 2023. SLD was defined by a controlled attenuation parameter (CAP) ≥280 dB/m. MASLD, MetALD, and ALD were defined according to the new nomenclature. Fibrosis and cirrhosis were estimated by liver stiffness measurements. Results: The age-standardized prevalence of SLD was 37.08% (MASLD: 32.42%, MetALD: 2.20%, and ALD: 1.29%) with males having higher prevalence rates versus females [SLD (42.40% vs. 31.59%), MASLD (35.84% vs. 28.88%), MetALD (2.82% vs. 1.56%), and ALD (2.17% vs. 0.38%) (all P < 0.03)]. For MASLD, the highest burden was observed in Mexicans (43.96%), followed by Whites (31.75%), Hispanics (32.69%), Asians (32.41%), and Blacks (27.39%). MetALD was most prevalent among Whites (2.56%) and least prevalent among Asians (0.25%). Between 2017 and 2020 and 2021 and 2023, the prevalence of SLD and its subtypes with fibrosis and cirrhosis increased, coinciding with rising alcohol consumption. Among individuals with MASLD, component of metabolic syndrome (type 2 diabetes and Obesity, especially severe obesity with BMI ≥40 kg/m²) were associated with increased risk of fibrosis and cirrhosis. Conclusion: The burden of SLD, its subtypes, and associated fibrosis in the US is substantial. This highlights an urgent need for targeted public health strategies to manage the rising burden of this important liver disease in the US population.