Epidemiology of metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis and associated cardiometabolic factors in adults in China (2013-2023): A systematic review and meta-analysis

BACKGROUND Although epidemiological data on non-alcoholic fatty liver disease in China are available, data on cardiometabolic risk factors have not been addressed under the metabolic dysfunction-associated steatotic liver disease (MASLD) consensus. AIM To synthesize the epidemiological characteristics of MASLD/metabolic dysfunction-associated steatohepatitis (MASH), especially their associated cardiometabolic risk factors in China. METHODS We searched EMBASE, MEDLINE, Central Cochrane, CNKI, and Wangfan for studies from January 1, 2013 to December 31, 2023. Studies involving individuals with MASLD/MASH in China that reported epidemiological outcomes were included. Meta-analysis was performed to assess the prevalence of MASLD/MASH. Exploratory outcomes included extrahepatic comorbidities and genetic variants related to MASLD. RESULTS In total, 561 studies involving 6632718 participants were included in this analysis. The prevalence of MASLD and MASH and the annual incidence of MASLD were 30.4% [95% confidence interval (CI): 29.4-31.3], 6.7% (95%CI: 2.2-13.4), and 37 cases per 1000 person-years (95%CI: 28-47), respectively. In addition, the prevalence rates of MASLD in individuals with dyslipidemia, obesity, and hypertension were 59.9% (95%CI: 52.6-67.0), 53.9% (95%CI: 47.9-59.9), and 44.3% (95%CI: 41.1-47.6), respectively. The prevalence of lean MASLD (body mass index < 24 kg/m2) was 12.0% (95%CI: 10.0-14.0), and 21.7% of the total MASLD population in China had lean MASLD. CONCLUSION This study provides a comprehensive overview of the epidemiology and disease burden of MASLD/MASH in China, providing additional evidence for optimizing MASLD/MASH management in China and a reference for the global understanding of MASLD/MASH epidemiology.