ILIVER · Nov 2026
Burden of metabolic dysfunction-associated fatty liver disease in people ≥70 years of age in Chinese Mainland, USA, and European Union during 2012–2023
By Yang H, Fu Y, Zhang B et al.
Background and Aims Nonalcoholic fatty liver disease (NAFLD), also termed metabolic dysfunction–associated steatotic liver disease (MASLD), is a leading cause of chronic liver disease worldwide. Evidence regarding MASLD burden in older adults remains limited. We aimed to estimate MASLD-attributable prevalence, mortality, and disability-adjusted life-years (DALYs) among adults aged ≥70 years in Chinese Mainland, the USA, and the European Union (EU), and to characterise temporal trends between 2012 and 2023. Methods We used data from the Global Burden of Disease (GBD) 2023. Age-standardized rates, estimated annual percentage change (EAPC), joinpoint regression, and decomposition analysis were deployed to assess secular trends and contributing drivers. Results In Chinese Mainland, significant increases in MASLD-related mortality and DALYs were confined to the ≥95-year age group, whereas age-standardized mortality fluctuated during the study period. The EU had declining mortality and DALYs despite rising prevalence in all older age groups. By contrast, mortality and DALYs increased across all adults aged ≥70 years in the USA, accompanied by a marked rise in age-standardized mortality. Female mortality was higher among Chinese adults aged ≥75 years, all older US subgroups, and EU residents aged ≥80 years. Population growth was the dominant driver of mortality increments in Chinese Mainland and the EU, and MASLD burden varied substantially across EU member states. Conclusion MASLD burden in older adults is highly heterogeneous across regions, age strata, and sexes. These findings support region-tailored, age- and sex-sensitive public health strategies, including strengthened surveillance, early detection, and integrated management for ageing populations. Real-world cohort studies are needed to validate GBD trends and identify individual-level risk factors for targeted prevention and clinical care.