{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T03:38:48Z","timestamp":1793417928812,"version":"4.5.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>With rising obesity and diabetes rates, the incidence of Metabolic dysfunction-associated steatotic liver disease (MASLD) among individuals aged 15\u201349 is increasing, affecting their productivity, health, and quality of life. However, a comprehensive global assessment of MASLD burden and long-term trends in this age group remains lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study analyzed prevalence, incidence, mortality, and disability-adjusted life years (DALYs) for individuals aged 15\u201349 using data from the Global Burden of Disease (GBD) 2021 study. Trends from 1990 to 2021 were assessed using Estimated Annual Percentage Change (EAPC), with data stratified by Socio-Demographic Index (SDI), sex, and age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 1990 and 2021, the number of individuals with MASLD increased from 343 to 666 million, reflecting an average annual growth rate of 0.95%. The number of MASLD-related deaths increased from 7,920 to 15,110, corresponding to an average annual growth rate of 0.8%. Over the same period, DALYs climbed from 399,000 to 751,000, indicating an increase of approximately 0.77%. Low-SDI regions showed the fastest growth in mortality and DALYs, whereas some high-SDI areas, notably high-income Asia Pacific, demonstrated a decline in these measures. Regarding sex-based differences, males exhibited a higher growth rate of MASLD-related deaths and DALYs compared to females, although the increase in prevalence was more pronounced among females. Age-group analysis revealed that the 45\u201349 years group experienced the most significant surge in MASLD burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Over the past three decades, the global burden of MASLD has risen significantly, especially in regions with rapidly increasing obesity rates. Despite progress in some high-income countries, the persistent escalation in low-income regions underscores the urgency for targeted interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1568211","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T01:26:07Z","timestamp":1750814767000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Global, regional and national burden of Metabolic dysfunction-associated steatotic liver disease in adolescents and adults aged 15\u201349 years from 1990 to 2021: results from the 2021 Global Burden of Disease study"],"prefix":"10.3389","volume":"12","author":[{"given":"Biwu","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijie","family":"Pi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaiyuan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1966","DOI":"10.1097\/HEP.0000000000000520","article-title":"A multisociety Delphi consensus statement on new fatty liver disease nomenclature.","volume":"78","author":"Rinella","year":"2023","journal-title":"Hepatology."},{"key":"B2","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1016\/S2468-1253(22)00165-0","article-title":"The prevalence and incidence of NAFLD worldwide: A systematic review and meta-analysis.","volume":"7","author":"Riazi","year":"2022","journal-title":"Lancet Gastroenterol Hepatol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1097\/HEP.0000000000000004","article-title":"The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): A systematic review.","volume":"77","author":"Younossi","year":"2023","journal-title":"Hepatology."},{"key":"B4","doi-asserted-by":"publisher","first-page":"103043","DOI":"10.1016\/j.arcmed.2024.103043","article-title":"Global Prevalence of nonalcoholic fatty liver disease: An updated review meta-analysis comprising a population of 78 million from 38 Countries.","volume":"55","author":"Amini-Salehi","year":"2024","journal-title":"Arch Med Res."},{"key":"B5","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1016\/S2468-1253(24)00193-6","article-title":"Natural history and progression of metabolic dysfunction-associated steatotic liver disease.","volume":"9","author":"Hagstr\u00f6m","year":"2024","journal-title":"Lancet Gastroenterol Hepatol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.1016\/S0140-6736(24)01811-7","article-title":"Steatotic liver disease.","volume":"404","author":"Israelsen","year":"2024","journal-title":"Lancet."},{"key":"B7","doi-asserted-by":"publisher","first-page":"101926","DOI":"10.1016\/j.aohep.2025.101926","article-title":"Non-alcoholic fatty liver disease, in contrast to alcoholic liver disease, is associated with lower socio-economic status: results from a German referral center.","volume":"2025","author":"Bugaichuk","year":"2025","journal-title":"Ann Hepatol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2809","DOI":"10.1016\/j.cgh.2021.12.002","article-title":"2019 Global NAFLD prevalence: A systematic review and meta-analysis.","volume":"20","author":"Le","year":"2022","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1161\/HYPERTENSIONAHA.124.24252","article-title":"Impact of NAFLD and fibrosis on adverse cardiovascular events in patients with hypertension.","volume":"82","author":"Huang","year":"2025","journal-title":"Hypertension."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1016\/j.cgh.2020.06.064","article-title":"Real-world burden of nonalcoholic steatohepatitis.","volume":"19","author":"Geier","year":"2021","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1097\/MCG.0000000000001229","article-title":"Increasing clinical and economic burden of nonalcoholic fatty liver disease among hospitalized adults in the United States.","volume":"53","author":"Hirode","year":"2019","journal-title":"J Clin Gastroenterol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes.","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e010912","DOI":"10.1161\/CIRCOUTCOMES.124.010912","article-title":"Risk of major adverse cardiovascular outcomes in families With MASLD: A population-based multigenerational cohort study.","volume":"17","author":"Ebrahimi","year":"2024","journal-title":"Circ Cardiovasc Qual Outcomes."},{"key":"B14","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1210\/clinem\/dgac567","article-title":"Nonalcoholic fatty liver disease and adverse pregnancy outcomes in women with normal prepregnant weight.","volume":"108","author":"Qian","year":"2023","journal-title":"J Clin Endocrinol Metab."},{"key":"B15","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1016\/j.jhep.2020.03.049","article-title":"Non-alcoholic fatty liver disease in pregnancy is associated with adverse maternal and perinatal outcomes.","volume":"73","author":"Sarkar","year":"2020","journal-title":"J Hepatol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1017\/S0007114522001313","article-title":"A healthy lifestyle during adolescence was inversely associated with fatty liver indices in early adulthood: Findings from the DONALD cohort study.","volume":"129","author":"Schnermann","year":"2023","journal-title":"Br J Nutr."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1822","DOI":"10.1053\/j.gastro.2019.12.053","article-title":"AGA clinical practice update on screening and surveillance for hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: Expert review.","volume":"158","author":"Loomba","year":"2020","journal-title":"Gastroenterology."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1097\/HEP.0000000000000323","article-title":"AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease.","volume":"77","author":"Rinella","year":"2023","journal-title":"Hepatology."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: A systematic analysis for the Global Burden of Disease Study 2021.","volume":"403","author":"Diseases","year":"2024","journal-title":"Lancet."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.1016\/S0140-6736(96)07495-8","article-title":"Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study.","volume":"349","author":"Murray","year":"1997","journal-title":"Lancet."},{"key":"B21","doi-asserted-by":"publisher","first-page":"2100","DOI":"10.1016\/S0140-6736(24)00367-2","article-title":"Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: A systematic analysis for the Global Burden of Disease Study 2021.","volume":"403","year":"2024","journal-title":"Lancet."},{"key":"B22","doi-asserted-by":"publisher","first-page":"112023","DOI":"10.1016\/j.envres.2021.112023","article-title":"Global burden of lung cancer attributable to ambient fine particulate matter pollution in 204 countries and territories, 1990-2019.","volume":"204","author":"Yang","year":"2022","journal-title":"Environ Res."},{"key":"B23","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1097\/HEP.0000000000000329","article-title":"Lean individuals with NAFLD have more severe liver disease and poorer clinical outcomes (NASH-CO Study).","volume":"78","author":"Nabi","year":"2023","journal-title":"Hepatology."},{"key":"B24","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1053\/j.gastro.2022.06.023","article-title":"AGA clinical practice update: Diagnosis and management of nonalcoholic fatty liver disease in lean individuals: Expert review.","volume":"163","author":"Long","year":"2022","journal-title":"Gastroenterology."},{"key":"B25","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1007\/s00018-018-2947-0","article-title":"Molecular pathways of nonalcoholic fatty liver disease development and progression.","volume":"76","author":"Bessone","year":"2019","journal-title":"Cell Mol Life Sci."},{"key":"B26","doi-asserted-by":"publisher","first-page":"197","DOI":"10.7570\/jomes23052","article-title":"Metabolic dysfunction-associated steatotic liver disease (MASLD): A state-of-the-art review.","volume":"32","author":"Chan","year":"2023","journal-title":"J Obes Metab Syndr."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1053\/j.gastro.2021.07.049","article-title":"Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease.","volume":"161","author":"Kanwal","year":"2021","journal-title":"Gastroenterology."},{"key":"B28","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.jhep.2019.08.027","article-title":"A cross-sectional study of the public health response to non-alcoholic fatty liver disease in Europe.","volume":"72","author":"Lazarus","year":"2020","journal-title":"J Hepatol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/S0140-6736(19)32908-3","article-title":"Unacceptable failures: The final report of the Lancet Commission into liver disease in the UK.","volume":"395","author":"Williams","year":"2020","journal-title":"Lancet."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e2230426","DOI":"10.1001\/jamanetworkopen.2022.30426","article-title":"Analysis of a simulation model to estimate long-term outcomes in patients with nonalcoholic fatty liver disease.","volume":"5","author":"Chhatwal","year":"2022","journal-title":"JAMA Netw Open."},{"key":"B31","doi-asserted-by":"publisher","first-page":"4985","DOI":"10.3748\/wjg.v27.i30.4985","article-title":"Malnutrition and liver disease in a developing country.","volume":"27","author":"Siddiqui","year":"2021","journal-title":"World J Gastroenterol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1530025","DOI":"10.3389\/fnut.2025.1530025","article-title":"The relationship between dietary sodium intake and all-cause mortality in patients with non-alcoholic fatty liver disease: A cohort study from NHANES 2003-2018.","volume":"12","author":"Li","year":"2025","journal-title":"Front Nutr."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1016\/S2468-1253(21)00275-2","article-title":"Epidemiology, risk factors, social determinants of health, and current management for non-alcoholic fatty liver disease in sub-Saharan Africa.","volume":"6","author":"Spearman","year":"2021","journal-title":"Lancet Gastroenterol Hepatol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1016\/j.jhep.2023.04.036","article-title":"Changing epidemiology, global trends and implications for outcomes of NAFLD.","volume":"79","author":"Wong","year":"2023","journal-title":"J Hepatol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.cgh.2020.04.067","article-title":"Women have a lower risk of nonalcoholic fatty liver disease but a higher risk of progression vs men: A systematic review and meta-analysis.","volume":"19","author":"Balakrishnan","year":"2021","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.3390\/nu16132063","article-title":"Association between lifestyle modification and all-cause, cardiovascular, and premature mortality in individuals with non-alcoholic fatty liver disease.","volume":"16","author":"Huang","year":"2024","journal-title":"Nutrients."},{"key":"B37","doi-asserted-by":"publisher","first-page":"e0263931","DOI":"10.1371\/journal.pone.0263931","article-title":"Lifestyle changes in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis.","volume":"17","author":"Fern\u00e1ndez","year":"2022","journal-title":"PLoS One."},{"key":"B38","doi-asserted-by":"publisher","first-page":"2759","DOI":"10.3390\/jcm11102759","article-title":"Non-alcoholic fatty liver disease and metabolic syndrome in women: Effects of lifestyle modifications.","volume":"11","author":"Guagnano","year":"2022","journal-title":"J Clin Med."},{"key":"B39","doi-asserted-by":"publisher","first-page":"3771","DOI":"10.3390\/nu14183771","article-title":"Association between mediterranean diet and fatty liver in women with overweight and obesity.","volume":"14","author":"Leone","year":"2022","journal-title":"Nutrients."},{"key":"B40","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1002\/hep.31559","article-title":"Reproductive health and liver disease: Practice guidance by the American Association for the Study of Liver Diseases.","volume":"73","author":"Sarkar","year":"2021","journal-title":"Hepatology."},{"key":"B41","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/S2468-1253(19)30419-4","article-title":"Prevalence of steatosis and fibrosis in young adults in the UK: A population-based study.","volume":"5","author":"Abeysekera","year":"2020","journal-title":"Lancet Gastroenterol Hepatol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"S19","DOI":"10.1038\/ijo.2008.203","article-title":"Total energy intake, adolescent discretionary behaviors and the energy gap.","volume":"32","author":"Sonneville","year":"2008","journal-title":"Int J Obes."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1754","DOI":"10.1017\/S1368980023000812","article-title":"Is the transition from primary to secondary school a risk factor for energy balance-related behaviours? A systematic review.","volume":"26","author":"Emke","year":"2023","journal-title":"Public Health Nutr."},{"key":"B44","doi-asserted-by":"publisher","first-page":"e13628","DOI":"10.1111\/obr.13628","article-title":"Understanding the dynamics emerging from the interplay among poor mental wellbeing, energy balance-related behaviors, and obesity prevalence in adolescents: A simulation-based study.","volume":"24","author":"Aguiar","year":"2023","journal-title":"Obes Rev."},{"key":"B45","doi-asserted-by":"publisher","first-page":"804","DOI":"10.3945\/ajcn.113.079277","article-title":"Dietary determinants of hepatic steatosis and visceral adiposity in overweight and obese youth at risk of type 2 diabetes.","volume":"99","author":"Mollard","year":"2014","journal-title":"Am J Clin Nutr."},{"key":"B46","doi-asserted-by":"publisher","first-page":"e1900838","DOI":"10.1002\/mnfr.201900838","article-title":"Differentiated hepatic response to fructose intake during adolescence reveals the increased susceptibility to non-alcoholic fatty liver disease of maternal high-fat diet male rat offspring.","volume":"64","author":"Oliveira","year":"2020","journal-title":"Mol Nutr Food Res."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.1113\/JP280034","article-title":"Exposure to high fructose corn syrup during adolescence in the mouse alters hepatic metabolism and the microbiome in a sex-specific manner.","volume":"599","author":"Bhat","year":"2021","journal-title":"J Physiol."},{"key":"B48","doi-asserted-by":"publisher","first-page":"2100","DOI":"10.1002\/hep.29068","article-title":"Nonalcoholic fatty liver disease in adolescents and young adults: The next frontier in the epidemic.","volume":"65","author":"Doycheva","year":"2017","journal-title":"Hepatology."},{"key":"B49","doi-asserted-by":"publisher","first-page":"1591523","DOI":"10.3389\/fmed.2025.1591523","article-title":"Artificial intelligence in imaging for liver disease diagnosis.","volume":"12","author":"Yin","year":"2025","journal-title":"Front Med."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1568211\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T01:26:07Z","timestamp":1750814767000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1568211\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,25]]},"references-count":49,"alternative-id":["10.3389\/fmed.2025.1568211"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1568211","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,25]]},"article-number":"1568211"}}