Burden of MASLD and liver fibrosis: evidence from Phenome India cohort

Background: Metabolic-dysfunction-associated steatotic liver disease (MASLD) is rising globally, including in India, yet community-based data remain scarce. We address this critical knowledge gap by assessing the prevalence, distribution, and characteristics of MASLD subgroups and fibrosis, leveraging the Phenome India cohort. Methods: In this prospective study, we recruited 10,267 adults across 37 laboratories of the Council of Scientific and Industrial Research (CSIR) from 27 Indian cities. All permanent staff members of the CSIR, including current employees, retirees, and their spouses who responded to the recruitment campaign and provided voluntary consent, were considered for participation in the Phenome India Cohort. Steatosis and fibrosis were assessed using Transient Elastography, along with associated clinical, biochemical, cytokine and anthropometric data. Overall, crude and age-adjusted prevalence rates were estimated in the study population and various subgroups. Findings: Of 10,267 individuals screened, 7764 were included, 3712 (47.8%) fulfilled MASLD criteria, corresponding to an age-adjusted prevalence of 38.9% (95% CI 37.2-40.6). Significant fibrosis, defined as liver stiffness measurement (LSM) ≥8.2 kPa (≥F2), was more frequent in MASLD (6.3% [234 of 3688]) than in cases without-MASLD (1.7% [69 of 4027]), corresponding to an age-adjusted prevalence of 4.1% in MASLD. Overall age-adjusted prevalence of significant fibrosis was 2.4%, which clustered in older adults (>60 years) and in those with diabetes or obesity class II, with evidence of possible regional variation. Interpretation: MASLD affected over one-third of participants. Site-specific disparities were observed, which suggest the need for large-scale longitudinal studies to elucidate region-specific risk factors and temporal trends. Community-based awareness and targeted public health interventions across diverse geographical and socio-cultural settings in India may help curb the rising burden. Funding: The work was funded by CSIR, India grant HCP47.