Rising burden of MASLD and CKM syndrome in Asia: A decade of trends and future projections

OBJECTIVE: To analyze epidemiological trends and project the future burden of metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular-kidney-metabolic (CKM) syndrome in Asia using data from the Global Burden of Disease (GBD) Study. This analysis quantifies the substantial co-occurrence of MASLD and CKM syndrome, which together accounted for 50.9% of the total disease prevalence in Asia in 2021, by evaluating incidence, prevalence, deaths, and disability-adjusted life years (DALYs) from 2010 to 2021. METHODS: Data from the GBD 2021 database were used to assess the burden of MASLD and CKM syndrome in Asia. The study analyzed incidence, prevalence, deaths and DALYs for nine metabolic diseases or related conditions: MASLD, atrial fibrillation and flutter (AF/AFL), ischemic heart disease (IHD), hypertension heart disease (HHD), lower extremity peripheral arterial disease (PAD), type 2 diabetes mellitus (T2DM), stroke, and chronic kidney disease (CKD) due to hypertension (HTN) and T2DM. Age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) were calculated. The autoregressive integrated moving average (ARIMA) model was applied to forecast the trend of MASLD over the next 20 years. This model, widely used in time-series forecasting, identifies trends, cyclical variations, and random fluctuations to provide scientifically grounded projections. RESULTS: In 2021, the collective burden of the nine CKM-related conditions analyzed (including MASLD) accounted for 50.9% of total disease prevalence and 34.4% of all deaths in Asia, with 12.68 million deaths and 306.82 million DALYs. Among the nine metabolic diseases analyzed, MASLD had the highest incidence and prevalence, with MASLD-related liver cirrhosis (MASLD-LC) and MASLD-related steatohepatitis (MASLD-SH) affecting approximately 786.69 million and 786.65 million individuals, respectively. IHD and stroke were the leading causes of death and DALYs. Between 2010 and 2021, the incidence (MASLD-LC/MASLD-SH: +25.4%) and prevalence (MASLD-LC/MASLD-SH: +38.0%) of MASLD increased substantially. T2DM showed the greatest rise in age-standardized incidence rate (EAPC: +1.7%) and age-standardized prevalence rate (EAPC: +2.0%). Geographically, MASLD represented the predominant metabolic burden in most Asian countries, with the exception of Central and South Asia, where IHD prevailed. ARIMA projections suggest that the MASLD burden will continue to grow, with a projected increase in incidence of approximately 34% compared to 1990 levels (MASLD-LC: +34.01%; MASLD-SH: +34.04%), underscoring the need for timely and proactive interventions. CONCLUSION: MASLD and CKM syndrome constitute a major and growing health challenge in Asia. These findings underscore the need for early diagnosis, targeted interventions, and comprehensive public health strategies. Future research should aim to elucidate the mechanisms of disease interactions, enhance diagnostic criteria, and improve data collection to support more accurate burden estimation and inform evidence-based policymaking.