Global trends, epidemiological patterns, and disability burden of metabolic dysfunction-associated steatotic liver disease–related cirrhosis from 1990 to 2021: A comprehensive analysis of the Global Burden of Disease study

ObjectivesTo assess long-term global trends in the burden of metabolic dysfunction-associated steatotic liver disease-related cirrhosis and develop a simplified, waist circumference-based prediction model for early identification of individuals at risk of advanced liver fibrosis.DesignThis study combined (i) ecological time-series analysis using Global Burden of Disease 2021 data (1990-2021) and (ii) cross-sectional analysis of population-based survey data (NHANES 2021-2023). A waist circumference-based logistic regression model was developed and validated to predict metabolic dysfunction-associated steatotic liver disease-related advanced fibrosis, with subgroup evaluation and model calibration.SettingGlobal analyses were based on Global Burden of Disease data across all World Health Organization regions and income groups. U.S.-based analyses used NHANES, a nationally representative health and nutrition survey, with data collected in community and outpatient settings across multiple states.ParticipantsThe Global Burden of Disease analysis included global population-level estimates from 204 countries. The NHANES component involved 11,933 adults aged ≥20 years, with subgroups defined by metabolic dysfunction-associated steatotic liver disease status, age, sex, and race/ethnicity. Exclusion criteria included viral hepatitis and excessive alcohol use.InterventionsThis was an observational study with no interventions. The waist circumference-based predictive model served as an analytic tool rather than a clinical intervention.Primary and secondary outcome measures: The primary outcomes were temporal trends in disability-adjusted life years attributable to metabolic dysfunction-associated steatotic liver disease-related cirrhosis and the performance of a waist circumference-based prediction model for advanced fibrosis (≥9.5 kPa by transient elastography). Secondary outcomes included subgroup-specific model performance (area under the curve, calibration) and comparison of metabolic profiles between metabolic dysfunction-associated steatotic liver disease and non-metabolic dysfunction-associated steatotic liver disease participants.