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Commentary

Metabolic dysfunction-associated steatotic liver disease (MASLD) is currently present in more than one-third of the general adult population (38.2%) and in more than two-thirds of the subjects with type 2 diabetes (T2D, 68.8%) (1). The relative global increase in the last 30 years is alarming, reaching +51.2% in the general population, +23.1% among adults with T2D (1), and +26.27% among adolescents (2).

The recent article by Zheng et al analyzed MASLD prevalence among US adolescents (12-19 years of age) using data from the National Health and Nutrition Examination Survey (NHANES) 2017−2020 cycles showing that MASLD is present in 24.77% (3). MASLD prevalence is similar between younger (12-15 years) and older (16-19 years) age groups, while boys tended to have slightly higher prevalence and were more likely to have multiple cardiometabolic risk factors (CMRF) than girls (3). Overweight or obesity was the most important CMRF, with additive interaction effects of obesity/overweight, dyslipidemia, and elevated glucose on the degree of liver steatosis (3) but not on liver stiffness, probably because of the early stage of the disease and the fact that it takes years to develop severe liver disease (steatohepatitis MASH, cirrhosis, and hepatocellular carcinoma) (4, 5). These data confirm a previous analysis in the adolescent population at the global level showing how excess body mass index was associated with MASLD (2); the association was confirmed at a continental level for Asia, Africa, and North America, but not for Europe, Oceania, or South America (2). Whether the differences between continents are due to differences in lifestyle or diet, which are the main environmental causes of MASLD, or to differences in genetic predisposition needs further investigation.

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