ArticleThe Lancet regional health. Europe2026
Epidemiology, temporal trends, and fibrosis risk stratification in metabolic dysfunction-associated steatotic liver disease in UK primary care: a population-based cohort and nested case-control study.
Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: We sought to determine the changing prevalence, incidence, and temporal trends in real-world, recorded diagnoses of metabolic dysfunction-associated steatotic liver disease (MASLD) and assess availability of fibrosis risk stratification following awareness campaigns and guideline updates over the last decade. Methods: This population-based cohort study identified MASLD diagnoses made between 2003 and 2022 in the UK primary-care Clinical Practice Research Datalink (CPRD) to estimate prevalence and incidence. A nested case-control analysis, utilising 1:4 age-, sex-, and general practice-matched controls, assessed clinical characteristics, availability of Fibrosis-4 (Fib-4) components, and its temporal trend pre- and post-2015. Findings: 11.7 million individuals were active in CPRD in 2022. 365,797 comprised the study cohort of people with a MASLD diagnosis (matched to 1,460,288 controls). From 2012 to 2022, recorded MASLD prevalence rose from 0.52% [N = 51,028] to 2.42% [N = 283,762] (p < 0.001); recorded incidence doubled from 1.60 to 3.31 per 1000 person-years (p < 0.001). People with MASLD diagnosis had a higher prevalence of type 2 diabetes (21.0% [N = 76,640] vs 7.7% [N = 112,812]) and hypertension (35.3% [N = 129,156] vs 18.7% [N = 273,502]). People of South Asian ethnicity were overrepresented in MASLD cohort but had the lowest availability of Fib-4 components (14.6% [N = 4467]; adjusted odds ratio 0.67, 95% CI: 0.65-0.70, vs White). Overall, Fib-4 availability increased pre-to post-2015 (4.3% [N = 4945] to 22.8% [N = 56,634]). Among those with a calculable score, fewer South Asian individuals had indeterminate/high risk (18.6% [N = 833] vs 35.3% [N = 15,115] in White individuals, p < 0.001). Interpretation: Recorded MASLD prevalence has increased 5-fold in a decade, yet a diagnostic gap persists. Fibrosis risk stratification has improved, but remains low and is potentially inequitable for people of South Asian ethnicity. Funding: Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA; Barts Charity.
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