Global and current overview in Argentina

Abstract

MASLD is defined as hepatic steatosis (>5%) associated with one or more of five cardiometabolic risk factors, including overweight/obesity, hyperglycemia/diabetes, hypertension, and dyslipidemia. Moderate daily alcohol consumption in patients with MASLD (20–50 grams in women and 30–60 grams in men) places them in the MetALD category.

Currently, the prevalence of MASLD in the general population is 38% worldwide, but this figure doubles in patients with diabetes.

In Latin America, Younossi et al. reported in 2023 a MASLD prevalence of 44.4% (meta-analysis of three studies; n = 5,875 patients), making it one of the regions with the highest prevalence in the world.

Previously, Cusi et al. reported in 2021 a MASLD prevalence of 70% in patients with type 2 diabetes. Recently, in Argentina, we published a study on the prevalence of MASLD in adult patients with type 2 diabetes, a multicenter cross-sectional study including 579 patients (median age: 60 years; 67% obese), and found a prevalence of 81.2%.

MASLD is currently the most common cause of chronic liver disease, and its prevalence has increased by more than 50% over the past three decades. Epidemiological data indicate that 12–40% of patients with MASLD develop metabolic dysfunction-associated steatohepatitis (MASH) within 8 to 13 years, and approximately 15% will develop fibrosis with progression to cirrhosis, potentially requiring liver transplantation in the future.

MASLD is a highly prevalent comorbidity in diabetes that increases cardio-renal and liver-related morbidity and mortality. Although its pathophysiology is multifactorial, the influence of genetic factors may help explain its high prevalence in Latin American populations.

The PNPLA3 gene polymorphism encoding the I148M variant has been strongly associated with MASLD, liver fibrosis, MASH-related cirrhosis, and hepatocellular carcinoma, especially in patients with diabetes and obesity.

In summary, early detection of MASLD in patients with diabetes and obesity is very important in order to treat these patients appropriately, prevent the progression of liver disease, and reduce cardiovascular mortality through personalized treatments based on risk stratification.