Global burden of metabolic dysfunction-associated steatotic liver disease, 2010 to 2021

Decoding survival in MASLD: the dominant role of metabolic factors

BACKGROUND

Metabolic factors are considered to influence disease progression in patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), but the impact of individual metabolic factors on the survival rate of patients with MASLD is still unclear.

AIMS

This article aims to reveal how metabolic components affect the survival of patients with this disease.

METHODS

A total of 3,086 participants with MASLD based on the diagnostic criteria established at the Delphi conference from NHANES III were included in this analysis. COX regression model (C-index = 0.64) was used to analyze the all-cause and attributable mortality of different number of metabolic factors. Elastic Network Regression model (C-index = 0.69), Accelerated Failure Time model and Randomized Survival Forest model (C-index = 0.63) based on machine learning were used to analyze the weight of each metabolic factor, and a Metabolism-related survival risk score formula was established and verified.

RESULTS

This study found that not only the number of metabolic factors had different effects on all-cause survival in MASLD patients, but also the degree of impact of different metabolic factors on survival was quite different, among which poor glycemic control was the most important influencing factor.

CONCLUSION

This study highlights the clinical value of relevant metabolic factors in predicting survival in the MASLD patient population. Related metabolic factors can be used as surrogate biomarkers for the follow-up of MASLD patients.

Metabolic dysfunction-associated steatotic liver disease: A story of muscle and mass

Skeletal muscle alterations (SMA) are increasingly recognized as both contributors and consequences of metabolic dysfunction-associated steatotic liver disease (MASLD), affecting disease progression and outcomes. Sarcopenia is common in patients with MASLD, with a prevalence ranging from 20% to 40% depending on the population and diagnostic criteria used. In advanced stages, such as metabolic dysfunction-associated steatohepatitis and fibrosis, its prevalence is even higher. Sarcopenia exacerbates insulin resistance, systemic inflammation, and oxidative stress, all of which worsen MASLD. It is an independent risk factor for fibrosis progression and poor outcomes including mortality. Myosteatosis refers to the abnormal accumulation of fat within muscle tissue, leading to decreased muscle quality. Myosteatosis is prevalent (> 30%) in patients with MASLD, especially those with obesity or type 2 diabetes, although this can vary with the imaging techniques used. It reduces muscle strength and metabolic efficiency, further contributing to insulin resistance and is usually associated with advanced liver disease, cardiovascular complications, and lower levels of physical activity. Altered muscle metabolism, which includes mitochondrial dysfunction and impaired amino acid metabolism, has been reported in metabolic syndromes, including MASLD, although its actual prevalence is unknown. Altered muscle metabolism limits glucose uptake and oxidation, worsening hyperglycemia and lipotoxicity. Reduced muscle perfusion and oxygenation due to endothelial dysfunction and systemic metabolic alterations are common in MASLD associated with comorbidities, such as obesity, hypertension, and atherosclerosis. It decreases the muscle capacity for aerobic metabolism, leading to fatigue and reduced physical activity in patients with MASLD, aggravating metabolic dysfunction. Various SMA in MASLD worsen insulin resistance and hepatic fat accumulation, may accelerate progression to fibrosis and cirrhosis, and increase the risk of cardiovascular disease and mortality. Management strategies for SMA include resistance training, aerobic exercise, and nutritional support (e.g., high-protein diets, vitamin D, and omega-3 fatty acids), which are essential for mitigating skeletal muscle loss and improving outcomes. However, pharmacological agents that target the muscle and liver (such as glucagon-like peptide-1 receptor agonists) show promise but have not yet been approved for the treatment of MASLD.

Global, Regional, and National Temporal Trend and Patterns of Change in the Burden of Asthma From 1990 to 2021: An Analysis of the Global Burden of Disease Study 2021

BACKGROUND

Asthma presents a significant challenge to the global healthcare systems and imposes a heavy socioeconomic burden. Previous studies had geographical limitations and lacked comprehensive global analysis. The study utilises data from the 2021 Global Burden of Disease (GBD) study to assess the global, regional, and national burden of asthma from 1990 to 2021. It examines disease trends, highlights health inequalities and aims to provide scientific evidence for future public health strategies and the optimisation of resource allocation.

METHODS

Data from GBD 2021 were used to estimate the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of asthma across 21 global regions and 204 countries and territories from 1990 to 2021. Temporal trends were analysed, and the relationship between asthma burden and the socio-demographic index (SDI) was examined using a smoothing spline model. Analyses included the slope index of inequality and the concentration index to assess health disparities, frontier analysis to estimate achievable outcomes based on development levels, and decomposition analysis to identify the drivers of changes in DALYs number.

RESULTS

Over the past three decades, the age-standardised burden of asthma has declined, with age-standardised mortality and DALY rates decreasing by 46% and 44%, respectively. However, the absolute number of deaths has increased by 17%, particularly among females, especially in low and low-middle SDI regions. Significant health inequalities persist, with high-SDI regions benefiting from better asthma control, while low-SDI regions face disproportionate burdens due to healthcare disparities. Frontier analysis highlights gaps between current and optimal disease burden levels, while low-SDI regions require increased investment in asthma control. Aging, population growth, and epidemiological changes are key drivers of asthma burden trends. High body mass index (BMI) remains the leading risk factor, while smoking and occupational exposures continue to contribute significantly.

CONCLUSIONS

The global burden of asthma has declined, yet significant regional disparities persist, with low-SDI regions experiencing higher mortality and DALYs due to limited healthcare access and environmental risks. High BMI, smoking and occupational exposures remain key contributors, requiring targeted public health interventions and lifestyle modifications.

Metabolic diseases in the East Asian populations

East Asian populations, which account for approximately 20% of the global population, have become central to the worldwide rise of metabolic diseases over the past few decades. The prevalence of metabolic disorders, including type 2 diabetes mellitus, hypertension and metabolic dysfunction-associated steatotic liver disease, has escalated sharply, contributing to a substantial burden of complications such as cardiovascular disease, chronic kidney disease, cancer and increased mortality. This concerning trend is primarily driven by a combination of genetic predisposition, unique fat distribution patterns and rapidly changing lifestyle factors, including urbanization and the adoption of Westernized dietary habits. Current advances in genomics, proteomics, metabolomics and microbiome research have provided new insights into the biological mechanisms that might contribute to the heightened susceptibility of East Asian populations to metabolic diseases. This Review synthesizes epidemiological data, risk factors and biomarkers to provide an overview of how metabolic diseases are reshaping public health in East Asia and offers insights into biological and societal drivers to guide effective, region-specific strategies.

MASLD: Prevalence, Mechanisms, and Sex-Based Therapies in Postmenopausal Women

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease influenced by genetic, lifestyle, and environmental factors. While MASLD is more prevalent in men, women are at increased risk after menopause, highlighting the critical pathogenetic role of sex hormones. The complex interplay between estrogen deficiency, visceral fat accumulation, metabolic syndrome (MetS), and inflammation accelerates disease progression, increases cardiovascular (CV) risk, and triggers a cycle of worsening adiposity, metabolic dysfunction, and psychological problems, including eating disorders. Weight loss in postmenopausal women can significantly improve both metabolic and psychological outcomes, helping to prevent MASLD and related conditions. This review examines the prevalence of MASLD, its comorbidities (type 2 diabetes T2D, CV, mental disorders), pathogenetic mechanisms, and pharmacological treatment with GLP-1 receptor agonists (GLP1-RAs), with a focus on postmenopausal women. Given the use of GLP1-RAs in the treatment of obesity and T2D in MASLD patients, and the increase in MetS and MASLD after menopause, this review analyzes the potential of a stable GLP-1-estrogen conjugate as a therapeutic approach in this subgroup. By combining the synergistic effects of both hormones, this dual agonist has been shown to increase food intake and food reward suppression, resulting in greater weight loss and improved insulin sensitivity, glucose, and lipid metabolism. Therefore, we hypothesize that this pharmacotherapy may provide more targeted therapeutic benefits than either hormone alone by protecting the liver, β-cells, and overall metabolic health. As these effects are only supported by preclinical data, this review highlights the critical need for future research to evaluate and confirm the mechanisms and efficacy in clinical settings, particularly in postmenopausal women.