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In this opening conversation on MASLD disease burden, Zobair Younossi summarizes and expands on some key points from the recent Diabetes Spectrum review article he co-authored with Linda Henry.

Zobair starts by discussing the recent review article, Understanding the Burden of Non-Alcoholic Fatty Liver Disease: Time for Action which he describes as "a summary of a large body of evidence that's being generated." He points to three pivotal issues:

1. The treatment burden associated with MASLD and MASH is extremely high and will grow over time. The prevalence of MASLD in the overall population has grown to ~38%, but for Type 2 diabetics, who have worse outcomes associated with MASLD, this number is 68%. MASH numbers are estimated to be 5-7% in the general population, but 37% among T2D patients. As diabetes increases across the globe, these rates will go higher.
2. The humanistic burden, as measured in Quality of Life scores, is also significant. Patients living with MASLD and MASH report lower QoL scores, which translates not only into a less happy, more depressed society, but also into significant indirect economic effects due to poorer worker performance and, presumably, more time away from work. 
3. The economic burden of MASLD is significant in every country, but the scale and structure of this burden varies from country to country. Key drivers include dietary issues and inactivity, and issues are becoming more pronounced globally. These economic issues are driven largely by the key downstream sequelae. The leading causes of death from MASLD are cardiovascular disease and extrahepatic cancers, which are costly, and patients with cirrhosis are highly susceptible to liver cancer as well. 

Jörn Schattenberg joins the conversation to commend Zobair on his work, which, as Jörn puts it,  "educate[s] us as physicians on where the risk factors and the at-risk populations are, and we're moving that way. I mean, we're trying to focus on patients with diabetes that are more advanced from the hepatologist perspective." He also discusses the ongoing effort to educate endocrinologists and primary care about these issues as well, since those two specialties treat the lion's share of diabetic patients. 

Zobair goes on to describe the Markov models of disease cost his group has built already in seven countries, and plans to build in more. Key point: MASLD is costly everywhere, but the structure of cost and, most importantly, public health solutions will vary from country to country.