Global and regional prevalence, burden, and risk factors for MASLD in children and adolescents aged 5 to 24 years: a systematic review, meta-analysis, and modeling study

Abstract Background Obesity is associated with metabolic dysfunction-associated steatotic liver disease (MASLD). Despite the rising prevalence of obesity among children and adolescents, no studies have examined risk factors or developed models to estimate MASLD burden by sex, age group, or geographic location. Objective To estimate and predict the distribution and shifting patterns of the burden of MASLD in children and adolescents aged 5 to 24 years, globally, regionally, and in China. Methods We systematically searched PubMed, EMBASE, Web of Science, Cochrane, and CNKI for studies reporting the prevalence of MASLD and its closely related diagnostic constructs, including metabolic dysfunction-associated fatty liver disease (MAFLD) and non-alcoholic fatty liver disease (NAFLD), in 5–24-year-olds, and synthesized evidence across these definitions to estimate the burden of MASLD. Random-effects meta-regression synthesized age-, sex-, and year-specific prevalence and risk factors. Additionally, using data from the Global Burden of Disease, World Population Prospects, and Chinese National Survey on Students’ Constitution and Health, a risk factor-based model estimated global, regional, and provincial (China) MASLD burden. The protocol was registered in PROSPERO (CRD420251062351). Results Of 2747 records, 56 studies (54 English, 2 Chinese) were included; 37 informed prevalence and 38 informed risk factors. Our model indicated that the global MASLD prevalence among 5–24-year-olds was 7.0% (95% CI: 4.1, 11.7), increasing with age and year, and higher in boys. Asia had the largest number of cases in 2000 (63.8 million [51.5, 76.6]) and 2020 (160.9 million [134.5, 187.6]). Our model further indicated that Africa is projected to surpass Asia in total case numbers from 2040 onward. In China, MASLD prevalence among 6–18-year-olds was highest in Hebei, Shandong, and Beijing (2000) and in Tianjin, Shandong, and Heilongjiang (from 2020 onwards). Conclusions The prevalence of MASLD among children and adolescents continues to rise alongside the epidemic of obesity. Model-based estimates suggest that the burden of MASLD may shift over time towards currently less developed regions of the world, such as Africa, and less well-developed regions in China. Targeted investment in obesity prevention is urgently needed, as are health services to reduce the health impacts of MASLD during and beyond childhood and adolescence.