Epidemiology of Metabolic Dysfunction–Associated Steatotic Liver Disease in South Asian Ethnicities: A Systematic Review and Meta-Analysis

Abstract

Background and Aims: People of South Asian ethnicities are at increased risk of metabolic syndrome, but the epidemiology of metabolic dysfunction–associated steatotic liver disease (MASLD) in this population remains poorly understood. This systematic review and meta-analysis assesses the prevalence, cross-sectional severity, and clinically relevant endpoints of MASLD in this group. Methods: Studies from January 2002 to November 2023 across PubMed, Embase, Ovid, and Cochrane databases, meeting inclusion criteria, were included. We performed a random effects meta-analysis to calculate pooled prevalence and proportions. Results: Sixty-two articles met inclusion criteria (n = 40 745). Fifty-three were based in India, 4 in Sri Lanka, 3 in Pakistan, and 2 in Bangladesh. The pooled prevalence of MASLD in studies that did not select for T2DM status was 34.7% (95% CI 29.0%–40.5%, I2 = 99.5%) and higher in studies with only T2DM patients, 60.0% (95% CI 48.9%–71.1%, I2 = 99.0%). The pooled prevalence was higher in urban (47.1%; 95% CI 36.1%–58.1%, I2 = 99.7%) compared with rural (18.5%; 95% CI 13.7%–23.3%, I2 = 96.2%) settings. The pooled average proportion of participants with advanced fibrosis (≥ F3) was 14.0% (95% CI 9.2%–18.7%, I2 = 91.5%). Four studies reported on clinical outcomes of interest; however, all had different endpoints, and so meta-analysis was not possible. Conclusions: MASLD prevalence in South Asian ethnicities is high, and the proportion of people with advanced fibrosis may be higher compared with multiethnic populations, though high-quality longitudinal studies are needed to better understand the epidemiology of this cohort.