Global, regional, and national time trends in prevalence of metabolic dysfunction associated steatotic liver disease among women of reproductive age: an age-period-cohort analysis for the global Burden of Disease 2021 study

This study aims to investigate the time trends in the prevalence of metabolic dysfunction associated steatotic liver disease (MASLD) among women of reproductive age (WRA) globally, regionally, and nationally from 1992 to 2021, and to explore associations with age, period, and birth cohort effects. MASLD prevalence estimates were sourced from the Global Burden of Disease (GBD) 2021 study. We used an age-period-cohort model to analyze cohort and period effects, overall annual percentage changes (net drifts), annual percentage change in each age group, and longitudinal age-specific rates. The global prevalence of MASLD among WRA nearly doubled from 165 million in 1992 to 307 million in 2021. Fifty-one countries reported over one million cases, with China, India, and Indonesia leading. The global net drift of MASLD prevalence among WRA was 0.70% per year, with a range from 0.38% in the low sociodemographic index (SDI) region to 1.29% in the high-SDI region. Of 204 countries, 195 exhibited increasing age-standardized prevalence rates (net drift ≥ 0.0% per year), with Italy, Brunei Darussalam, and Oman showing the largest increases. Both period and cohort effects displayed unfavorable trends across most countries, except for Cambodia. Increased MASLD prevalence was associated with rising summary exposure values for high BMI, low physical activity, and high fasting plasma glucose. MASLD in the WRA is an increasing health problem in all countries, and is accompanied by worsening period and cohort risks. These population-level trends warrant further investigation of their clinical implications for maternal health outcomes. Future research should focus on establishing evidence-based screening strategies and evaluating the clinical utility of interventions targeting liver health in WRA.本研究旨在探究1992年至2021年全球、区域及国家层面育龄女性（women of reproductive age, WRA）人群中与代谢功能障碍相关的脂肪性肝病（metabolic dysfunction associated steatotic liver disease, MASLD）患病率的时间趋势，并分析其与年龄、时期及出生队列效应的关联。MASLD患病率估算数据源自2021年全球疾病负担（Global Burden of Disease, GBD）研究。本研究采用年龄-时期-队列模型，分析队列与时期效应、总体年度百分比变化（净漂移值）、各年龄组的年度百分比变化及纵向年龄别患病率。全球育龄女性的MASLD患者数近乎翻倍，从1992年的1.65亿增至2021年的3.07亿。共有51个国家的MASLD患者数超过100万，其中中国、印度及印度尼西亚患者规模居首。全球育龄女性MASLD患病率的年度净漂移值为0.70%，社会人口指数（sociodemographic index, SDI）较低的区域为0.38%，高SDI区域则达1.29%。在204个国家中，195个国家的年龄标化患病率呈上升趋势（年度净漂移≥0.0%），其中意大利、文莱达鲁萨兰国及阿曼的增幅最为显著。除柬埔寨外，多数国家的时期效应与队列效应均呈现不利变化趋势。MASLD患病率升高与高体重指数、低体力活动及空腹血糖升高的综合暴露分值上升显著相关。育龄女性的MASLD已成为全球各国日益严峻的公共卫生问题，且伴随时期与队列风险的不断恶化。此类人群层面的趋势亟需进一步探究其对孕产妇健康结局的临床意义。未来研究应聚焦于建立基于循证依据的筛查策略，并评估针对育龄女性肝脏健康干预措施的临床应用价值。