Trends in the prevalence of steatotic liver disease among Chinese adults, 2015–2023: A nationwide cross-sectional study

Background: Metabolic dysfunction–associated fatty liver disease and steatotic liver disease (SLD) have emerged as one of the fastest-growing liver complications over recent decades; this study evaluated trends in SLD prevalence among Chinese adults and its variation across demographic groups. Methods: A multicenter, retrospective study analyzed health examination data from 600,536 Chinese adults across 10 provinces between 2015 and 2023. Participants (≥18 y) with complete data on age, sex, weight, waist circumference, ultrasound, and biochemical tests were included. SLD was defined as hepatic steatosis with at least 1 metabolic disorder. Age-adjusted SLD prevalence was calculated using direct standardization, and trends were assessed through Joinpoint regression. Logistic regression models examined associations between SLD and demographic/metabolic factors. Results: Of 501,017 participants (mean age: 43.39±12.89 y, 54.8% male), the age-standardized SLD prevalence rose from 36.24% in 2015 to 48.11% in 2023 (estimated annual percentage change=3.38, p =0.002). Metabolic dysfunction–associated SLD (MASLD) prevalence also increased from 30.01% to 43.17% (estimated annual percentage change=4.48, p <0.001). Subgroup analysis revealed significant increases in individuals aged 18–40, and higher prevalence in older adults, with the highest risk in those aged 41–64. Males had a higher risk than females (53.0% vs. 18.6%, adjusted prevalence ratio=1.97). Participants from North China had a higher risk of both SLD and MASLD compared with South China. Laborers had a lower risk of SLD compared with farmers, while administrative personnel had a higher risk of MASLD. Conclusions: The prevalence of SLD and MASLD significantly increased from 2015 to 2023, with notable variations across demographic groups, highlighting the need for targeted public health strategies to address the growing burden of SLD in China.