DAY 2: Double Burden of Steatotic Liver Disease and Metabolic Disorders May Affect Women Disproportionately

A retrospective analysis of U.S. mortality trends over the past two decades revealed a steep increase in the death rates associated with metabolic dysfunction-associated steatohepatitis (MASH) among individuals with metabolic comorbidities, particularly type 2 diabetes and obesity. While these trends reflect an upward trajectory of metabolic dysfunction in the U.S. population at large, women with comorbid diabetes or obesity have been disproportionately affected by MASH-related mortality, according to the findings presented at the 2026 Annual Scientific Meeting of the American College of Gastroenterology in Nashville, Tennessee.

Data collected from the CDC WONDER Multiple Cause of Death databases, documenting U.S. mortality trends in adults aged 25 years or older, showed that nearly 19,000 deaths were attributed to MASH and comorbid type 2 diabetes and/or obesity between 1999 and 2024. Mortality rates related to MASH and co-documented diabetes or obesity rose nearly 12-fold between 1999 and 2021. While the death rates peaked in 2021 for both men and women, age-adjusted mortality rates were higher for women both before and after the 2021 peak. More than half (55.5%) of the death cases related to MASH and comorbid metabolic disorders were attributed to women over the 26-year span. The analysis showed that overall mortality rates registered a significant decline after 2021. However, when analyzed separately, the decline in mortality was not significant for either sex. 

“This is one of the most rapid liver disease-related mortality surges documented nationally,” said Maryam Nasir, MBBS, MD, an internal medicine resident at the University of Alabama at Birmingham Heersink School of Medicine, who presented the results in a poster session. “Women carry a larger share of deaths and higher mortality rates than men, which is a distinctive pattern compared to most chronic liver diseases. These findings support sex-aware surveillance and aggressive metabolic risk management in high-burden populations.” 

Nasir noted that multiple factors, including prevalence of obesity and diabetes in women, could have contributed to these trends. However, she added, additional data are needed to clarify the potential drivers of disproportionate mortality in women and to determine whether the recent decline in mortality will continue over time for both sexes. 
“In clinical practice, early recognition is critical for preventing progression to cirrhosis,” Nasir concluded. Clinical management strategies should include “identification of risk factors like type 2 diabetes, screening for steatosis, staging fibrosis, and repeating assessments every 6 months,” the author suggested.