METABOLIC dysfunction-associated steatotic liver disease (MASLD) may be the leading cause of cirrhosis in parts of South America, according to new multicentre research examining patients across six countries.
Cirrhosis is characterised by extensive scarring (fibrosis), distortion of the liver’s normal architecture and the formation of regenerative nodules. It may remain compensated — without major complications — for years, with a median survival of around 12 years after diagnosis. Once it becomes decompensated, defined by complications such as ascites (fluid accumulation in the abdomen), variceal bleeding, hepatic encephalopathy or hepatocellular carcinoma, median survival falls to under 18 months.
Globally, cirrhosis is estimated to have affected nearly 123 million people in 2017 and caused more than 1.5 million deaths in 2019, ranking as the twelfth leading cause of death by 2021. In Latin America, alcohol-related liver disease (ALD) and chronic hepatitis C virus infection have historically been considered the predominant causes, although contemporary regional data remains limited.
MASLD and The Changing Landscape of Cirrhosis
The study, conducted by the South American Liver Research Network, analysed 1,780 adults with confirmed cirrhosis treated at 11 centres in Argentina, Brazil, Colombia, Chile, Ecuador and Peru.
At diagnosis, 51.9% of patients had compensated cirrhosis, while 48.1% had decompensated disease. Among those with decompensation, just over half experienced their first complication at the time of diagnosis, suggesting late presentation in many cases.
Comorbid conditions were common: 32% of patients had obesity, 33.7% had diabetes mellitus, 36.2% had hypertension, and 37.8% reported alcohol use. The median body mass index was 27, placing the cohort in the overweight range.
When causes were examined, MASLD accounted for 34.1% of cases when considered alone or in combination with alcohol — termed metabolic dysfunction-associated alcohol-related liver disease (MetALD). Overall, MASLD-related causes featured in 39.3% of patients when all combinations were included. Viral causes accounted for 19.8% of cases, autoimmune liver diseases for 18%, and ALD alone for 16.3%.
Complications and Transplant Pathway
During follow-up, 63.5% of patients developed at least one liver-related complication, most commonly ascites. Around 28% underwent pre-transplant evaluation, although a smaller proportion ultimately received a liver transplant.
The inclusion of women in almost equal numbers highlighted that decompensation, ascites, variceal bleeding, and other complications occurred across both sexes, underlining that advanced liver disease is a significant concern for women as well as men.
The authors note that differences from earlier regional studies — which often identified alcohol as the dominant cause — may reflect rising metabolic risk factors, potential underreporting of alcohol intake, or updated disease classifications. While limitations include the retrospective design, uneven country representation, and concentration of tertiary centres, the gender-balanced cohort provides valuable insight into cirrhosis patterns in both men and women.
Overall, the findings offer an updated overview of cirrhosis in participating South American centres and may help inform public health strategies, particularly in the context of increasing obesity, diabetes, and MASLD prevalence across the region.
Reference
Prieto E J et al. Clinical, etiological, and demographic aspects of cirrhosis in South America: a report from the South American Liver Research Network. Ann Hepatol. 2026;DOI:10.1016/j.aohep.2026.102186
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