RESEARCH suggests that metabolic dysfunction-associated steatotic liver disease (MASLD) may now be the leading driver of chronic liver disease and cirrhosis in northeastern Mexico, reflecting a marked epidemiological shift over 25 years. Chronic liver disease, defined by progressive liver inflammation, fibrosis and functional decline, is commonly caused by viral hepatitis, alcohol-related liver disease, autoimmune liver disease, and increasingly MASLD.
Rising MASLD Burden Reshapes the Landscape of Liver Disease
Long-term data from a major hepatology centre in Monterrey show MASLD accounted for 33% of chronic liver disease cases, making it the most common aetiology among the 2,679 patients analysed between 1995 and 2019. This increase coincided with a growing burden of metabolic comorbidities, including obesity and type 2 diabetes mellitus, both strongly associated with MASLD development and progression.
Obesity was present in 72% of patients, underlining its central role as a modifiable risk factor. The findings align with wider trends showing increasing metabolic syndrome prevalence in Mexico, alongside rising diabetes rates in the northeast region.
Cirrhosis Rates Nearly Double Over Time
Overall, 49% of patients had cirrhosis at presentation, with prevalence rising from 36% in 1995 to 67% in 2019. MASLD accounted for the largest proportion of cirrhosis over time within the cohort. Alcohol-related liver disease and autoimmune liver disease remained relatively stable in frequency, although alcohol related liver disease carried the highest proportion of cirrhosis at 80%. Notably, alcohol consumption in northern Mexico remained consistently high, reflecting persistent public health challenges.
Viral Hepatitis Declines in Line with Treatment Advances
In contrast, hepatitis C virus, once the leading cause of chronic liver disease in the late 1990s, declined significantly over the study period. Its prevalence dropped from 30% in 1995-2003 to 17% in 2012-2019, likely reflecting improved access to direct-acting antivirals introduced into the public health system in 2017. Rates of hepatitis B virus also showed a steady decrease across the study period.
Interplay of Genetics, Lifestyle and Inequality
The rising dominance of MASLD appears multifactorial. Increased rates of obesity, hypertriglyceridaemia and diabetes, combined with genetic susceptibility in Hispanic populations, are key contributors. Broader social determinants—including poverty, migration-related disadvantage, and limited access to preventive healthcare—may further exacerbate risk.
These findings illustrate a transition from infectious to metabolic drivers of liver disease. For clinicians, the study emphasises the importance or early identification of metabolic risk factors and proactive management to slow fibrosis progression.
While causality cannot be definitively established, the parallel rise in metabolic disorders and cirrhosis indicates an urgent need for integrated public health strategies targeting diet, physical activity and alcohol consumption.
Reference
Cordero-Perez P et al. Situational panorama of chronic liver diseases: A single-center experience at a university hospital in northeast Mexico (1995–2019). Ann Hepatol. 2026;DOI:10.1016/j.aohep.2025.102116.
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