{
  "abstract": "Background and aims: Insufficient physical activity contributes to the global rise of metabolic dysfunction–associated steatotic liver disease (MASLD). Although physical activity levels in Saudi Arabia have increased in recent years, MASLD shows an increasing prevalence trend, affecting over 30% of the population. This study aimed to determine the impact of increased physical activity, and resulting reduction in hepatic steatosis, on the projected health and economic burden of MASLD in Saudi Arabia. Methods: We simulated MASLD progression from 2025 to 2045 using a validated Markov model. Three aspirational physical activity intervention scenarios were evaluated, assuming that 10%, 20%, and 30% of individuals with MASLD achieved a clinically significant ≥30% relative reduction in hepatic steatosis. Health outcomes were measured in disability-adjusted life years (DALYs), and economic outcomes were analyzed using U.S.-based direct healthcare costs. Results: MASLD prevalence in Saudi Arabia is projected to increase from approximately 10.0 million in 2025 to 14.3 million in 2045. In scenarios where 10%, 20%, and 30% of individuals with MASLD achieved a ≥ 30% reduction in hepatic steatosis, cumulative liver-related deaths are projected to decline by 4.3%–12.3%, hepatocellular carcinoma cases by 4.9%–14.2%, and decompensated cirrhosis cases by up to 14.0%. Direct health care costs are estimated to reduce by 4.0%–11.5%, and DALYs are projected to decline by 8.6%–24.2% across scenarios. Conclusions: Increased physical activity could significantly reduce the future health and economic impacts of MASLD in Saudi Arabia. Achieving a ≥ 30% reduction in hepatic steatosis among individuals with MASLD could reduce liver-related complications, deaths, DALYs, and healthcare costs. These findings support the integration of MASLD-specific outcomes into national physical activity promotion campaigns and noncommunicable disease advocacy efforts, aligned with Saudi Vision 2030.",
  "abstract_shown": true,
  "affiliations": [
    "Center for Disease Analysis Foundation, Lafayette, Colorado, United States of America",
    "Department of Public Health, Saudi Electronic University, Riyadh, Saudi Arabia",
    "Liver, Digestive, and Lifestyle Health Research Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia",
    "Center for Cancer, Society and Public Health, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom",
    "Department of Medicine, Gastroenterology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia",
    "College of Medicine, Alfaisal University, Riyadh, Saudi Arabia",
    "Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia",
    "Obesity Research Center, and the Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia",
    "Department of Medicine, Section of Endocrinology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia",
    "Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia",
    "Department of Community Health Sciences – Clinical Nutrition, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia",
    "Hepatology Section, Hepatobiliary Sciences and Organs Transplant Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
    "King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia",
    "King Abdullah International Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia",
    "Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia",
    "Physical Rehabilitation Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia",
    "Department of Medicine, Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia",
    "World Bank Group, Washington, District of Columbia, United States of America",
    "Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, United States of America"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 23,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Carolyn Wallace"
    },
    {
      "affs": [
        1
      ],
      "name": "Saleh A. Alessy"
    },
    {
      "affs": [
        2
      ],
      "name": "Faisal Abaalkhail"
    },
    {
      "affs": [
        3
      ],
      "name": "Saad Alghamdi"
    },
    {
      "affs": [
        4
      ],
      "name": "Assim A. Alfadda"
    },
    {
      "affs": [
        5
      ],
      "name": "Abdulrahman Al Qabbani"
    },
    {
      "affs": [
        6
      ],
      "name": "Fadiah Alkhattabi"
    },
    {
      "affs": [
        7
      ],
      "name": "Reem S. AlAhmed"
    },
    {
      "affs": [
        8
      ],
      "name": "Tagreed A. Mazi"
    },
    {
      "affs": [
        9
      ],
      "name": "Hamdan Alghamdi"
    },
    {
      "affs": [
        10
      ],
      "name": "Sadeem Aldarwesh"
    },
    {
      "affs": [
        11
      ],
      "name": "Shoug Alashmali"
    },
    {
      "affs": [
        12
      ],
      "name": "Rowaedh A. Bawaked"
    },
    {
      "affs": [
        13
      ],
      "name": "Khalid Alobthani"
    },
    {
      "affs": [
        14
      ],
      "name": "Bandar Al-Judaibi"
    },
    {
      "affs": [
        15
      ],
      "name": "Waleed K. Al-Hamoudi"
    },
    {
      "affs": [
        16
      ],
      "name": "Dimitri A. Raptis"
    },
    {
      "affs": [
        17
      ],
      "name": "Brandon Eurich"
    },
    {
      "affs": [
        18
      ],
      "name": "Homie Razavi"
    },
    {
      "name": "Predrag Zivotic"
    },
    {
      "name": "Severin Rakic"
    },
    {
      "name": "Volkan Cetinkaya"
    },
    {
      "name": "Saleh A. Alqahtani"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8pxgbavj5xxy5.bib",
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  "doi": "10.1371/journal.pone.0354332",
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  "licence_label": "CC BY 4.0",
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  "native_subjects": [
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  "published": "2026-09-15",
  "publisher": "Public Library of Science",
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  "title": "Modelling the impact of physical activity on MASLD in Saudi Arabia",
  "title_text": "Modelling the impact of physical activity on MASLD in Saudi Arabia",
  "type": "peer-reviewed",
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