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Peer-reviewedCC BY 4.0PLOS One

Modelling the impact of physical activity on MASLD in Saudi Arabia

  • Carolyn Wallace1
  • Saleh A. Alessy2
  • Faisal Abaalkhail3
  • Saad Alghamdi4
  • Assim A. Alfadda5
  • Abdulrahman Al Qabbani6
  • Fadiah Alkhattabi7
  • Reem S. AlAhmed8
  • Tagreed A. Mazi9
  • Hamdan Alghamdi10
  • Sadeem Aldarwesh11
  • Shoug Alashmali12
11 more authors
  • Rowaedh A. Bawaked13
  • Khalid Alobthani14
  • Bandar Al-Judaibi15
  • Waleed K. Al-Hamoudi16
  • Dimitri A. Raptis17
  • Brandon Eurich18
  • Homie Razavi19
  • Predrag Zivotic
  • Severin Rakic
  • Volkan Cetinkaya
  • Saleh A. Alqahtani
19 affiliations
  1. 1Center for Disease Analysis Foundation, Lafayette, Colorado, United States of America
  2. 2Department of Public Health, Saudi Electronic University, Riyadh, Saudi Arabia
  3. 3Liver, Digestive, and Lifestyle Health Research Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
  4. 4Center for Cancer, Society and Public Health, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
  5. 5Department of Medicine, Gastroenterology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
  6. 6College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
  7. 7Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
  8. 8Obesity Research Center, and the Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  9. 9Department of Medicine, Section of Endocrinology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
  10. 10Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
  11. 11Department of Community Health Sciences – Clinical Nutrition, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
  12. 12Hepatology Section, Hepatobiliary Sciences and Organs Transplant Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
  13. 13King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
  14. 14King Abdullah International Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
  15. 15Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
  16. 16Physical Rehabilitation Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
  17. 17Department of Medicine, Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  18. 18World Bank Group, Washington, District of Columbia, United States of America
  19. 19Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, United States of America
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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.

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Cite

BibTeXRIS
BibTeX
@article{wallace2026modelling,
  title = {{Modelling the impact of physical activity on MASLD in Saudi Arabia}},
  author = {Carolyn Wallace and Saleh A. Alessy and Faisal Abaalkhail and Saad Alghamdi and Assim A. Alfadda and Abdulrahman Al Qabbani and Fadiah Alkhattabi and Reem S. AlAhmed and Tagreed A. Mazi and Hamdan Alghamdi and Sadeem Aldarwesh and Shoug Alashmali and Rowaedh A. Bawaked and Khalid Alobthani and Bandar Al-Judaibi and Waleed K. Al-Hamoudi and Dimitri A. Raptis and Brandon Eurich and Homie Razavi and Predrag Zivotic and Severin Rakic and Volkan Cetinkaya and Saleh A. Alqahtani},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0354332},
  url = {https://doi.org/10.1371/journal.pone.0354332},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Modelling the impact of physical activity on MASLD in Saudi Arabia
AU  - Carolyn Wallace
AU  - Saleh A. Alessy
AU  - Faisal Abaalkhail
AU  - Saad Alghamdi
AU  - Assim A. Alfadda
AU  - Abdulrahman Al Qabbani
AU  - Fadiah Alkhattabi
AU  - Reem S. AlAhmed
AU  - Tagreed A. Mazi
AU  - Hamdan Alghamdi
AU  - Sadeem Aldarwesh
AU  - Shoug Alashmali
AU  - Rowaedh A. Bawaked
AU  - Khalid Alobthani
AU  - Bandar Al-Judaibi
AU  - Waleed K. Al-Hamoudi
AU  - Dimitri A. Raptis
AU  - Brandon Eurich
AU  - Homie Razavi
AU  - Predrag Zivotic
AU  - Severin Rakic
AU  - Volkan Cetinkaya
AU  - Saleh A. Alqahtani
PY  - 2026
DA  - 2026/09/15
JO  - PLOS One
DO  - 10.1371/journal.pone.0354332
UR  - https://doi.org/10.1371/journal.pone.0354332
AB  - 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.
SN  - 1932-6203
ER  -