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In Context

The global burden of non-communicable diseases (NCDs) is profound, accounting for 74% of all deaths worldwide. Conditions such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer not only drive mortality but also contribute significantly to years lived with disability.¹

South Africa faces an especially severe non-communicable disease (NCD) crisis. The World Health Organisation estimates that the country’s NCD burden is two to three times higher than that of comparable developing nations. Notably, this burden is not evenly distributed—poorer urban communities carry a disproportionate share.^1,2

Two increasingly important contributors to South Africa’s NCD profile are chronic kidney disease (CKD) and metabolic dysfunction-associated steatotic liver disease (MASLD). Both are closely linked to one of the most modifiable and rapidly escalating public health risks: obesity.^5,6,8

Obesity plays a central role in the development and progression of multiple NCDs. Its association with type 2 diabetes mellitus and hypertension—both primary drivers of CKD and MASLD—has placed it at the forefront of public health concerns. This rising epidemic is fuelled by socioeconomic transitions, urbanisation, dietary shifts toward processed and energy-dense foods, and increasingly sedentary lifestyles.^4,5,6

Globally South Africa ranks among the countries with the highest projected increases in obesity, with prevalence expected to rise by 47.7% in women and 23.3% in men by 2025. These shifts are already being felt across the healthcare system.⁴

According to the International Society of Nephrology (ISN) Global Health Atlas, chronic kidney disease (CKD) affects approximately 10.7% of the South African population.⁵ Obesity contributes to CKD both indirectly, through its effect on diabetes and hypertension, and directly, via a complex interplay of metabolic, inflammatory, and haemodynamic mechanisms.^4,5,9

Meanwhile, MASLD—a liver disease driven by metabolic dysfunction—is emerging as another under-recognised consequence of obesity. Globally, it affects over 30% of the population. In sub-Saharan Africa, the burden of MASLD is increasing but remains poorly documented. Its key risk factors, such as diabetes, obesity, and hypertension, mirror those of CKD.^6,7 

Given the shared metabolic pathways and overlapping risk profiles of MASLD, MASH, and CKD, particularly in relation to obesity, insulin resistance, and hypertension, there is a compelling need to address these conditions not in isolation but as part of a broader, interconnected spectrum of metabolic diseases.