NAFLD in adolescents aged 10–19: Global Burden of Disease analysis from 1990 to 2021

This study analyzes long-term trends in nonalcoholic fatty liver disease (NAFLD) burden among adolescents aged 10 to 19 years using Global Burden of Disease (GBD) data (1990-2021). Utilizing GBD 2021 data, we assessed NAFLD incidence, prevalence, mortality, disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs) globally, regionally, nationally, and by sex, incorporating sociodemographic index (SDI) stratification; frontier analysis and health inequality assessments were also conducted. Findings reveal a substantial increase in global NAFLD burden: incidence rose 24.2% to 530.28 per 100,000 (95% confidence interval [CI]: 406.24-669.20), prevalence increased 17.7% to 2567.44 per 100,000 (95% CI: 1962.91-3275.69), and DALYs grew 7.7% to 1.67 per 100,000 (95% CI: 1.07-2.55). Significant sex disparities existed, with higher 2021 male incidence (620.50 per 100,000 [95% CI: 476.85-780.21]) and EAPC (0.93 [95% CI: 0.84-1.01]) versus females (434.68 per 100,000 [95% CI: 331.41-548.06]; EAPC 0.79 [95% CI: 0.75-0.85]). SDI stratification showed high-middle SDI regions bore the highest incidence (594.96 per 100,000 [95% CI: 458.84-748.69]) and prevalence (2769.36 per 100,000 [95% CI: 2115.84-3581.69]), while low SDI regions had the highest DALYs (2.31 per 100,000 [95% CI: 1.35-3.59]) and mortality (0.03 per 100,000 [95% CI: 0.02-0.05]). Prevalence increased universally across all 21 GBD regions, peaking in North Africa/Middle East (1109.96 per 100,000 [95% CI: 860.27-1395.52]). Equatorial Guinea exhibited the highest prevalence EAPC increase (2.04 [95% CI: 1.93-2.15]), contrasting with Japan's decrease. Health inequities worsened significantly, evidenced by a decline in the DALY concentration index from -0.28 (95% CI: -0.38 to -0.16) to -0.38 (95% CI: -0.47 to -0.28). Frontier analysis indicated most high-SDI nations managed lower burdens, though several mid-high SDI countries underperformed. This escalating adolescent NAFLD pandemic, characterized by rising metabolic morbidity and widening socioeconomic disparities, necessitates urgent targeted interventions and health policy reforms for mitigation.