Global non-alcoholic fatty liver disease: analysis of the Global Burden of Disease Study (1990 to 2021)

Recent meta-analyses highlight the rising global incidence of non-alcoholic fatty liver disease, now the fastest-growing cause of liver-related mortality and a leading driver of end-stage liver disease. Previous estimates needed updated assessments of its epidemiological burden. Using Global Burden of Disease 2021 data, we analyzed age-standardized prevalence, incidence, and disability-adjusted life years for non-alcoholic fatty liver disease across 204 countries /regions from 1990 to 2021. Trends in disease burden were evaluated by sex, age, region, and Socio-Demographic Index. Between 1990 and 2021, non-alcoholic fatty liver disease incidence increased by 31.5% (466 to 613 cases/100 000 population), with new cases rising 94.5% (24.86 to 48.35 million). Prevalence surged 52% (10.58% to 16.07%), affecting 1.268 billion individuals (+124.8%). Disability-adjusted life years increased 46.7% (31.67 to 46.47 years/100 000 population), totaling 3.667 million (+117.2%). Middle-aged adults (30 to 60 years) accounted for 55% of cases, with female prevalence peaking at 35 to 44 years. Women ≥65 years had higher prevalence (18.2% vs 15.5% in men) and bore 30% of disability-adjusted life years. Men aged 15-60 had 40% higher prevalence due to smoking and high-fat diets. The Middle East, China, and Southeast Asia contributed over half of global cases, while high-income regions reported the highest disability-adjusted life years rates due to metabolic risks and aging. Hyperglycemia accounted for 38% of global disability-adjusted life years, and smoking contributed 28% in low/middle-income regions, declining from 22% to 15% in high Socio-Demographic Index nations. Targeted interventions such as metabolic risk reduction via diabetes control and diet in high-SDI nations, tobacco control and low-fat diets in low/middle-income regions, smoking & obesity counseling for men aged 15 to 60, menopause metabolic monitoring for women ≥65 are needed. Integrating non-alcoholic fatty liver disease into chronic disease programs, prioritizing exercise/diet strategies, and tailoring policies to regional Socio-Demographic Index are key to easing its burden.