Global and Chinese burden of three major non-communicable diseases attributable to high BMI: trends from 1990 to 2021 and projections to 2050

Chronic non‑communicable diseases (NCDs) are the leading cause of mortality worldwide. High body mass index (BMI) is a major modifiable risk factor for NCDs. This study aimed to compare temporal trends and age- and sex-specific patterns of high BMI-attributable NCD burden in China and globally from 1990 to 2021, disentangle the underlying drivers, and project the burden to 2050. We used data from the Global Burden of Disease Study 2021 (GBD 2021) to estimate deaths and disability‑adjusted life years (DALYs) attributable to high BMI for neoplasms, cardiovascular diseases (CVDs), and diabetes mellitus in China and globally from 1990 to 2021. We applied Joinpoint regression, Age‑Period‑Cohort (APC) analysis, and decomposition analysis to identify temporal trends, inflection points, and driving factors, and used autoregressive integrated moving average (ARIMA) time series models to project future trends through 2050. In 2021, age‑standardized mortality rates (ASMR) per 100,000 population in China attributable to high BMI were 2.81 (95% UI 1.20–4.76) for neoplasms, 18.80 (10.07–29.43) for CVDs, and 3.57 (1.37–5.72) for diabetes; corresponding age‑standardized DALY rates (ASDR) were 79.17 (33.82–134.14), 396.09 (197.27–638.54), and 292.46 (136.21–439.33), all higher than global averages. From 1990 to 2021, China showed positive AAPCs for neoplasms (ASMR, 2.4%; ASDR, 2.3%), CVDs (ASMR, 1.0%; ASDR, 1.1%), and diabetes (ASMR, 1.1%; ASDR, 2.3%). Compared with the corresponding global estimates, the increases were more pronounced for neoplasms, CVDs, and diabetes ASDR, whereas the diabetes ASMR trends were similar. Decomposition revealed that epidemiological change was the dominant driver in China, whereas population growth was the main driver globally, with smaller, outcome-specific contributions from aging. ARIMA projections suggested that the burden of high BMI-related NCDs in China may continue to increase through 2050, particularly for neoplasms and CVDs. The deaths and DALYs burden of NCDs attributable to high BMI in China and globally showed an increasing trend since 1990 and will continue increasing through 2050. Epidemiological changes were the predominant driver in China, whereas population growth was the main driver globally. Targeted screening and proactive weight-management strategies for high-risk populations may help mitigate the growing burden of high BMI-related NCDs.