The evolving burden of non-alcoholic fatty liver disease in China: A comprehensive analysis from the Global Burden of Disease (GBD) study 1990–2021

BackgroundNon-alcoholic fatty liver disease (NAFLD) poses a growing global public health challenge, yet its long-term trajectory and future burden in China remain insufficiently characterized.AimThis study quantified the disease burden of NAFLD in China from 1990 to 2021 and projected trends to 2036 using data from the Global Burden of Disease 2021 study.MethodsAnalytical methods included joinpoint regression, age-period-cohort modeling, decomposition analysis, frontier comparison, and autoregressive integrated moving average forecasting.SummaryFrom 1990 to 2021, NAFLD incident cases in China increased from 6.18 million to 9.56 million, while prevalent cases rose from 137.11 million to 291.25 million. Age-standardized incidence showed fluctuating, wave-like patterns with marked gender differences-male incidence surpassed female incidence around 2016-whereas age-standardized mortality and disability-adjusted life year (DALY) rates declined steadily. Decomposition analysis indicated that population growth (59.39%) and epidemiological transition (62.34%) were the primary drivers of rising incidence, while population aging was the dominant factor for increased prevalence (48.03%), mortality (174.28%), and DALYs (323.98%). Projections suggest rising incidence in females, stable incidence in males, and a modest decline in overall prevalence over the next 15 years. In conclusion, NAFLD burden in China has risen substantially over the past three decades and is expected to persist, with shifting gender patterns and population aging as key drivers. These findings highlight the urgent need for targeted preventive interventions, especially among aging populations and women.