Global liver cancer burden attributed to high body mass index: trends, projections, and its relationship with socioeconomic development status (1990-2021).

As the third leading cause of cancer-related mortality globally, liver cancer exhibits a rising metabolic risk profile, with high BMI emerging as a critical etiological driver. To systematically quantify the global burden of liver cancer disease attributable to high BMI from 1990 to 2021 and project its epidemiological trajectory through 2036. Using the Global Burden of Disease data for 2021, we analyzed mortality rates, disability-adjusted life years (DALYs), and age-standardized rates categorized by sex, age, time cohort, and sociodemographic index (SDI) strata. We employed spatiotemporal clustering to identify regional patterns of burden, and utilized autoregressive integrated moving average models to predict future trends. In 2021, high BMI accounted for 46 200 (95% uncertainty interval: 42 800-49 700) liver cancer deaths and 1.24 million (95% uncertainty interval: 1.15-1.33) DALYs globally, representing 3.5 and 3.2% increases from 1990, respectively. The burden of deaths and DALYs demonstrated significant sex differences (male to female ratio of 1.6 : 1 and 1.9 : 1, respectively), age-dependent progression (peak mortality at 90-94 years for men: 6.54 per 100 000; peak mortality at 95+ for women: 6.53 per 100 000), and SDI-associated increases (R2 = 0.039, P < 0.0001). Projections indicate that the age-standardized death rate will rise to 17.63 per 100 000 (95% uncertainty interval: 16.83-18.44) by 2036, representing a 120% increase from 2021 levels. High BMI-associated liver cancer burden has intensified globally since 1990, disproportionately affecting males, aging populations, and high-SDI regions. Accelerated epidemiological transitions and persistent obesity trends suggest continued burden escalation without targeted metabolic intervention strategies.