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Background: Nonalcoholic fatty liver disease (NAFLD)-including cirrhosis has emerged as a central component of the global chronic liver disease burden. Its progression is closely linked to metabolic syndrome and exhibits significant geographic and population-specific heterogeneity. This study systematically analyzed the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) of NAFLD-including cirrhosis at global, regional, and national levels from 1990 to 2021, using data from the Global Burden of Disease Study 2021 (GBD 2021). Materials and Methods: Data were sourced from GBD 2021. To quantify temporal trends in age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) for NAFLD-including cirrhosis, estimated annual percentage changes were calculated for 1990–2021. Analyses were stratified by sex, 20 age-groups, 5 socio-demographic index (SDI) quintiles, 21 GBD regions and 204 countries and territories. Statistical analyses and visualizations were performed using R software (version 4.5.1). Results: In 2021, the global burden of NAFLD-including cirrhosis remained substantial. Total cases reached 1 267 815 566 (95% uncertainty interval UI: 1 157 880 130–1 380 382 443), with ASPR at 15 017.5 per 100 000 (13 755.8–16 360.8), ASIR at 592.8 per 100 000 (542.2–643.2), ASMR at 1.14 per 100 000 (0.82–1.52), and ASDR at 30.9 per 100 000 (22.2–41.5). Significant regional heterogeneity was observed. Low–middle SDI regions had the highest ASMR and ASDR, while middle SDI regions led in ASPR and ASIR. Geographically, Andean Latin America had the highest ASMR and ASDR globally, whereas East Asia had the lowest; North Africa and the Middle East ranked highest for ASIR and ASPR, high-income North America had the lowest ASIR, and Southeast Asia the lowest ASPR. Conclusions: Global NAFLD-including cirrhosis burden exhibits marked regional heterogeneity. High mortality in low–middle SDI regions likely reflects limited healthcare resources, while high prevalence in middle SDI regions correlates with metabolic syndrome prevalence. The extreme burden in Andean Latin America underscores the impact of restricted healthcare access. Given these findings, intervention strategies should be tailored to regional contexts. We therefore recommend prioritizing integrated metabolic management in middle SDI regions with a high burden of metabolic syndrome, and strengthening capacity for complication prevention in resource-constrained low–middle SDI regions, to effectively reduce disparities in disease burden.
Chen et al. (Thu,) studied this question.