Burden and trends of alcohol- and NAFLD/NASH-related liver disease in 5 East Asian countries: A GBD 2021 analysis

This study quantified and compared the 2006 to 2021 burden (incidence, mortality, and disability-adjusted life years DALYs) of alcohol- and nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH)-related cirrhosis and hepatocellular carcinoma (HCC) across China, Japan, South Korea, North Korea (Democratic People’s Republic of Korea DPRK), and Mongolia to inform targeted prevention and policy priorities. Utilizing Global Burden of Disease (GBD) 2021 data, we analyzed the epidemiology of alcohol-related liver disease and NAFLD/NASH leading to cirrhosis and HCC. Using data from the GBD 2021 study, we calculated age-standardized incidence rates, age-standardized mortality rates, and age-standardized DALY rates, and assessed temporal trends using estimated annual percentage changes and segmented regression analysis. In 2021, China recorded the highest absolute all-age incidence, mortality, and DALYs for alcoholic cirrhosis, NASH-related HCC, and NAFLD-related cirrhosis. However, in terms of age-standardized incidence rates, age-standardized mortality rates, and age-standardized DALY rates, Mongolia bears the heaviest overall disease burden. Conversely, the lowest age-standardized burdens varied: alcohol-related HCC was lowest in DPRK, alcoholic cirrhosis in China, NASH-related HCC in Japan, and NAFLD in South Korea and Japan. From 2006 to 2021, alcohol-related HCC metrics declined in Japan, South Korea, and DPRK but rose modestly in China and Mongolia. Alcoholic cirrhosis declined in all 5 countries, most notably in Japan, South Korea, and Mongolia. NASH-related HCC generally decreased in Japan, South Korea, and DPRK, while increasing slowly in China and remaining stable in Mongolia. Notably, while NAFLD prevalence and incidence rose across all 5 nations, associated DALYs declined, suggesting improved clinical management despite intensifying upstream metabolic risks. East Asian countries exhibit a heterogeneous yet convergent transition where alcohol- and metabolism-related liver diseases are displacing viral etiologies. While alcoholic cirrhosis incidence is declining regionally, the rising burden of alcohol-related HCC in China and Mongolia, alongside increasing NAFLD/NASH incidence, necessitates a policy shift. Priorities should include comprehensive alcohol control, metabolic risk reduction, and targeted fibrosis/HCC screening in high-risk populations. Although GBD data are subject to inherent biases, they provide actionable guidance for regional health strategies.