Table 1.
ASIR and ASPR of NAFLD in 1990 and 2021 for all locations, with EAPC from 1990 and 2021.
Table 2.
ASMR and ASDR of NAFLD in 1990 and 2021 for all locations, with EAPC from 1990 and 2021.
Fig 1.
Global Burden of NAFLD in Adults Aged ≥45 Years (2021) A: Age-standardized incidence rates (per 100,000 population).
Highest rates in Afghanistan, Iran, and Libya; lowest in Denmark, Japan, and Switzerland. B: Age-standardized prevalence rates (per 100,000 population). Highest in Kuwait, Egypt, Iran, Qatar, and Saudi Arabia; lowest in Japan, Denmark, and Finland. C: Age-standardized mortality rates (per 100,000 population). Highest in Egypt and Mongolia; lowest in Papua New Guinea and Sri Lanka. D: Age-standardized DALY rates (per 100,000 population). Highest in Egypt and Mexico; lowest in Singapore and Papua New Guinea. Abbreviations: NAFLD, Nonalcoholic Fatty Liver Disease; DALY, Disability-Adjusted Life Year. Uncertainty intervals (95% UI) denote data variability. Basemap source: Natural Earth (public domain, https://www.naturalearthdata.com/). Maps were generated using the rnaturalearth package in R.
Fig 2.
Trends in Age-Standardized NAFLD Rates by SDI Quintiles and GBD Regions (1990–2021) A: Incidence rates showing a bell-shaped SDI correlation, peaking in medium-SDI regions (e.g., North Africa/Middle East).
B: Prevalence rates mirroring incidence trends, with highest burdens in medium-SDI regions. C: Mortality rates exhibiting nonlinear SDI associations, highest in Andean and Central Latin America. D: DALY rates highlighting severe burdens in Andean Latin America and Central Latin America. Abbreviations: SDI, Socio-demographic Index; GBD, Global Burden of Disease; ASIR, Age-Standardized Incidence Rate; ASPR, Age-Standardized Prevalence Rate; ASMR, Age-Standardized Mortality Rate; ASDR, Age-Standardized DALY Rate.
Fig 3.
Sex-Stratified Trends in Age-Standardized DALY Rates (1990–2021) A: Both sexes.
Eastern Europe showed the steepest increase (EAPC = 3.36). B: Females. Andean Latin America had the highest rates with rising trajectories. C: Males. Southern Sub-Saharan Africa experienced sharp increases before stabilizing post-1998. Abbreviations: EAPC, Estimated Annual Percentage Change. Shaded areas represent 95% uncertainty intervals.
Fig 4.
Sex-Specific Mortality and DALY Rates by Region (2021) A: Age-standardized mortality rates (ASMR).
Andean Latin American women bore the highest burden. B: Age-standardized DALY rates (ASDR). Andean Latin America and North Africa/Middle East had the highest rates, with women disproportionately affected. Regional order: Ranked from highest to lowest burden. GBD regions are grouped by SDI levels.
Fig 5.
Health Inequality in DALY Rates by SDI (1990 vs. 2021).
Slope Index of Inequality (SII) for age-standardized DALY rates. Negative SII values (−0.39 in 1990; −0.33 in 2021) indicate higher burdens in low-SDI regions. The narrowing gap reflects reduced inequality between high- and low-income nations. Abbreviations: SII, Absolute difference in DALY rates between extreme SDI percentiles.
Fig 6.
Concentration Indices (CI) for NAFLD Burden Metrics (1990 vs. 2021).
A: Incidence CI shifted from 0.02 (1990) to −0.04 (2021), indicating growing disparities in disease onset. B: Prevalence CI changed from 0 (1990) to −0.06 (2021), reflecting widening inequalities in disease persistence. C: Mortality CI improved from −0.15 (1990) to −0.12 (2021), signaling reduced mortality inequality. D: DALY CI rose from −0.13 (1990) to −0.10 (2021), showing modest reductions in disability inequality. Abbreviations: Negative CI, Concentration of burden in low-SDI populations.
Fig 7.
BAPC Projections of NAFLD Burden to 2035.
A–B: Incidence rates projected to rise, with women consistently higher (826.11 vs. 665.72 per 100,000 by 2035). C–D: Mortality rates declining more sharply in women (11.97% reduction) than men (9.60%). E–F: DALY rates decreasing, with steeper declines in women (10.88% vs. 9.98% in men). Abbreviations: BAPC, Bayesian age-period-cohort modeling. Dashed lines represent Projections; shaded areas represent 95% uncertainty intervals.
Fig 8.
Decomposition Analysis of NAFLD Incidence Drivers (1990–2021).
A: Global contributions to incidence change.population growth (58.68%) and Epidemiological shifts (33.76%) were primary drivers; aging had minimal impact (7.56%). B: Contributions to the rise in NAFLD prevalence among adults aged ≥45 years: Population growth, Epidemiological shifts and aging accounted for 81.97%, 18.97% and −0.63% respectively.