# Global, regional, and national burden of nonalcoholic fatty liver disease among adults aged ≥ 45 years: A comprehensive analysis of epidemiological trends and projections to 2035

## TL;DR

This study shows that nonalcoholic fatty liver disease is increasing globally in people over 45, with rising cases and health impacts expected to 2035.

## Contribution

The study provides the first comprehensive global analysis of NAFLD trends and projections in adults aged 45+ from 1990 to 2035.

## Key findings

- NAFLD prevalence in adults aged 45+ reached 48.35 million cases in 2021, with rising incidence and prevalence rates.
- Middle-to-high SDI regions show the highest NAFLD burden, driven by aging populations.
- Women are projected to have higher NAFLD incidence by 2035, while men still face higher mortality rates.

## Abstract

Nonalcoholic fatty liver disease (NAFLD) has emerged as the leading cause for chronic liver diseases around the globe, disproportionately affecting aging populations. This research focused on the global burden of NAFLD in adults aged 45 and older from 1990 to 2021, with projections extending to 2035.

Using data from the Global Burden of Disease (GBD) Study between 1990 and 2021, we assessed the incidence, prevalence, mortality and disability-adjusted life years (DALYs) related to NAFLD in adults aged 45 and older in 204 countries and territories. To evaluate the underlying drivers including demographics and lifestyle, Bayesian age-period-cohort (BAPC) modeling was employed.

In 2021, the worldwide prevalence of NAFLD has reached 48.35 million cases (with a 95% uncertainty interval of 44.23 to 52.36 million). Among individuals aged ≥ 45 years, age-standardized incidence rose by 18.3% (EAPC = 0.53) from 1990 to 2021, while prevalence increased by 24.5% (EAPC = 0.74). Mortality and DALYs also climbed, with Egypt, Mongolia, and Andean Latin America bearing the highest burdens. A bell-shaped Socio-Demographic Index (SDI) correlation emerged, peaking in medium-SDI regions (e.g., North Africa, Middle East). Projections indicate persistent female predominance, with ASIR expected to rise to 826.11 (women) vs. 665.72 (men) per 100,000 by 2035.

This analysis explored the global burden of NAFLD in people aged 45 years and older from 1990 to 2021, demonstrating significant epidemiological changes. Age-standardized incidence and prevalence rates rose by 18.3% and 24.5%, respectively, with the most pronounced burden observed in middle-to-high SDI regions attributable to aging populations. Although women exhibited higher incidence rates, mortality rates remained consistently elevated among men, underscoring unmet intervention needs. Projections to 2035 indicate increasing incidence (particularly in women) alongside moderate declines in mortality and DALYs, underlining the requirement for prevention strategies that are specific to age and gender.