Epidemiological Transition of Nonalcoholic Fatty Liver Disease and Cirrhosis in Asia: Three Decades of Spatiotemporal Dynamics, Health Inequality, and Future Burden.

OBJECTIVE

To analyze spatiotemporal distribution, health inequalities, and future trends of nonalcoholic fatty liver disease (NAFLD) burden in Asia from 1990 to 2023.

METHODS

Using Global Burden of Disease (GBD) 2023 data, age-standardized prevalence rates (ASPRs), incidence rates (ASIR), mortality rates (ASMR), and disability-adjusted life years (DALYs) rates (ASDR) were calculated. Joinpoint regression analyzed temporal trends, age-period-cohort models evaluated multidimensional effects, and Das Gupta decomposition explored contributions from population, aging, and epidemiological factors. Data envelopment analysis (DEA) assessed relationships with Human Development Index (HDI), while slope index of inequality (SII) and concentration index (CI) analyzed health inequalities. Bayesian age-period-cohort (BAPC) model projected 2024-2038 trends.

RESULTS

In 2023, Asia carried 797.20 million prevalent cases (95% UI 693.74-910.71), 30.61 million incident cases, 27,083 deaths, and 760,383 DALYs. ASPR and ASIR had increased since 1990 (EAPC +0.851% and +0.696%), while ASMR (-0.903%) and ASDR (-0.895%) had fallen. Country dispersion was extreme: Kuwait's ASPR exceeded Japan's more than fourfold, and Central Asia's ASMR was an order of magnitude above East Asia's. Decomposition attributed 69.75% of prevalence-burden change to population growth and 29.00% to epidemiologic factors; East Asia was uniquely dominated by aging (47.24%). DEA flagged efficiency gaps in several upper-HDI states, including Kazakhstan and the Gulf countries. SII rose from 4.882 to 8.864 (81.6%), while CI remained negative throughout, signaling widening absolute inequality and persistent concentration of burden among lower-HDI populations. Projections to 2038 suggested gradual decline in all four indicators.

CONCLUSION

Asia's NAFLD trajectory is not a uniform rise. Morbidity is expanding while prognosis improves, and efficiency and equity gaps are growing. One-size-fits-all continental strategies will underdeliver; development-stage-specific responses are required.