The burden of metabolic diseases in Chinese youth, 1990-2021: a Global Burden of Disease Study 2021.

BACKGROUND

Socioeconomic shifts have increased metabolic disorders, yet long-term trends among Chinese youth (aged 5-24 years) remain under-researched.

OBJECTIVES

To examine the disease burden of metabolic disorders in China's population aged 5-24 years (1990-2021) and compare with global levels.

DESIGN

A population-based modeling study utilizing Global Burden of Disease (GBD) 2021 data.

METHODS

We analyzed disability-adjusted life years (DALYs) and age-standardized DALY rates (ASDR) for hypertension (HTN), non-alcoholic fatty liver disease (NAFLD), obesity, and Type 2 diabetes mellitus (T2DM). Trends were assessed using Joinpoint regression. The Bayesian age-period cohort (BAPC) model predicted trends. Drivers were explored via decomposition analysis.

RESULTS

HTN ASDR decreased significantly (average annual percentage change (AAPC) = -2.89%), faster than the global average. Obesity and T2DM ASDRs surged (AAPCs: 3.06% and 3.12%), consistent with global upward trends. Despite lower NAFLD (AAPC = -1.84%), the burden rebounded after the mid-2010s, particularly among females. Males bore higher DALY proportions. BAPC predicted improving HTN but worsening obesity and T2DM by 2030. Epidemiological shifts primarily enhanced DALY increases. Population growth and aging provided mitigating effects.

CONCLUSION

Chinese youth face a bifurcated metabolic landscape: improving HTN but worsening obesity and T2DM. The recent NAFLD resurgence among females necessitates targeted public health interventions.

IMPACT: Key Message: The study highlights worsening burdens of obesity and T2DM among Chinese youth, alongside improving trends in HTN and NAFLD, with significant sex disparities. Added Value: Provides a comprehensive, sex- and age-stratified analysis of metabolic disease burdens in China, using advanced decomposition and projection methods.

IMPACT: Calls for urgent, targeted interventions to address rising obesity and T2DM, emphasizing the need for sex-specific public health strategies.