Global burden of metabolic dysfunction-associated steatotic liver disease attributable to high fasting plasma glucose in 204 countries and territories from 1990 to 2021

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) brings heavy clinical and economic burdens to patients worldwide. High fasting plasma glucose (HFPG) was proven to be an important modifiable risk factor. However, the global burden distribution of HFPG-attributable MASLD has not been fully studied. This study aimed to describe the epidemiological distribution and trends of the burden of HFPG-attributable MASLD worldwide. The data source was the 2021 Global Burden of Disease Study. Descriptive statistics were mainly conducted using disability-adjusted life years (DALYs) and deaths of HFPG-attributable MASLD from 1990 to 2021, as well as their age-standardized rates (ASRs) and population-attributable fractions. Subgroup analyses were conducted by region, age group, and sex. We found that 213.48 thousand DALYs and 10.02 thousand deaths in MASLD were attributable to HFPG worldwide in 2021, with an increase of 2.96 and 3.32 times compared with 1990, respectively. Over the past 32 years, age-standardized DALY rates (ASDRs) have fluctuated upward, reaching 2.45 per 100,000 people in 2021, with an increase of 81.21%. The ASDRs continued to rise in low, low-middle, and high social demographic index (SDI) regions, fluctuated upward at high levels in middle SDI regions, and were relatively low in high-middle SDI regions. People aged 50-69 accounted for the largest proportion of DALYs, while people over 70 had the largest increase of 3.73 times. Men had higher ASDRs, and the sex difference has been gradually expanding over the past 32 years, peaking at the age of 45-49. In conclusion, the burden of HFPG-attributable MASLD has continued to increase globally, with differences in geographical area, age, and sex distribution. HFPG, as a modifiable risk factor, should be given more importance. The implementation of targeted health intervention strategies is recommended for each country based on trends in the burden of HFPG-attributable MASLD.

Keywords: Disability-adjusted life years; Ecological study; Global burden of disease; High fasting plasma glucose; Metabolic dysfunction-associated steatotic liver disease; Non-alcoholic fatty liver disease.

Fig. 1

Global trends in the PAF of ASD (A), ASDRs (B), ASR-YLDs (C), ASR-YLLs (D) of HFPG-attributable MASLD, 1990–2021. ASD age-standardized disability-adjusted life-years, ASDR age-standardized disability-adjusted life-years rate, ASR age-standardized rate, HFPG high fasting plasma glucose, MASLD metabolic dysfunction-associated steatotic liver disease, PAF population-attributable fraction, SDI sociodemographic index, YLD years lived with disability, YLL years of life lost.

Fig. 2

ASDRs in 2021 (A) and percentage of changes in ASDRs in 32 years (B) of HFPG-attributable MASLD in 204 countries and territories. ASDR age-standardized disability-adjusted life-year rate, HFPG high fasting plasma glucose, MASLD metabolic dysfunction-associated steatotic liver disease.

Fig. 3

Trends of DALYs of HFPG-attributable MASLD in different regions by age, 1990–2021. (A) Total DALYs; (B) Percentage of changes in DALY rates in 32 years; (C) DALY rates and DALYs in 15 age groups. DALY disability-adjusted life-year, HFPG high fasting plasma glucose, MASLD metabolic dysfunction-associated steatotic liver disease, SDI sociodemographic index.

Fig. 4

Trends of DALYs of HFPG-attributable MASLD in different regions by sex, 1990–2021. (A) Total DALY; (B) ASDRs; (C) Percentage of changes in 32 years; (D) MWRs of ASDRs; (E) MWRs of DALY rates. ASDR age-standardized disability-adjusted life-year rate, DALY disability-adjusted life-year, HFPG high fasting plasma glucose, MWR men-to-women ratio, MASLD metabolic dysfunction-associated steatotic liver disease, SDI sociodemographic index.

Fig. 5

The trends between SDI and the burden of HFPG-attributable MASLD across 204 countries and territories and 21 GBD regions, 1990–2021. (A) ASDRs in 2021; (B) ASMRs in 2021; (C) ASDRs and PAFs of ASD across 21 GBD regions, 1990–2021. ASD age-standardized disability-adjusted life-years, ASDR age-standardized disability-adjusted life-years rate, ASMR age-standardized mortality rate, GBD global burden of disease, HFPG high fasting plasma glucose, MASLD metabolic dysfunction-associated steatotic liver disease, PAF population-attributable fraction; SDI, sociodemographic index.