Global, Regional, and National Burden of Primary Liver Cancer Attributable to Metabolic Risks: An Analysis of the Global Burden of Disease Study 1990-2021

Chutian Wu¹, Giovanni Targher^{2

3}, Christopher D Byrne⁴, Yilei Mao⁵, Tan To Cheung⁶, Yusuf Yilmaz⁷, Luca Valenti^{8

9}, Nahum Méndez-Sánchez¹⁰, Silvia Sookoian^{11

12

13}, Wah-Kheong Chan¹⁴, Sombat Treeprasertsuk¹⁵, Hon Ho Yu¹⁶, Seung Up Kim¹⁷, Jacob George¹⁸, Dandan Hu¹⁹, Giada Sebastiani²⁰, John D Ryan²¹, Rodolfo J Oviedo²², Jian-Hong Zhong²³, Jörn M Schattenberg²⁴, Amedeo Lonardo²⁵, Elena Ruiz-Úcar²⁶, Wai-Kay Seto^{27

28

29}, Mohammadjavad Sotoudeheian^{30

31}, Ponsiano Ocama³², Monica Lupşor-Platon³³, Tian Yang³⁴, Hasmik Ghazinyan³⁵, Qiuwei Pan³⁶, Saeed Hamid³⁷, Leon Adams^{38

39}, Jin Chai^{40

41

42}, Arun Prasad⁴³, Nilanka Perera⁴⁴, Khalid Alswat⁴⁵, Vasily Isakov⁴⁶, Shiv Kumar Sarin⁴⁷, Ala I Sharara⁴⁸, Faisal M Sanai⁴⁹, Said A Al-Busafi⁵⁰, Christopher Kenneth Opio⁵¹, Carlos Jesus Toro-Huamanchumo^{52

53

54}, Wah Yang⁵⁵, Yu Jun Wong^{56

57}, Guido Torzilli⁵⁸, Yasser Fouad⁵⁹, Ming-Hua Zheng^{60

61}

Affiliations

¹ Department of Gastroenterology, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
² Department of Medicine, University of Verona, Verona, Italy.
³ Metabolic Diseases Research Unit, IRCSS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy.
⁴ Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton and University of Southampton, Southampton General Hospital, Southampton, UK.
⁵ Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, Peking Union Medical College (PUMC) & Chinese Academy of Medical Sciences (CAMS), Beijing, China.
⁶ Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
⁷ Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Türkiye.
⁸ Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
⁹ Precision Medicine and Biological Resource Center, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milano, Milan, Italy.
¹⁰ Liver Research Unit, Medica Sur Clinic & Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
¹¹ Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
¹² Faculty of Health Science, Maimónides University, Buenos Aires, Argentina.
¹³ Clinical and Molecular Hepatology, Translational Health Research Center (CENITRES), Maimónides University, Buenos Aires, Argentina.
¹⁴ Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
¹⁵ Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
¹⁶ Department of Gastroenterology and Hepatology, Kiang Wu Hospital, Macau, China.
¹⁷ Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
¹⁸ Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, Australia.
¹⁹ Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China.
²⁰ Division of Gastroenterology and Hepatology, Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada.
²¹ Department of Hepatology, RCSI School of Medicine and Medical Sciences, Beaumont Hospital, Dublin, Ireland.
²² Nacogdoches Center for Metabolic & Weight Loss Surgery, Nacogdoches Medical Center, Nacogdoches, Texas, USA.
²³ Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China.
²⁴ Department of Internal Medicine II, Saarland University Medical Center, Homburg, Germany.
²⁵ Department of Internal Medicine, Ospedale Civile di Baggiovara (-2023), Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
²⁶ Department of Metabolic, Bariatric and Endocrine Surgery, Fuenlabrada University Hospital, Madrid, Spain.
²⁷ Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China.
²⁸ Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
²⁹ State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China.
³⁰ Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
³¹ Department of General Medicine, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
³² Department of Medicine, Makerere University of College of Health Sciences, Kampala, Uganda.
³³ Department of Medical Imaging, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
³⁴ Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
³⁵ Gastroenterology and Hepatology Service, Yerevan Scientific Medical Center, Yerevan, Armenia.
³⁶ Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands.
³⁷ Department of Medicine, Aga Khan University, Karachi, Pakistan.
³⁸ Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Australia.
³⁹ Medical School, The University of Western Australia, Perth, Australia.
⁴⁰ Department of Gastroenterology, The First Affiliated Hospital (Southwest Hospital), Third Military Medical University (Army Medical University), Chongqing, China.
⁴¹ Institute of Digestive Diseases of PLA, The First Affiliated Hospital (Southwest Hospital), Third Military Medical University (Army Medical University), Chongqing, China.
⁴² Cholestatic Liver Diseases Center and Center for Metabolic-Associated Fatty Liver Disease, The First Affiliated Hospital (Southwest Hospital), Third Military Medical University (Army Medical University), Chongqing, China.
⁴³ Surgical Gastroenterology, Bariatric and Robotic Surgery, Apollo Hospital, New Delhi, India.
⁴⁴ Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
⁴⁵ Liver Disease Research Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁴⁶ Department of Gastroenterology and Hepatology, Federal Research Center for Nutrition, Biotechnology and Food Safety, Moscow, Russian Federation.
⁴⁷ Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, India.
⁴⁸ Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
⁴⁹ Gastroenterology Section, Department of Medicine, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
⁵⁰ Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
⁵¹ Department of Medicine, Aga Khan University, Nairobi, Kenya.
⁵² Universidad San Ignacio de Loyola, Lima, Peru.
⁵³ OBEMET Center for Obesity and Metabolic Health, Lima, Peru.
⁵⁴ Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.
⁵⁵ Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.
⁵⁶ Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore.
⁵⁷ Duke-NUS Medical School, Singapore.
⁵⁸ Department of Surgery, Humanitas University, School of Medicine, Milano, Italy.
⁵⁹ Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt.
⁶⁰ MAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁶¹ Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China.

PMID: 39749919
DOI: 10.14309/ajg.0000000000003288

Global, Regional, and National Burden of Primary Liver Cancer Attributable to Metabolic Risks: An Analysis of the Global Burden of Disease Study 1990-2021

Chutian Wu et al. Am J Gastroenterol. 2025.

. 2025 Oct 1;120(10):2280-2290.

doi: 10.14309/ajg.0000000000003288. Epub 2025 Jan 3.

Authors

Affiliations

¹ Department of Gastroenterology, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
² Department of Medicine, University of Verona, Verona, Italy.
³ Metabolic Diseases Research Unit, IRCSS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy.
⁴ Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton and University of Southampton, Southampton General Hospital, Southampton, UK.
⁵ Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, Peking Union Medical College (PUMC) & Chinese Academy of Medical Sciences (CAMS), Beijing, China.
⁶ Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
⁷ Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Türkiye.
⁸ Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
⁹ Precision Medicine and Biological Resource Center, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milano, Milan, Italy.
¹⁰ Liver Research Unit, Medica Sur Clinic & Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
¹¹ Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
¹² Faculty of Health Science, Maimónides University, Buenos Aires, Argentina.
¹³ Clinical and Molecular Hepatology, Translational Health Research Center (CENITRES), Maimónides University, Buenos Aires, Argentina.
¹⁴ Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
¹⁵ Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
¹⁶ Department of Gastroenterology and Hepatology, Kiang Wu Hospital, Macau, China.
¹⁷ Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
¹⁸ Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, Australia.
¹⁹ Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China.
²⁰ Division of Gastroenterology and Hepatology, Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada.
²¹ Department of Hepatology, RCSI School of Medicine and Medical Sciences, Beaumont Hospital, Dublin, Ireland.
²² Nacogdoches Center for Metabolic & Weight Loss Surgery, Nacogdoches Medical Center, Nacogdoches, Texas, USA.
²³ Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China.
²⁴ Department of Internal Medicine II, Saarland University Medical Center, Homburg, Germany.
²⁵ Department of Internal Medicine, Ospedale Civile di Baggiovara (-2023), Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
²⁶ Department of Metabolic, Bariatric and Endocrine Surgery, Fuenlabrada University Hospital, Madrid, Spain.
²⁷ Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China.
²⁸ Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
²⁹ State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China.
³⁰ Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
³¹ Department of General Medicine, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
³² Department of Medicine, Makerere University of College of Health Sciences, Kampala, Uganda.
³³ Department of Medical Imaging, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
³⁴ Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
³⁵ Gastroenterology and Hepatology Service, Yerevan Scientific Medical Center, Yerevan, Armenia.
³⁶ Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands.
³⁷ Department of Medicine, Aga Khan University, Karachi, Pakistan.
³⁸ Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Australia.
³⁹ Medical School, The University of Western Australia, Perth, Australia.
⁴⁰ Department of Gastroenterology, The First Affiliated Hospital (Southwest Hospital), Third Military Medical University (Army Medical University), Chongqing, China.
⁴¹ Institute of Digestive Diseases of PLA, The First Affiliated Hospital (Southwest Hospital), Third Military Medical University (Army Medical University), Chongqing, China.
⁴² Cholestatic Liver Diseases Center and Center for Metabolic-Associated Fatty Liver Disease, The First Affiliated Hospital (Southwest Hospital), Third Military Medical University (Army Medical University), Chongqing, China.
⁴³ Surgical Gastroenterology, Bariatric and Robotic Surgery, Apollo Hospital, New Delhi, India.
⁴⁴ Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
⁴⁵ Liver Disease Research Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁴⁶ Department of Gastroenterology and Hepatology, Federal Research Center for Nutrition, Biotechnology and Food Safety, Moscow, Russian Federation.
⁴⁷ Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, India.
⁴⁸ Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
⁴⁹ Gastroenterology Section, Department of Medicine, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
⁵⁰ Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
⁵¹ Department of Medicine, Aga Khan University, Nairobi, Kenya.
⁵² Universidad San Ignacio de Loyola, Lima, Peru.
⁵³ OBEMET Center for Obesity and Metabolic Health, Lima, Peru.
⁵⁴ Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.
⁵⁵ Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.
⁵⁶ Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore.
⁵⁷ Duke-NUS Medical School, Singapore.
⁵⁸ Department of Surgery, Humanitas University, School of Medicine, Milano, Italy.
⁵⁹ Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt.
⁶⁰ MAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁶¹ Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China.

PMID: 39749919
DOI: 10.14309/ajg.0000000000003288

Abstract

Introduction: The global burden of metabolic diseases is increasing, but estimates of their impact on primary liver cancer are uncertain. We aimed to assess the global burden of primary liver cancer attributable to metabolic risk factors, including high body mass index (BMI) and high fasting plasma glucose (FPG) levels, between 1990 and 2021.

Methods: The total number and age-standardized rates of deaths and disability-adjusted life years (DALYs) from primary liver cancer attributable to each metabolic risk factor were extracted from the Global Burden of Disease Study 1990-2021. The metabolic burden trends of liver cancer across regions and countries by sociodemographic index (SDI) and sex were estimated. The annual percentage changes in age-standardized DALYs rate were also calculated.

Results: Globally, in 2021, primary liver cancer attributable to high BMI and/or high FPG was estimated to have caused 59,970 deaths (95% uncertainty interval [UI] 20,567-104,103) and 1,540,437 DALYs (95% UI 540,922-2,677,135). The age-standardized rates of death and DALYs were 0.70 (95% UI 0.24-1.21) and 17.64 (95% UI 6.19-30.65) per 100,000 person-years. A consistent global rise in liver cancer attributable to metabolic risks was observed from 1990 to 2021, with high BMI identified as the major contributing risk factor. The highest burden of deaths and DALYs of liver cancer consistently occurred in high SDI countries, while the fastest growth trends were observed in low-middle SDI countries. The burdens of high levels of BMI and FPG were higher in men than in women.

Discussion: Primary liver cancer attributable to high BMI and/or high FPG imposes an increasingly substantial clinical burden on global public health, particularly in high SDI countries. Rapid growth trends are also found in middle SDI countries.

Keywords: DALYs; death; liver cancer; metabolic risk factors.

PubMed Disclaimer

References

1. Gao F, Chen G, Byrne CD, et al. Metabolic dysfunction-associated fatty liver disease and hepatocellular carcinoma: Present and future. Hepatobiliary Surg Nutr 2023;12(6):945–8.
1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024;74(3):229–63.
1. Sagnelli E, Macera M, Russo A, et al. Epidemiological and etiological variations in hepatocellular carcinoma. Infection 2020;48(1):7–17.
1. Wang M, Liu J, Yan L, et al. Burden of liver cancer attributable to high fasting plasma glucose: A global analysis based on the global burden of disease study 2019. J Nutr Health Aging 2024;28(6):100261.
1. Rumgay H, Arnold M, Ferlay J, et al. Global burden of primary liver cancer in 2020 and predictions to 2040. J Hepatol 2022;77(6):1598–606.

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Global, Regional, and National Burden of Primary Liver Cancer Attributable to Metabolic Risks: An Analysis of the Global Burden of Disease Study 1990-2021

Affiliations

Global, Regional, and National Burden of Primary Liver Cancer Attributable to Metabolic Risks: An Analysis of the Global Burden of Disease Study 1990-2021

Authors

Affiliations

Abstract

References

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical