NAFLD in adolescents aged 10–19: Global Burden of Disease analysis from 1990 to 2021

This study analyzes long-term trends in nonalcoholic fatty liver disease (NAFLD) burden among adolescents aged 10 to 19 years using Global Burden of Disease (GBD) data (1990–2021). Utilizing GBD 2021 data, we assessed NAFLD incidence, prevalence, mortality, disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs) globally, regionally, nationally, and by sex, incorporating sociodemographic index (SDI) stratification; frontier analysis and health inequality assessments were also conducted. Findings reveal a substantial increase in global NAFLD burden: incidence rose 24.2% to 530.28 per 100,000 (95% confidence interval [CI]: 406.24–669.20), prevalence increased 17.7% to 2567.44 per 100,000 (95% CI: 1962.91–3275.69), and DALYs grew 7.7% to 1.67 per 100,000 (95% CI: 1.07–2.55). Significant sex disparities existed, with higher 2021 male incidence (620.50 per 100,000 [95% CI: 476.85–780.21]) and EAPC (0.93 [95% CI: 0.84–1.01]) versus females (434.68 per 100,000 [95% CI: 331.41–548.06]; EAPC 0.79 [95% CI: 0.75–0.85]). SDI stratification showed high-middle SDI regions bore the highest incidence (594.96 per 100,000 [95% CI: 458.84–748.69]) and prevalence (2769.36 per 100,000 [95% CI: 2115.84–3581.69]), while low SDI regions had the highest DALYs (2.31 per 100,000 [95% CI: 1.35–3.59]) and mortality (0.03 per 100,000 [95% CI: 0.02–0.05]). Prevalence increased universally across all 21 GBD regions, peaking in North Africa/Middle East (1109.96 per 100,000 [95% CI: 860.27–1395.52]). Equatorial Guinea exhibited the highest prevalence EAPC increase (2.04 [95% CI: 1.93–2.15]), contrasting with Japan’s decrease. Health inequities worsened significantly, evidenced by a decline in the DALY concentration index from −0.28 (95% CI: −0.38 to −0.16) to −0.38 (95% CI: −0.47 to −0.28). Frontier analysis indicated most high-SDI nations managed lower burdens, though several mid-high SDI countries underperformed. This escalating adolescent NAFLD pandemic, characterized by rising metabolic morbidity and widening socioeconomic disparities, necessitates urgent targeted interventions and health policy reforms for mitigation.