Three Decades of Epidemiological Transition in Non-Alcoholic Fatty Liver Disease and Cirrhosis in Asia: A Comprehensive Analysis of Spatiotemporal Distribution, Health Inequalities, and Future Trends

Three Decades of Epidemiological Transition in Non-Alcoholic Fatty Liver Disease and Cirrhosis in Asia: A Comprehensive Analysis of Spatiotemporal Distribution, Health Inequalities, and Future Trends | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Three Decades of Epidemiological Transition in Non-Alcoholic Fatty Liver Disease and Cirrhosis in Asia: A Comprehensive Analysis of Spatiotemporal Distribution, Health Inequalities, and Future Trends Liu Xiaoheng, Zhou chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8134919/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To analyze spatiotemporal distribution, health inequalities, and future trends of non-alcoholic fatty liver disease (NAFLD) burden in Asia from 1990–2023. Methods Using Global Burden of Disease (GBD) 2023 data, age-standardized prevalence rates (ASPR), 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 recorded 797.20 million NAFLD cases (95% uncertainty interval [UI]: 693.74-910.71 million), ASPR 14,965.250/100,000; 30.61 million incident cases, ASIR 607.867/100,000; 27,100 deaths, ASMR 0.511/100,000; and 760,400 DALYs, ASDR 13.989/100,000. During 1990–2023, ASPR and ASIR showed upward trends (estimated annual percentage change [EAPC] 0.851% and 0.696%), while ASMR and ASDR declined (EAPC − 0.903% and − 0.895%). Central Asia exhibited highest ASMR and DALYs rates; Kuwait recorded highest ASPR (35,363.464/100,000). Males showed higher burden during middle age; mortality peaked in elderly. Population growth (69.75%) and epidemiological effects (29.00%) primarily drove burden changes. Health inequalities intensified during 1990–2023. BAPC projections indicated continued ASPR and ASIR declines through 2038, with greater ASMR and ASDR improvements. Conclusion NAFLD in Asia demonstrated "rising prevalence with improving prognosis," marked regional disparities, and expanding health inequalities. Population growth was the primary burden driver, while medical advances improved outcomes. Future strategies should implement differentiated prevention measures based on socioeconomic levels, targeting high-burden regions and vulnerable populations. Strengthening metabolic disease prevention, improving early screening systems, and enhancing NAFLD management accessibility are essential for effective burden control and health equity improvement. Health sciences/Diseases Health sciences/Gastroenterology Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors NAFLD disease burden health inequalities Asian trends multidimensional analysis predictive modeling Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8134919","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":546917451,"identity":"d0927e57-2073-462e-aa30-0b4d317b37b2","order_by":0,"name":"Liu 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Trends","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"NAFLD, disease burden, health inequalities, Asian trends, multidimensional analysis, predictive modeling","lastPublishedDoi":"10.21203/rs.3.rs-8134919/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8134919/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo analyze spatiotemporal distribution, health inequalities, and future trends of non-alcoholic fatty liver disease (NAFLD) burden in Asia from 1990\u0026ndash;2023.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eUsing Global Burden of Disease (GBD) 2023 data, age-standardized prevalence rates (ASPR), 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\u0026ndash;2038 trends.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn 2023, Asia recorded 797.20\u0026nbsp;million NAFLD cases (95% uncertainty interval [UI]: 693.74-910.71\u0026nbsp;million), ASPR 14,965.250/100,000; 30.61\u0026nbsp;million incident cases, ASIR 607.867/100,000; 27,100 deaths, ASMR 0.511/100,000; and 760,400 DALYs, ASDR 13.989/100,000. During 1990\u0026ndash;2023, ASPR and ASIR showed upward trends (estimated annual percentage change [EAPC] 0.851% and 0.696%), while ASMR and ASDR declined (EAPC \u0026minus;\u0026thinsp;0.903% and \u0026minus;\u0026thinsp;0.895%). Central Asia exhibited highest ASMR and DALYs rates; Kuwait recorded highest ASPR (35,363.464/100,000). Males showed higher burden during middle age; mortality peaked in elderly. Population growth (69.75%) and epidemiological effects (29.00%) primarily drove burden changes. Health inequalities intensified during 1990\u0026ndash;2023. BAPC projections indicated continued ASPR and ASIR declines through 2038, with greater ASMR and ASDR improvements.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eNAFLD in Asia demonstrated \"rising prevalence with improving prognosis,\" marked regional disparities, and expanding health inequalities. Population growth was the primary burden driver, while medical advances improved outcomes. Future strategies should implement differentiated prevention measures based on socioeconomic levels, targeting high-burden regions and vulnerable populations. Strengthening metabolic disease prevention, improving early screening systems, and enhancing NAFLD management accessibility are essential for effective burden control and health equity improvement.\u003c/p\u003e","manuscriptTitle":"Three Decades of Epidemiological Transition in Non-Alcoholic Fatty Liver Disease and Cirrhosis in Asia: A Comprehensive Analysis of Spatiotemporal Distribution, Health Inequalities, and Future Trends","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 10:24:02","doi":"10.21203/rs.3.rs-8134919/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b1d6e874-0ede-4ec2-b0cb-a52959c1e19e","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":58184342,"name":"Health sciences/Diseases"},{"id":58184343,"name":"Health sciences/Gastroenterology"},{"id":58184344,"name":"Health sciences/Health care"},{"id":58184345,"name":"Health sciences/Medical research"},{"id":58184346,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-11-20T07:23:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-19 10:24:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8134919","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8134919","identity":"rs-8134919","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}