Non-Alcoholic Fatty Liver Disease Associated with Increased Global Burden

Data show global burden of NAFLD increased, while burden of cirrhosis decreased in adolescents and young adults.

A recent study presented during Digestive Disease Week (DDW) 2021 Virtual Conference aimed to describe the global burden of cirrhosis as the most common complication of chronic liver disease (CLD), among adolescents and young adults.

Investigators, led by Zobair Younossi, MD of the Inova Fairfax Medical Campus, found the global burden of hepatitis B virus (HBV) cirrhosis incidence among adolescents and young adults is decreasing, while non-alcoholic fatty liver disease (NAFLD) resulted in increased incidence.


Investigators used the Global Burden of Disease (GBD) database to assess incidence, deaths, and disability-adjusted life-years (DALYs) related to liver cancer (LC) and cirrhosis.

Patients included early adolescents (15 – 19 years), late adolescents (20 – 24 years), and young adults (25 – 29 years) from 2009 – 2019.

Younossi and colleagues used GBD study estimation methods in assessment of cirrhosis incidence and deaths, according to 21 GBD regions.

The team also calculated the annual percent change (APC) using a Joinpoint regression model.


Investigators found a total of 2,051,554 incidence cases of cirrhosis and 1,472,012 cirrhosis related deaths worldwide. In this data set, adolescents and young adults made up 11.3% of cirrhosis incidence and 37.7% of cirrhosis death.

Data show cirrhosis rates per 100,000 annually from 2009 - 2019 increased for adolescents from 7.23 to 8.12, with an annual percent change (APC) of 1.18% (P <.001). The rate remained stable among adults, from 18.27 to 18.29 (APC 0.02%, P = .651).

The team noted that trends in cirrhosis incidence rates differed across GBD regions, with every 2 in 3 regions experiencing a worsening trend (APC ≥0%) in cirrhosis incidence rates among adolescents.

However, the team found in contrast to incidence rates, the overall cirrhosis death rate per 100,000 annually decreased in all age groups within the study.

In adolescents, the rate decreased from 2.02 to 1.76 (APC -1.60%, P < .001). The rate also decreased in late adolescents from 3.07 to 2.85 (APC = -0.78%, P < .001) and in young adults from 5.43 to 4.55 (APC = -1.89%, P < .001).

Investigators noted the improvement in death rate trends were due to the decrease in proportion of cirrhosis deaths related to HBV (P < .001), while the proportion of death from HCV and NAFLD increased (P < .001).

Age played a factor in incidence rates, where an increase in proportion of death with NAFLD rose with age (adolescent APC 0.05%, late adolescent APC 0.34%, and young adults 0.59%, P < .001).

Data show among causes for cirrhosis death, the highest sociodemographic index-adjusted correlation with type 2 diabetes and high BMI was NAFLD in all age groups.


Investigations concluded the global burden of NAFLD is on the rise, while the global burden of HBV and HCV among adolescents and young adults is decreasing.

“This data should inform policy makers to address the global public health challenges of NAFLD among all age groups,” investigators wrote.

The study, “Non-alcoholic fatty liver disease (NAFLD) is Driving the Global Burden of Chronic Liver Disease (CLD) Among Adolescents and Young Adults,” was published online by DDW.