Global liver cancer burden attributable to high BMI from 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Na ¹ , LIU Qian ¹ , DING Ziyuan ² , MA Jianfeng ³ , WANG Yongfeng ³ ,  LI Sheng ⁴

1. School of Public Health of Lanzhou University, Lanzhou 730000, P. R. China;
2. The Second Clinical Medical College of Lanzhou University, Lanzhou 730000, P. R. China;
3. The First Clinical Medical College of Lanzhou University, Lanzhou 730000, P. R. China;
4. General Surgery Department, Lanzhou First People’s Hospital, Lanzhou 730000, P. R. China;

Corresponding author：

LI Sheng, Email: doctorlisheng@163.com

Keywords：

liver cancer; high BMI; burden of disease; global; time trend

DOI：

10.7507/1007-9424.202505015

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective This study utilized the 2021 Global Burden of Disease database to systematically analyze global liver cancer mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALY) from 1990 to 2021. It focuses on differences across genders and age groups to reveal epidemiological patterns of liver cancer attributable to high BMI, providing reference for global liver cancer prevention and control. Method Based on the 2021 Global Burden of Disease database, the Global Health Data Exchange query tool was used to extract the total number of global liver cancer deaths, DALY, age-standardized mortality rate (ASMR), and age-standardized DALY rate from 1990 to 2021. These metrics were assessed using estimated annual percentage change. Joinpoint regression analysis was employed to calculate annual percentage change and average annual percentage change , comparing differences in subtype composition from 1990 to 2021. Smooth curve regression analysis was applied to assess the correlation between liver cancer mortality and DALY rates attributable to high BMI and the socio-demographic index (SDI). Results From 1990 to 2021, the cumulative number of liver cancer deaths attributable to high BMI increased from 10 282.12 cases in 1990 ［95%UI (4 196.72, 16 721.85)］ to 46 200.88 cases［95%UI (38 606.14, 77 983.02)］ in 2021, representing a 3.5-fold increase. DALYs attributable to high BMI-related liver cancer increased from 292,696.35 years in 1990［95%UI (119 094.56, 475 962.67)］ to 1 273 312.58 years［95%UI (504 391.1, 2,101,957.87)］ in 2021, representing a 3.2-fold increase.② Cumulative deaths attributable to high BMI: For males, deaths increased from 5,913.45 cases [95% UI (2,479.64, 9,717.69)] in 1990 to 28,511.99 cases［95%UI (11 721.81, 49 277.60)］ in 2021, representing a 3.8-fold increase. For women, the cumulative number increased from 4,368.66 cases［95%UI (1 707.64, 7 078.83)］in 1990 to 17 691.88 cases［95%UI (7 169.44, 29 573.18)］in 2021, representing a threefold increase.③ Cumulative mortality values increased across all SDI income regions to varying degrees. ASMR and death counts steadily rose with increasing age, mirroring the growth trend in DALYs attributable to liver cancer associated with high BMI. Correlation analysis and slope index results demonstrated a significant positive correlation between SDI and both death counts and DALYs. The mortality concentration index rose from –0.277 (1990) to –0.258 (2021), while the DALY concentration index increased from –0.222 (1990) to –0.208 (2021). The mortality slope index increased from 0.284 (1990) to 0.881 (2021), while the DALY rate slope index rose from 7.002 (1990) to 19.244 (2021). Conclusions The burden of liver cancer associated with high BMI remains substantial and varies significantly across different age groups, genders, and geographic locations worldwide. The global disease burden of liver cancer linked to high BMI is projected to remain severe in the future, necessitating sustained attention and the development of more targeted prevention and control measures tailored to current circumstances.

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8.	Huang J, Gao T, Zhang H, et al. Association of obesity profiles and metabolic health status with liver injury among US adult population in NHANES 1999-2016. Sci Rep, 2023, 13(1): 15958. doi: 10.1038/s41598-023-43028-7.
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11.	覃胜林, 赵金华, 邓萍, 等. Joinpoint回归模型在2005-2023年青海省流行性感冒发病趋势的应用. 中华疾病控制杂志, 2024, 28(11): 1295-1300,1307.
12.	刘倩, 刘娜, 丁姿源, 等. 2001-2021年中国食道癌的疾病负担及趋势. 中国循证医学杂志, 2025, 25(9): 1012-1019.
13.	蒋露, 张志东, 吴建军, 等. 1990-2021年中国和美国肝癌疾病负担变化趋势及预测. 中国癌症防治杂志, 2025, 17(1): 55-60.
14.	Jung-Choi K, Khang YH, Cho HJ. Changes in contribution of causes of death to socioeconomic mortality inequalities in Korean adults. J Prev Med Public Health, 2011, 44(6): 249-259.
15.	Danpanichkul P, Suparan K, Dutta P, et al. Disparities in metabolic dysfunction-associated steatotic liver disease and cardiometabolic conditions in low and lower middle-income countries: a systematic analysis from the global burden of disease study 2019. Metabolism, 2024, 158: 155958. doi: 10.1016/j.metabol.2024.155958.
16.	Li Q, Ding C, Cao M, et al. Global epidemiology of liver cancer 2022: an emphasis on geographic disparities. Chin Med J (Engl), 2024, 137(19): 2334-2342.
17.	王兵. 全球及中国的肥胖症流行病学现状及趋势. 中国普外基础与临床杂志, 2025, 32(6): 661-668.
18.	黄燕萍, 张琴, 孙明瑜. 慢性乙型肝炎相关性肝细胞癌的危险因素研究进展. 肝脏, 2023, 28(1): 124-127.
19.	张宁, 张圆, 魏君, 等. 模拟饮酒干预与肝脂肪变性: 一项大型队列的纵向研究. 四川大学学报(医学版), 2024, 55(3): 653-661.
20.	殷雨来, 张银旭, 崔枫宁, 等. 1990-2021年中国和全球肝癌疾病负担趋势分析与比较及未来15年预测. 中国医学前沿杂志 (电子版), 2025, 17(2): 68-80.
21.	Younossi ZM, Golabi P, Paik JM, et al. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology, 2023, 77(4): 1335-1347.
22.	杨龙山. 肥胖相关人体测量指标与原发性肝癌发生风险及预后的系统综述和荟萃分析. 济南: 山东大学, 2024.
23.	何凤蝶, 王秋童, 胡亚男, 等. 中国人群肝癌发病危险因素病例对照研究的meta分析. 现代预防医学, 2022, 49(23): 4230-4240.
24.	Lizcano F, Guzmán G. Estrogen deficiency and the origin of obesity during menopause. Biomed Res Int, 2014, 2014: 757461. doi: 10.1155/2014/757461.
25.	Mahboobifard F, Pourgholami MH, Jorjani M, et al. Estrogen as a key regulator of energy homeostasis and metabolic health. Biomed Pharmacother, 2022, 156: 113808. doi: 10.1016/j.biopha.2022.113808.
26.	Tao Z, Cheng Z. Hormonal regulation of metabolism-recent lessons learned from insulin and estrogen. Clin Sci (Lond), 2023, 137(6): 415-434.
27.	王海鹏. 我国诊断糖尿病疾病经济负担趋势预测研究. 济南: 山东大学, 2013.
28.	Boonpor J, Petermann-Rocha F, Parra-Soto S, et al. Types of diet, obesity, and incident type 2 diabetes: findings from the UK biobank prospective cohort study. Diabetes Obes Metab, 2022, 24(7): 1351-1359.
29.	Vercalsteren E, Vranckx C, Corbeels K, et al. Carbohydrates to prevent and treat obesity in a murine model of diet-induced obesity. Obes Facts, 2021, 14(4): 370-381.
30.	GBD 2019 Human Resources for Health Collaborators. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2022, 399(10341): 2129-2154.
31.	Park B, Jung KW, Oh CM, et al. Ten-year changes in the hepatitis B prevalence in the birth cohorts in Korea: results from nationally representative cross-sectional surveys. Medicine (Baltimore), 2015, 94(41): e1469. doi: 10.1097/MD.0000000000001469.
32.	刘曼琪, 徐梦圆, 单天昊, 等. 2022年全球肝癌与胆囊癌发病死亡及2050年预测分析. 肝癌电子杂志, 2024, 11(2): 53-60.
33.	单天昊, 安澜, 徐梦圆, 等. 2020年全球肝癌和胆囊癌发病死亡分析. 肝癌电子杂志, 2022, 9(4): 46-51.
34.	姚一菲, 孙可欣, 郑荣寿. 《2022全球癌症统计报告》解读: 中国与全球对比. 中国普外基础与临床杂志, 2024, 31(7): 769-780.
35.	Rumgay H, Arnold M, Ferlay J, et 王小水批注 al. Global burden of primary liver cancer in 2020 and predictions to 2040. J Hepatol, 2022, 77(6): 1598-1606.
36.	Zhu R, Wang R, He J, et al. Prevalence of cardiovascular-kidney-metabolic syndrome stages by social determinants of health. JAMA Netw Open, 2024, 7(11): e2445309. doi: 10.1001/jamanetworkopen.2024.45309.
37.	陈嘉慧, 王海博, 柯立鑫, 等. 1990年-2021年中国因非酒精性脂肪性肝炎所致肝癌的疾病负担分析与未来趋势预测研究. 华西医学, 2025, 40(4): 546-553.
38.	Camon C, Garratt M, Correa SM. Exploring the effects of estrogen deficiency and aging on organismal homeostasis during menopause. Nat Aging, 2024, 4(12): 1731-1744.
39.	Lee MM, Barrett JL, Kenney EL, et al. A sugar-sweetened beverage excise tax in california: projected benefits for population obesity and health equity. Am J Prev Med, 2024, 66(1): 94-103.
40.	The Lancet Public Health None. Obesity: the sweet revenge of tax. Lancet Public Health, 2017, 2(1): e1. doi: 10.1016/S2468-2667(16)30041-X.

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): 229-263.
2. Campbell PT, Newton CC, Freedman ND, et al. Body mass index, waist circumference, diabetes, and risk of liver cancer for U. S. adults. Cancer Res, 2016, 76(20): 6076-6083.
3. 郝运, 李川, 文天夫, 等. 全球及中国的肝癌流行病学特征: 基于《2022全球癌症统计报告》解读. 中国普外基础与临床杂志, 2024, 31(7): 781-789.
4. Chen X, Liu F, Li B, et al. p53 codon 72 polymorphism and liver cancer susceptibility: a meta-analysis of epidemiologic studies. World J Gastroenterol, 2011, 17(9): 1211-1218.
5. Dongiovanni P, Romeo S, Valenti L. Hepatocellular carcinoma in nonalcoholic fatty liver: role of environmental and genetic factors. World J Gastroenterol, 2014, 20(36): 12945-12955.
6. Mackowiak B, Fu Y, Maccioni L, et al. Alcohol-associated liver disease. J Clin Invest, 2024, 134(3): e176345. doi: 10.1172/JCI176345.
7. Wang S, Zhang QY, Zhou RL. Relationship between LAPTM4B gene polymorphism and susceptibility of primary liver cancer. Ann Oncol, 2012, 23(7): 1864-1869.
8. Huang J, Gao T, Zhang H, et al. Association of obesity profiles and metabolic health status with liver injury among US adult population in NHANES 1999-2016. Sci Rep, 2023, 13(1): 15958. doi: 10.1038/s41598-023-43028-7.
9. 吕华胜, 冀伟, 孙丰宇, 等. 1990-2021年全球与中国新生儿先天性出生缺陷疾病负担趋势分析. 西安交通大学学报 (医学版), 2025-10-28.
10. Ren F, Shi Z, Shen X, et al. The global, regional, and national burden of stomach cancer attributed to smoking in 204 countries, 1990-2019: a systematic analysis for the global burden of Disease Study 2019. Tob Induc Dis, 2024, 22. doi: 10.18332/tid/183803.
11. 覃胜林, 赵金华, 邓萍, 等. Joinpoint回归模型在2005-2023年青海省流行性感冒发病趋势的应用. 中华疾病控制杂志, 2024, 28(11): 1295-1300,1307.
12. 刘倩, 刘娜, 丁姿源, 等. 2001-2021年中国食道癌的疾病负担及趋势. 中国循证医学杂志, 2025, 25(9): 1012-1019.
13. 蒋露, 张志东, 吴建军, 等. 1990-2021年中国和美国肝癌疾病负担变化趋势及预测. 中国癌症防治杂志, 2025, 17(1): 55-60.
14. Jung-Choi K, Khang YH, Cho HJ. Changes in contribution of causes of death to socioeconomic mortality inequalities in Korean adults. J Prev Med Public Health, 2011, 44(6): 249-259.
15. Danpanichkul P, Suparan K, Dutta P, et al. Disparities in metabolic dysfunction-associated steatotic liver disease and cardiometabolic conditions in low and lower middle-income countries: a systematic analysis from the global burden of disease study 2019. Metabolism, 2024, 158: 155958. doi: 10.1016/j.metabol.2024.155958.
16. Li Q, Ding C, Cao M, et al. Global epidemiology of liver cancer 2022: an emphasis on geographic disparities. Chin Med J (Engl), 2024, 137(19): 2334-2342.
17. 王兵. 全球及中国的肥胖症流行病学现状及趋势. 中国普外基础与临床杂志, 2025, 32(6): 661-668.
18. 黄燕萍, 张琴, 孙明瑜. 慢性乙型肝炎相关性肝细胞癌的危险因素研究进展. 肝脏, 2023, 28(1): 124-127.
19. 张宁, 张圆, 魏君, 等. 模拟饮酒干预与肝脂肪变性: 一项大型队列的纵向研究. 四川大学学报(医学版), 2024, 55(3): 653-661.
20. 殷雨来, 张银旭, 崔枫宁, 等. 1990-2021年中国和全球肝癌疾病负担趋势分析与比较及未来15年预测. 中国医学前沿杂志 (电子版), 2025, 17(2): 68-80.
21. Younossi ZM, Golabi P, Paik JM, et al. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology, 2023, 77(4): 1335-1347.
22. 杨龙山. 肥胖相关人体测量指标与原发性肝癌发生风险及预后的系统综述和荟萃分析. 济南: 山东大学, 2024.
23. 何凤蝶, 王秋童, 胡亚男, 等. 中国人群肝癌发病危险因素病例对照研究的meta分析. 现代预防医学, 2022, 49(23): 4230-4240.
24. Lizcano F, Guzmán G. Estrogen deficiency and the origin of obesity during menopause. Biomed Res Int, 2014, 2014: 757461. doi: 10.1155/2014/757461.
25. Mahboobifard F, Pourgholami MH, Jorjani M, et al. Estrogen as a key regulator of energy homeostasis and metabolic health. Biomed Pharmacother, 2022, 156: 113808. doi: 10.1016/j.biopha.2022.113808.
26. Tao Z, Cheng Z. Hormonal regulation of metabolism-recent lessons learned from insulin and estrogen. Clin Sci (Lond), 2023, 137(6): 415-434.
27. 王海鹏. 我国诊断糖尿病疾病经济负担趋势预测研究. 济南: 山东大学, 2013.
28. Boonpor J, Petermann-Rocha F, Parra-Soto S, et al. Types of diet, obesity, and incident type 2 diabetes: findings from the UK biobank prospective cohort study. Diabetes Obes Metab, 2022, 24(7): 1351-1359.
29. Vercalsteren E, Vranckx C, Corbeels K, et al. Carbohydrates to prevent and treat obesity in a murine model of diet-induced obesity. Obes Facts, 2021, 14(4): 370-381.
30. GBD 2019 Human Resources for Health Collaborators. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2022, 399(10341): 2129-2154.
31. Park B, Jung KW, Oh CM, et al. Ten-year changes in the hepatitis B prevalence in the birth cohorts in Korea: results from nationally representative cross-sectional surveys. Medicine (Baltimore), 2015, 94(41): e1469. doi: 10.1097/MD.0000000000001469.
32. 刘曼琪, 徐梦圆, 单天昊, 等. 2022年全球肝癌与胆囊癌发病死亡及2050年预测分析. 肝癌电子杂志, 2024, 11(2): 53-60.
33. 单天昊, 安澜, 徐梦圆, 等. 2020年全球肝癌和胆囊癌发病死亡分析. 肝癌电子杂志, 2022, 9(4): 46-51.
34. 姚一菲, 孙可欣, 郑荣寿. 《2022全球癌症统计报告》解读: 中国与全球对比. 中国普外基础与临床杂志, 2024, 31(7): 769-780.
35. Rumgay H, Arnold M, Ferlay J, et 王小水批注 al. Global burden of primary liver cancer in 2020 and predictions to 2040. J Hepatol, 2022, 77(6): 1598-1606.
36. Zhu R, Wang R, He J, et al. Prevalence of cardiovascular-kidney-metabolic syndrome stages by social determinants of health. JAMA Netw Open, 2024, 7(11): e2445309. doi: 10.1001/jamanetworkopen.2024.45309.
37. 陈嘉慧, 王海博, 柯立鑫, 等. 1990年-2021年中国因非酒精性脂肪性肝炎所致肝癌的疾病负担分析与未来趋势预测研究. 华西医学, 2025, 40(4): 546-553.
38. Camon C, Garratt M, Correa SM. Exploring the effects of estrogen deficiency and aging on organismal homeostasis during menopause. Nat Aging, 2024, 4(12): 1731-1744.
39. Lee MM, Barrett JL, Kenney EL, et al. A sugar-sweetened beverage excise tax in california: projected benefits for population obesity and health equity. Am J Prev Med, 2024, 66(1): 94-103.
40. The Lancet Public Health None. Obesity: the sweet revenge of tax. Lancet Public Health, 2017, 2(1): e1. doi: 10.1016/S2468-2667(16)30041-X.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesGlobal liver cancer burden attributable to high BMI from 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021

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