Divergent Trajectories of the Burden of MASLD Attributable to High Fasting Plasma Glucose in China and Globally: A GBD Study 1990-2021 and Projections to 2046.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern. High fasting plasma glucose (HFPG) is a major metabolic driver, yet its long-term burden and future trends in China versus globally remain unclear. Methods: Data from the Global Burden of Disease Study 2021 were analyzed. Deaths and disability-adjusted life years (DALYs) were assessed using counts and age-standardized rates (ASRs). Temporal trends were evaluated using estimated annual percentage change (EAPC). An age-period-cohort (APC) model was used to project the burden through 2046. Results: In 2021, HFPG-attributable MASLD caused 10,021 deaths and 213,481 DALYs worldwide. From 1990 to 2021, global age-standardized death and DALY rates increased significantly (EAPC, 2.22% and 2.02%, respectively). The burden was higher in males and increased with age, peaking in those aged ≥ 80 years. Projections suggest that absolute deaths and DALYs will continue to rise globally and in China through 2046, whereas ASRs are expected to decline, particularly among females. China showed a lower increase in age-standardized death rate (EAPC, 1.28%) compared with the global average. Conclusion: The burden of HFPG-attributable MASLD continues to increase globally and remains substantial in China. Although ASRs may stabilize or decline, population aging is expected to sustain growth in the absolute burden. These findings highlight the need for early metabolic screening, integrated management of metabolic and liver diseases, and targeted interventions for older adults and other high-risk populations.