Global burden of metabolic diseases, 1990–2021

Background: Common metabolic diseases, such as type 2 diabetes mellitus (T2DM), hypertension, obesity, hypercholesterolemia, and metabolic dysfunction-associated steatotic liver disease (MASLD), have become a global health burden in the last three decades. The Global Burden of Disease, Injuries, and Risk Factors Study (GBD) data enables the first insights into the trends and burdens of these metabolic diseases from 1990 to 2021, highlighting regional, temporal and differences by sex. Methods: Global estimates of disability-adjusted life years (DALYs) and deaths from GBD 2021 were analyzed for common metabolic diseases (T2DM, hypertension, obesity, hypercholesterolemia, and MASLD). Age-standardized DALYs (mortality) per 100,000 population and annual percentage change (APC) between 1990 and 2021 were estimated for trend analyses. Estimates are reported with uncertainty intervals (UI). Results: In 2021, among five common metabolic diseases, hypertension had the greatest burden (226 million [95 % UI: 190–259] DALYs), whilst T2DM (75 million [95 % UI: 63–90] DALYs) conferred much greater disability than MASLD (3.67 million [95 % UI: 2.90–4.61]). The highest absolute burden continues to be found in the most populous countries of the world, particularly India, China, and the United States, whilst the highest relative burden was mostly concentrated in Oceania Island states. The burden of these metabolic diseases has continued to increase over the past three decades but has varied in the rate of increase (1.6-fold to 3-fold increase). The burden of T2DM (0.42 % [95 % UI: 0.34–0.51]) and obesity (0.26 % [95 % UI: 0.17–0.34]) has increased at an accelerated rate, while the rate of increase for the burden of hypertension (−0.30 % [95 % UI: −0.34 to −0.25]) and hypercholesterolemia (−0.33 % [95 % UI: −0.37 to −0.30]) is slowing. There is no significant change in MASLD over time (0.05 % [95 % UI: −0.06 to 0.17]). Conclusion: In the 21st century, common metabolic diseases are presenting a significant global health challenge. There is a concerning surge in DALYs and mortality associated with these conditions, underscoring the necessity for a coordinated global health initiative to stem the tide of these debilitating diseases and improve population health outcomes worldwide.