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

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.