ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutritional Epidemiology
This article is part of the Research TopicLifestyle behaviors and chronic diseases: pathways, interventions, knowledge and public health challengesView all 11 articles
Global Burden of Colorectal Cancer Attributable to High Body Mass Index and High Fasting Plasma Glucose from 1990 to 2021: A Decomposition and Forecasting Analysis Based on the GBD 2021 Study
Provisionally accepted
- 1Medical College of Yan'an University, Yan'an, China
- 2Yan'an University Affiliated Hospital, Yan'an, China
- 3Lanzhou University Second Hospital, Lanzhou, China
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Background: High body mass index (HBMI) and high fasting plasma glucose (HFPG), two key metabolic risk factors, are strongly associated with colorectal cancer (CRC). However, systematic quantification of their impact on the global CRC burden—and trends in related health inequalities— remains limited. Using data from the Global Burden of Disease Study 2021, this study assessed the disability-adjusted life years (DALYs) and deaths attributable to HBMI and HFPG in CRC from 1990 to 2021. Methods: Decomposition analysis quantified the contributions of population growth, aging, and epidemiological changes. The concentration index and Lorenz curve assessed health inequality trends, and the Estimated Annual Percentage Change (EAPC) measured burden change rates. Burden trends were projected for 2022-2035 using the Bayesian Age-Period-Cohort (BAPC) model. All indicators were stratified by country, Socio-demographic Index (SDI) tier, gender, and age for comparative analysis. Results: From 1990-2021, the burden of CRC attributable to HBMI and HFPG increased, primarily driven by population growth and aging. In high SDI countries, epidemiological changes reduced the burden, while in low-and medium-SDI countries they contributed positively. Although the disease burden remains concentrated in high SDI countries, inequality has declined. Central and Eastern Europe face high DALYs and mortality rates whereas parts of Africa exhibit a lower but rising burden. The burden is primarily concentrated in men over 60. The BAPC model predicts that HBMI-and HFPG-associated DALYs will increase by 47.90% and 41.94%, respectively, while age-standardized DALYs and mortality rates remain relatively stable. Conclusion: Targeted strategies focusing on metabolic risk management and early CRC screening—especially in low-and middle-SDI countries-—are essential to mitigate the projected burden.
Keywords: colorectal cancer, Decomposition analysis, GlobalBurden of Disease Study 2021, high body mass index, High fasting plasma glucose
Received: 25 Jun 2025; Accepted: 29 Nov 2025.
Copyright: © 2025 Gao, Yang and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Juangjuan Huang
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