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Using GBD 2021 data, this study quantified the burden by age, sex, socio\u2010demographic index (SDI), and region, computed average annual percent changes (AAPC) via Joinpoint regression, and projected 2022\u20132036 burden using the Bayesian age\u2010period\u2010cohort (BAPC) model. During 1990\u20132021, the AAPC of the age\u2010standardized DALY rate (ASDR) and mortality rate (ASMR) was 0.0223 [95% uncertainty interval (UI): \u22120.1432, 0.1880,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.79] and 0.2660 (95%UI: 0.1666, 0.3655,\n                    <jats:italic>p<\/jats:italic>\n                    &lt; 0.001), suggesting that the death\u2010related burden increased mostly. Notably, males contributed the most to this trend, with the sharpest upward trend recorded in low\u2010middle SDI regions. Global cross\u2010country inequality revealed that this death\u2010related burden is widening, especially among females. In contrast to this historical trajectory, predictive models suggest a steady decline by 2036. In conclusion, global ASMR of smoking\u2010attributable NAFLD\/MAFLD increased during 1990\u20132021, especially in low\u2010middle SDI regions and male populations. Despite a projected gradual burden decline over the next 15 years, it still emphasizes the need for strengthened tobacco control and NAFLD\/MAFLD prevention in low\u2010middle SDI regions and male populations.\n                  <\/jats:p>","DOI":"10.1002\/adbi.202500232","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T02:33:34Z","timestamp":1775010814000},"source":"Crossref","is-referenced-by-count":0,"title":["Burden, Trends and Prediction of NAFLD\/MAFLD Attributable to Smoking From 1990 to 2021: GBD 2021 Analysis"],"prefix":"10.1002","volume":"10","author":[{"given":"Lijuan","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism The First Affiliated Hospital with Nanjing Medical University  Nanjing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziyi","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Developmental Molecular and Chemical Biology Tufts University School of Medicine  Medford Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yishu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism The First Affiliated Hospital with Nanjing Medical University  Nanjing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism The First Affiliated Hospital with Nanjing Medical University  Nanjing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenzhen","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism The First Affiliated Hospital with Nanjing Medical University  Nanjing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xianyong","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics School of Public Health Nanjing Medical University  Nanjing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Zhong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Molecular Biology Nanjing Medical University  Nanjing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8570-6904","authenticated-orcid":false,"given":"Yingyun","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism The First Affiliated Hospital with Nanjing Medical University  Nanjing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9309-3546","authenticated-orcid":false,"given":"Hongwen","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism The First Affiliated Hospital with Nanjing Medical University  Nanjing 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