{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T03:01:02Z","timestamp":1783393262685,"version":"3.54.6"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Minufiya University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Exp Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Lean non-alcoholic fatty liver disease (NAFLD) presents a unique clinical phenotype increasingly recognized within the evolving nomenclature of metabolic dysfunction\u2013associated fatty liver disease (MAFLD) and metabolic dysfunction\u2013associated steatotic liver disease (MASLD). This study evaluated the diagnostic applicability of both frameworks in lean Egyptian patients and explored their capacity to encompass metabolically healthy lean phenotypes. Ninety ultrasonography confirmed lean NAFLD patients (BMI\u2009&lt;\u200925\u00a0kg\/m\u00b2) were reassessed using MAFLD and MASLD criteria. Clinical, metabolic, and biochemical parameters, alongside non-invasive fibrosis indices and transient elastography, were compared across classifications. Among all patients, 87.8% met MASLD and 77.8% fulfilled MAFLD criteria, showing substantial overlap yet minor classification differences. MASLD identified a slightly higher proportion of lean cases, whereas MAFLD more stringently captured those with overt metabolic dysfunction. Clinical, biochemical, and fibrosis parameters were comparable among groups (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&gt;\u20090.05). However, 12.2% of patients remained unclassified under either definition, representing a metabolically healthy lean with steatotic liver disease (MHL-SLD) subgroup. In lean steatotic liver disease, MASLD and MAFLD show substantial diagnostic overlaps and identify similar patient profiles with no significant metabolic or fibrosis differences. MASLD includes slightly more patients, yet without clear clinical distinction. Refinement of criteria may be needed to better capture metabolically healthy lean individuals with liver steatosis (MHL-SLD).\n                  <\/jats:p>","DOI":"10.1007\/s10238-025-01983-7","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T16:04:58Z","timestamp":1766505898000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["MASLD versus MAFLD in lean steatotic liver disease: diagnostic overlap, inclusivity, and the metabolically healthy lean phenotype"],"prefix":"10.1007","volume":"26","author":[{"given":"Maha","family":"Elsabaawy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba","family":"Demerdash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Ragab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madiha","family":"Naguib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"issue":"7","key":"1983_CR1","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1038\/s41575-023-00789-4","volume":"20","author":"ZM Younossi","year":"2023","unstructured":"Younossi ZM, Golabi P, Paik JM, et al. Global burden of NAFLD and NASH: Trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2023;20(7):504\u201316. https:\/\/doi.org\/10.1038\/s41575-023-00789-4.","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"2","key":"1983_CR2","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1007\/s12072-021-10271-9","volume":"16","author":"Y Fouad","year":"2022","unstructured":"Fouad Y, Elwakil R, Elsabaawy M, et al. Non-alcoholic fatty liver disease in egypt: epidemiology and management. Hepatol Int. 2022;16(2):255\u201366. https:\/\/doi.org\/10.1007\/s12072-021-10271-9.","journal-title":"Hepatol Int"},{"issue":"1","key":"1983_CR3","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1002\/hep.29367","volume":"67","author":"N Chalasani","year":"2018","unstructured":"Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the AASLD. Hepatology. 2018;67(1):328\u201357. https:\/\/doi.org\/10.1002\/hep.29367.","journal-title":"Hepatology"},{"issue":"2","key":"1983_CR4","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s12072-024-10774-3","volume":"19","author":"M Eslam","year":"2025","unstructured":"Eslam M, Fan JG, Yu ML, et al. The Asian Pacific association for the study of the liver clinical practice guidelines for the diagnosis and management of metabolic dysfunction-associated fatty liver disease. Hepatol Int. 2025;19(2):261\u2013301. https:\/\/doi.org\/10.1007\/s12072-024-10774-3.","journal-title":"Hepatol Int"},{"issue":"2","key":"1983_CR5","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1097\/HEP.0000000000000426","volume":"78","author":"ME Rinella","year":"2023","unstructured":"Rinella ME, Lazarus JV, Ratziu V, et al. The MASLD consensus statement: redefining fatty liver disease for global harmonization. Hepatology. 2023;78(2):462\u201376. https:\/\/doi.org\/10.1097\/HEP.0000000000000426.","journal-title":"Hepatology"},{"issue":"7","key":"1983_CR6","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1016\/S2468-1253(23)00113-7","volume":"8","author":"Y Yilmaz","year":"2023","unstructured":"Yilmaz Y, Byrne CD. Metabolic dysfunction-associated steatotic liver disease (MASLD): a more inclusive terminology for global use. Lancet Gastroenterol Hepatol. 2023;8(7):579\u201390. https:\/\/doi.org\/10.1016\/S2468-1253(23)00113-7.","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"12","key":"1983_CR7","doi-asserted-by":"publisher","first-page":"dgz248","DOI":"10.1210\/clinem\/dgz248","volume":"105","author":"Q Ye","year":"2020","unstructured":"Ye Q, Zou B, Yeo YH, et al. Global prevalence, incidence, and outcomes of lean NAFLD: systematic review and meta-analysis. J Clin Endocrinol Metab. 2020;105(12):dgz248. https:\/\/doi.org\/10.1210\/clinem\/dgz248.","journal-title":"J Clin Endocrinol Metab"},{"issue":"9","key":"1983_CR8","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1136\/gutjnl-2019-319312","volume":"69","author":"H Lee","year":"2020","unstructured":"Lee H, Kim SU, Kim HC, et al. Metabolic profiles and cardiovascular risk in lean NAFLD: A population-based study. Gut. 2020;69(9):1751\u20139. https:\/\/doi.org\/10.1136\/gutjnl-2019-319312.","journal-title":"Gut"},{"issue":"1","key":"1983_CR9","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1002\/hep.32154","volume":"76","author":"R Mehta","year":"2022","unstructured":"Mehta R, Schwimmer JB, Behling C, et al. Genetics, microbiome, and non-metabolic pathways in lean NAFLD. Hepatology. 2022;76(1):70\u201383. https:\/\/doi.org\/10.1002\/hep.32154.","journal-title":"Hepatology"},{"issue":"7","key":"1983_CR10","doi-asserted-by":"publisher","first-page":"1999","DOI":"10.1053\/j.gastro.2020.03.051","volume":"158","author":"M Eslam","year":"2020","unstructured":"Eslam M, Sanyal AJ, George J. MAFLD: a consensus-driven redefinition of fatty liver disease. Gastroenterology. 2020;158(7):1999-2014.e1. https:\/\/doi.org\/10.1053\/j.gastro.2020.03.051.","journal-title":"Gastroenterology"},{"key":"1983_CR11","volume-title":"Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series No. 894","author":"World Health Organization","year":"2000","unstructured":"World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series No. 894. 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Hepatology. 2006;43(6):1317\u201325. https:\/\/doi.org\/10.1002\/hep.21178.","journal-title":"Hepatology"},{"issue":"1","key":"1983_CR16","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1007\/s12072-023-10579-8","volume":"18","author":"BK De","year":"2024","unstructured":"De BK, Das A, Mukherjee PS, et al. Comparison between MAFLD and MASLD definitions and their clinical implications: insights from a tertiary center experience. Hepatol Int. 2024;18(1):72\u201384. https:\/\/doi.org\/10.1007\/s12072-023-10579-8.","journal-title":"Hepatol Int"},{"issue":"12","key":"1983_CR17","doi-asserted-by":"publisher","first-page":"2045","DOI":"10.1111\/jgh.16238","volume":"38","author":"N Kobayashi","year":"2023","unstructured":"Kobayashi N, Hashimoto Y, Fukuda T, et al. Impact of MASLD versus MAFLD criteria on diagnosis and clinical characteristics in lean individuals with hepatic steatosis. J Gastroenterol Hepatol. 2023;38(12):2045\u201354. https:\/\/doi.org\/10.1111\/jgh.16238.","journal-title":"J Gastroenterol Hepatol"},{"key":"1983_CR18","doi-asserted-by":"publisher","first-page":"1312476","DOI":"10.3389\/fendo.2024.1312476","volume":"15","author":"Y Zhou","year":"2024","unstructured":"Zhou Y, Ma X, Wang L, et al. Comparative performance of MAFLD and MASLD definitions for lean fatty liver: A population-based analysis. Front Endocrinol (Lausanne). 2024;15:1312476. https:\/\/doi.org\/10.3389\/fendo.2024.1312476.","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"3","key":"1983_CR19","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1002\/hep.33052","volume":"79","author":"JJ Pan","year":"2024","unstructured":"Pan JJ, Sidhu SS, Singh S, et al. Distinct metabolic and genetic determinants of lean NAFLD: toward phenotype-specific management. 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Tzu Chi Med J. 2024;36(4):425\u201332. https:\/\/doi.org\/10.4103\/tcmj.tcmj_253_23.","journal-title":"Tzu Chi Med J"}],"container-title":["Clinical and Experimental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10238-025-01983-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10238-025-01983-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10238-025-01983-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T15:40:32Z","timestamp":1781624432000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10238-025-01983-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,23]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1983"],"URL":"https:\/\/doi.org\/10.1007\/s10238-025-01983-7","relation":{},"ISSN":["1591-9528"],"issn-type":[{"value":"1591-9528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,23]]},"assertion":[{"value":"18 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"None.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Disclosure of interest"}},{"value":"None.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Financial support"}},{"value":"\u201cThis study was conducted per the principles of the Declaration of Helsinki. This study was approved by the Ethics Committee of the National Liver Institute, Menoufia University as unique research and not a part of an approved student thesis.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"was obtained from all patients or their legal representatives before enrolment in the study.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}],"article-number":"81"}}