{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:03:45Z","timestamp":1787501025604,"version":"build-2736575974"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health","award":["K23DK131290"],"award-info":[{"award-number":["K23DK131290"]}]},{"name":"NIH\/NCATS","award":["Grant UL1TR000127"],"award-info":[{"award-number":["Grant UL1TR000127"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Dig Dis Sci"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Exercise training is recommended for all patients with metabolic dysfunction-associated steatotic liver disease. Whether exercise training improves liver histology independent of body weight loss remains controversial. Given the increasing reliance on non-invasive biomarkers as a surrogate for liver histology, we investigated the relationship between exercise training and improvement in liver histology using the MASH Resolution Index (MASH-RI), a validated composite score of multiple biomarkers, in a post hoc analysis of the NASHFit trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study randomized adults with biopsy-proven MASH to moderate-intensity aerobic exercise training or standard of care for 20 weeks. Mediterranean-informed dietary counseling was provided to each group. Change in the MASH-RI was measured and compared between the two groups (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200923).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Applying the MASH-RI, those who performed exercise training achieved MASH resolution nearly three times more often (33% vs. 13%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) versus those who received standard of care. Exercise training improved individual biomarkers included in the MASH-RI, including ALT, AST, and MRI-PDFF.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Exercise training leads to MASH resolution, as defined by the MASH-RI at greater rates than standard lifestyle counseling. Future research is needed to determine how best to use the MASH-RI as a therapeutic monitoring tool to gauge response to lifestyle intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>NCT03518294.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10620-025-09361-9","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T07:24:18Z","timestamp":1756884258000},"page":"628-635","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Aerobic Exercise Training Leads to MASH Resolution as Defined by the MASH Resolution Index"],"prefix":"10.1007","volume":"71","author":[{"given":"Theja","family":"Channapragada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Batra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Breianna L.","family":"Hummer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vernon M.","family":"Chinchilli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Loomba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian R.","family":"Schreibman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan G.","family":"Stine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"9361_CR1","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1002\/hep.29466","volume":"67","author":"C Estes","year":"2018","unstructured":"Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology 2018;67:123\u2013133. https:\/\/doi.org\/10.1002\/hep.29466.","journal-title":"Hepatology"},{"key":"9361_CR2","doi-asserted-by":"publisher","first-page":"2537","DOI":"10.1016\/j.cell.2021.04.015","volume":"184","author":"R Loomba","year":"2021","unstructured":"Loomba R, Friedman SL, Shulman GI. Mechanisms and disease consequences of nonalcoholic fatty liver disease. Cell 2021;184:2537\u20132564. https:\/\/doi.org\/10.1016\/j.cell.2021.04.015.","journal-title":"Cell"},{"key":"9361_CR3","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1007\/s40265-024-02045-0","volume":"84","author":"SJ Keam","year":"2024","unstructured":"Keam SJ. Resmetirom: First Approval. Drugs 2024;84:729\u2013735. https:\/\/doi.org\/10.1007\/s40265-024-02045-0.","journal-title":"Drugs"},{"key":"9361_CR4","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1053\/j.gastro.2020.11.051","volume":"160","author":"ZM Younossi","year":"2021","unstructured":"Younossi ZM, Corey KE, Lim JK. AGA Clinical Practice Update on Lifestyle Modification Using Diet and Exercise to Achieve Weight Loss in the Management of Nonalcoholic Fatty Liver Disease: Expert Review. Gastroenterology 2021;160:912\u2013918. https:\/\/doi.org\/10.1053\/j.gastro.2020.11.051.","journal-title":"Gastroenterology"},{"key":"9361_CR5","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1111\/liv.14869","volume":"41","author":"AC Cardoso","year":"2021","unstructured":"Cardoso AC, de Figueiredo-Mendes C, Villela\u2010Nogueira CA. Current management of NAFLD\/NASH. Liver Int 2021;41:89\u201394. https:\/\/doi.org\/10.1111\/liv.14869.","journal-title":"Liver Int"},{"key":"9361_CR6","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1249\/mss.0000000000003199","volume":"55","author":"JG Stine","year":"2023","unstructured":"Stine JG, Long MT, Corey KE et al. Physical Activity and Nonalcoholic Fatty Liver Disease: A Roundtable Statement from the American College of Sports Medicine. Med Sci Sports Exerc 2023;55:1717\u20131726. https:\/\/doi.org\/10.1249\/mss.0000000000003199.","journal-title":"Med Sci Sports Exerc"},{"key":"9361_CR7","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1007\/s11901-020-00543-9","volume":"19","author":"A Thorp","year":"2020","unstructured":"Thorp A, Stine JG. Exercise as Medicine: The Impact of Exercise Training on Nonalcoholic Fatty Liver Disease. Curr Hepatol Rep 2020;19:402\u2013411. https:\/\/doi.org\/10.1007\/s11901-020-00543-9.","journal-title":"Curr Hepatol Rep"},{"key":"9361_CR8","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.1016\/j.cgh.2020.07.023","volume":"19","author":"D Kim","year":"2021","unstructured":"Kim D, Murag S, Cholankeril G et al. Physical Activity, Measured Objectively, Is Associated With Lower Mortality in Patients With Nonalcoholic Fatty Liver Disease. Clin Gastroenterol Hepatol 2021;19:1240-1247.e5. https:\/\/doi.org\/10.1016\/j.cgh.2020.07.023.","journal-title":"Clin Gastroenterol Hepatol"},{"key":"9361_CR9","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1111\/liv.15769","volume":"44","author":"SJ Harris","year":"2024","unstructured":"Harris SJ, Smith N, Hummer B et al. Exercise training improves serum biomarkers of liver fibroinflammation in patients with metabolic dysfunction-associated steatohepatitis. Liver Int 2024;44:532\u2013540. https:\/\/doi.org\/10.1111\/liv.15769.","journal-title":"Liver Int"},{"key":"9361_CR10","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.14309\/ajg.0000000000002098","volume":"118","author":"JG Stine","year":"2023","unstructured":"Stine JG, DiJoseph K, Pattison Z et al. Exercise Training Is Associated With Treatment Response in Liver Fat Content by Magnetic Resonance Imaging Independent of Clinically Significant Body Weight Loss in Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2023;118:1204\u20131213. https:\/\/doi.org\/10.14309\/ajg.0000000000002098.","journal-title":"Am J Gastroenterol"},{"key":"9361_CR11","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1053\/j.gastro.2015.04.005","volume":"149","author":"E Vilar-Gomez","year":"2015","unstructured":"Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L et al. Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis. Gastroenterology. 2015;149:367\u201378.e5. https:\/\/doi.org\/10.1053\/j.gastro.2015.04.005. (quiz e14-5).","journal-title":"Gastroenterology."},{"key":"9361_CR12","doi-asserted-by":"publisher","first-page":"401","DOI":"10.3350\/cmh.2023.0062","volume":"29","author":"KH Chuah","year":"2023","unstructured":"Chuah KH, Chan WK. Non-invasive biomarkers for liver inflammation in non-alcoholic fatty liver disease: present and future. Clin Mol Hepatol 2023;29:401\u2013403.","journal-title":"Clin Mol Hepatol"},{"key":"9361_CR13","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1097\/mog.0000000000000621","volume":"36","author":"A Khalifa","year":"2020","unstructured":"Khalifa A, Rockey DC. The utility of liver biopsy in 2020. Curr Opin Gastroenterol 2020;36:184\u2013191. https:\/\/doi.org\/10.1097\/mog.0000000000000621.","journal-title":"Curr Opin Gastroenterol"},{"key":"9361_CR14","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1002\/hep.29797","volume":"68","author":"C Caussy","year":"2018","unstructured":"Caussy C, Reeder SB, Sirlin CB, Loomba R. Noninvasive, Quantitative Assessment of Liver Fat by MRI-PDFF as an Endpoint in NASH Trials. Hepatology 2018;68:763\u2013772. https:\/\/doi.org\/10.1002\/hep.29797.","journal-title":"Hepatology"},{"key":"9361_CR15","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1136\/gutjnl-2021-324264","volume":"71","author":"N Tamaki","year":"2022","unstructured":"Tamaki N, Munaganuru N, Jung J et al. Clinical utility of 30% relative decline in MRI-PDFF in predicting fibrosis regression in non-alcoholic fatty liver disease. Gut 2022;71:983\u2013990. https:\/\/doi.org\/10.1136\/gutjnl-2021-324264.","journal-title":"Gut"},{"key":"9361_CR16","doi-asserted-by":"publisher","first-page":"2967","DOI":"10.3390\/diagnostics13182967","volume":"13","author":"R Chinnappan","year":"2023","unstructured":"Chinnappan R, Mir TA, Alsalameh S et al. Low-Cost Point-of-Care Monitoring of ALT and AST Is Promising for Faster Decision Making and Diagnosis of Acute Liver Injury. Diagnostics (Basel) 2023;13:2967. https:\/\/doi.org\/10.3390\/diagnostics13182967.","journal-title":"Diagnostics (Basel)"},{"key":"9361_CR17","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.jhep.2020.03.036","volume":"73","author":"Y Vali","year":"2020","unstructured":"Vali Y, Lee J, Boursier J et al. Enhanced liver fibrosis test for the non-invasive diagnosis of fibrosis in patients with NAFLD: A systematic review and meta-analysis. J Hepatol 2020;73:252\u2013262. https:\/\/doi.org\/10.1016\/j.jhep.2020.03.036.","journal-title":"J Hepatol"},{"key":"9361_CR18","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1055\/s-0044-1788277","volume":"44","author":"MA Tincopa","year":"2024","unstructured":"Tincopa MA, Loomba R. Noninvasive Tests to Assess Fibrosis and Disease Severity in Metabolic Dysfunction-Associated Steatotic Liver Disease. Semin Liver Dis 2024;44:287\u2013299. https:\/\/doi.org\/10.1055\/s-0044-1788277.","journal-title":"Semin Liver Dis"},{"key":"9361_CR19","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1053\/j.gastro.2021.10.051","volume":"162","author":"R Loomba","year":"2022","unstructured":"Loomba R, Ratziu V, Harrison SA. Expert Panel Review to Compare FDA and EMA Guidance on Drug Development and Endpoints in Nonalcoholic Steatohepatitis. Gastroenterology 2022;162:680\u2013688. https:\/\/doi.org\/10.1053\/j.gastro.2021.10.051.","journal-title":"Gastroenterology"},{"key":"9361_CR20","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1038\/s41591-023-02242-6","volume":"29","author":"SA Harrison","year":"2023","unstructured":"Harrison SA, Allen AM, Dubourg J, Noureddin M, Alkhouri N. Challenges and opportunities in NASH drug development. Nat Med 2023;29:562\u2013573. https:\/\/doi.org\/10.1038\/s41591-023-02242-6.","journal-title":"Nat Med"},{"key":"9361_CR21","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1136\/gutjnl-2023-331401","volume":"73","author":"R Loomba","year":"2024","unstructured":"Loomba R, Amangurbanova M, Bettencourt R et al. MASH Resolution Index: development and validation of a non-invasive score to detect histological resolution of MASH. Gut 2024;73:1343\u20131349. https:\/\/doi.org\/10.1136\/gutjnl-2023-331401.","journal-title":"Gut"},{"key":"9361_CR22","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1002\/hep.32274","volume":"76","author":"JG Stine","year":"2022","unstructured":"Stine JG, Schreibman IR, Faust AJ et al. NASHFit: A randomized controlled trial of an exercise training program to reduce clotting risk in patients with NASH. Hepatology 2022;76:172\u2013185. https:\/\/doi.org\/10.1002\/hep.32274.","journal-title":"Hepatology"},{"key":"9361_CR23","doi-asserted-by":"publisher","first-page":"100560","DOI":"10.1016\/j.conctc.2020.100560","volume":"18","author":"JG Stine","year":"2020","unstructured":"Stine JG, Schreibman I, Navabi S et al. Nonalcoholic steatohepatitis Fitness Intervention in Thrombosis (NASHFit): Study protocol for a randomized controlled trial of a supervised aerobic exercise program to reduce elevated clotting risk in patients with NASH. Contemp Clin Trials Commun 2020;18:100560. https:\/\/doi.org\/10.1016\/j.conctc.2020.100560.","journal-title":"Contemp Clin Trials Commun"},{"key":"9361_CR24","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1002\/hep.20701","volume":"41","author":"DE Kleiner","year":"2005","unstructured":"Kleiner DE, Brunt EM, Van Natta M et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313\u20131321. https:\/\/doi.org\/10.1002\/hep.20701.","journal-title":"Hepatology"},{"key":"9361_CR25","doi-asserted-by":"publisher","first-page":"1316284","DOI":"10.3389\/fmed.2023.1316284","volume":"10","author":"MV Machado","year":"2023","unstructured":"Machado MV. MASLD treatment-a shift in the paradigm is imminent. Front Med (Lausanne) 2023;10:1316284. https:\/\/doi.org\/10.3389\/fmed.2023.1316284.","journal-title":"Front Med (Lausanne)"},{"key":"9361_CR26","doi-asserted-by":"publisher","first-page":"e0681","DOI":"10.1097\/hc9.0000000000000681","volume":"9","author":"SE Keating","year":"2025","unstructured":"Keating SE, Owen PJ, Pugh CJA, Cuthbertson DJ, Stine JG. Aerobic exercise interventions lead to MASH resolution in clinical trials: Pooled analysis using the MASH resolution index. Hepatol Commun 2025;9:e0681. https:\/\/doi.org\/10.1097\/hc9.0000000000000681.","journal-title":"Hepatol Commun"},{"key":"9361_CR27","doi-asserted-by":"publisher","first-page":"2274","DOI":"10.1016\/j.cgh.2020.08.061","volume":"19","author":"JG Stine","year":"2021","unstructured":"Stine JG, Munaganuru N, Barnard A et al. Change in MRI-PDFF and Histologic Response in Patients With Nonalcoholic Steatohepatitis: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol 2021;19:2274-2283.e5. https:\/\/doi.org\/10.1016\/j.cgh.2020.08.061.","journal-title":"Clin Gastroenterol Hepatol"},{"key":"9361_CR28","doi-asserted-by":"publisher","first-page":"2347","DOI":"10.1007\/s40279-023-01918-w","volume":"53","author":"SE Keating","year":"2023","unstructured":"Keating SE, Sabag A, Hallsworth K et al. Exercise in the Management of Metabolic-Associated Fatty Liver Disease (MAFLD) in Adults: A Position Statement from Exercise and Sport Science Australia. Sports Med 2023;53:2347\u20132371. https:\/\/doi.org\/10.1007\/s40279-023-01918-w.","journal-title":"Sports Med"},{"key":"9361_CR29","doi-asserted-by":"publisher","DOI":"10.1097\/hep.0000000000001058","author":"D IvancovskyWajcman","year":"2024","unstructured":"IvancovskyWajcman D, Byrne CJ, Dillon JF et al. A narrative review of lifestyle management guidelines for metabolic dysfunction-associated steatotic liver disease. Hepatology. 2024. https:\/\/doi.org\/10.1097\/hep.0000000000001058.","journal-title":"Hepatology"},{"key":"9361_CR30","doi-asserted-by":"publisher","DOI":"10.1097\/hep.0000000000001396","author":"R Loomba","year":"2025","unstructured":"Loomba R, Daniel PCN, Amangurbanova M et al. Head-to-head comparison of MASH resolution index versus FAST for noninvasive prediction of resolution of MASH on biopsy. Hepatology. 2025. https:\/\/doi.org\/10.1097\/hep.0000000000001396.","journal-title":"Hepatology"},{"key":"9361_CR31","doi-asserted-by":"publisher","first-page":"1155","DOI":"10.1016\/j.jhep.2018.07.013","volume":"69","author":"A Mazzotti","year":"2018","unstructured":"Mazzotti A, Caletti MT, Brodosi L et al. An internet-based approach for lifestyle changes in patients with NAFLD: Two-year effects on weight loss and surrogate markers. J Hepatol 2018;69:1155\u20131163. https:\/\/doi.org\/10.1016\/j.jhep.2018.07.013.","journal-title":"J Hepatol"},{"key":"9361_CR32","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1002\/hep.23623","volume":"52","author":"G Musso","year":"2010","unstructured":"Musso G, Gambino R, Cassader M, Pagano G. A meta-analysis of randomized trials for the treatment of nonalcoholic fatty liver disease. Hepatology 2010;52:79\u2013104. https:\/\/doi.org\/10.1002\/hep.23623.","journal-title":"Hepatology"},{"key":"9361_CR33","doi-asserted-by":"publisher","first-page":"2452","DOI":"10.3390\/nu15112452","volume":"15","author":"JW Heinle","year":"2023","unstructured":"Heinle JW, DiJoseph K, Sabag A et al. Exercise Is Medicine for Nonalcoholic Fatty Liver Disease: Exploration of Putative Mechanisms. Nutrients 2023;15:2452. https:\/\/doi.org\/10.3390\/nu15112452.","journal-title":"Nutrients"},{"key":"9361_CR34","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.freeradbiomed.2025.02.017","volume":"230","author":"B Lin","year":"2025","unstructured":"Lin B, Wu T, Nasb M, Li Z, Chen N. Regular exercise alleviates metabolic dysfunction-associated steatohepatitis through rescuing mitochondrial oxidative stress and dysfunction in liver. Free Radic Biol Med 2025;230:163\u2013176. https:\/\/doi.org\/10.1016\/j.freeradbiomed.2025.02.017.","journal-title":"Free Radic Biol Med"},{"key":"9361_CR35","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1097\/hep.0000000000000323","volume":"77","author":"ME Rinella","year":"2023","unstructured":"Rinella ME, Neuschwander-Tetri BA, Siddiqui MS et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology 2023;77:1797\u20131835. https:\/\/doi.org\/10.1097\/hep.0000000000000323.","journal-title":"Hepatology"},{"key":"9361_CR36","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1111\/apt.15989","volume":"52","author":"P O\u2019Gorman","year":"2020","unstructured":"O\u2019Gorman P, Naimimohasses S, Monaghan A et al. Improvement in histological endpoints of MAFLD following a 12-week aerobic exercise intervention. Aliment Pharmacol Ther 2020;52:1387\u20131398. https:\/\/doi.org\/10.1111\/apt.15989.","journal-title":"Aliment Pharmacol Ther"},{"key":"9361_CR37","doi-asserted-by":"publisher","first-page":"204201882311603","DOI":"10.1177\/20420188231160394","volume":"14","author":"JT Stefano","year":"2023","unstructured":"Stefano JT, Duarte SMB, Ribeiro LeiteAltikes RG, Oliveira CP. Non-pharmacological management options for MAFLD: a practical guide. Ther Adv Endocrinol Metab 2023;14:20420188231160390. https:\/\/doi.org\/10.1177\/20420188231160394.","journal-title":"Ther Adv Endocrinol Metab"}],"container-title":["Digestive Diseases and Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10620-025-09361-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10620-025-09361-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10620-025-09361-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T08:01:51Z","timestamp":1772092911000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10620-025-09361-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,3]]},"references-count":37,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["9361"],"URL":"https:\/\/doi.org\/10.1007\/s10620-025-09361-9","relation":{},"ISSN":["0163-2116","1573-2568"],"issn-type":[{"value":"0163-2116","type":"print"},{"value":"1573-2568","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,3]]},"assertion":[{"value":"7 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 September 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":"Dr. Stine receives or has received research support from Astra Zeneca, Galectin, Kowa, Novo Nordisk, Regeneron, and Zydus Therapeutics. Dr. Stine consults for Novo Nordisk and is on an advisory board for Madrigal. Following submission of this manuscript, Dr. Stine commenced employment with Astra\u00a0Zeneca. Dr. Loomba serves as a consultant or advisory board member for Arrowhead Pharmaceuticals, AstraZeneca, Bird Rock Bio, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Cirius, CohBar, Conatus, Eli Lilly, Galmed, Gemphire, Gilead, Glympse Bio, GNI, GRI Bio, Intercept, Ionis, Janssen Inc., Merck, Metacrine, Inc., NGM Biopharmaceuticals, Novartis, Novo Nordisk, Pfizer, Prometheus, Sanofi, Siemens, and Viking Therapeutics. In addition, his institution has received grant support from Allergan, Boehringer-Ingelheim, Bristol-Myers Squibb, Cirius, Eli Lilly and Company, Galectin Therapeutics, Galmed Pharmaceuticals, GE, Genfit, Gilead, Intercept, Grail, Janssen, Madrigal Pharmaceuticals, Merck, NGM Biopharmaceuticals, NuSirt, Pfizer, pH Pharma, Prometheus, and Siemens. He is also co-founder of Liponexus, Inc.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All patients provided informed consent prior to being included in the study, and the study was approved by the Penn State Health Institutional Review Board (Study 8507). All research was conducted in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines, and Penn State Health local regulatory requirements.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"No material from another source was reproduced.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Permission to reproduce material from another source"}}]}}