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We aimed to compare the prevalence, metabolic characteristics, and outcomes of lean vs overweight\/obese-MAFLD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Databases of Embase, Medline, and Web of Science were searched from inception till October 2023. Only cohorts adhering to the lean-MAFLD criteria as defined by the international consensus statement were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the pooled analysis of 10,013,382 individuals, the prevalence of lean-MAFLD in the general population was 1.94% (95% CI 1.10\u20133.39%,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200998.7%). Lean and overweight\/obese-MAFLD patients had similar metabolic characteristics for blood pressure, LDL, TG, blood glucose, and HbA1c. There was an increased incidence rate and likelihood for liver-related mortality for lean-MAFLD vs overweight\/obese-MAFLD [1.33 per 1000 patient-years (95% CI 1.28\u20131.39) vs 0.76 (95% CI 0.25\u20132.28), (OR 3.56 (95% CI 3.45\u20133.67),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). There were similar incidence rates and odds ratios between lean vs overweight\/obese-MAFLD for: (1) all-cause mortality [10.08 per 1000 patient-years (95% CI 9.93\u201310.23) vs 8.94 per 1000 patient-years (95% CI 4.08\u201319.57), (OR 1.92 (95% CI 0.01\u2013220.57),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.33)]; (2) cardiovascular-related mortality [2.53 per 1000 patient-years (95% CI 0.65\u20139.96) vs 2.07 per 1000 patient-years (95% CI 0.80\u20135.39), (OR 1.91 (95% CI 0.02\u2013142.76),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.58)]; and (3) cancer-related mortality [3.42 per 1000 patient-years (95% CI 3.33\u20133.51) vs 3.15 per 1000 patient-years (95% CI 1.21\u20138.19), (OR 1.99 (95% CI 0.29\u201313.52),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.13).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lean-MAFLD patients have an equivalent metabolic burden compared to overweight\/obese-MAFLD patients and thus a similar incidence rate of major extrahepatic complications. However, they have an increased risk of liver-related mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s12072-025-10801-x","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T13:35:36Z","timestamp":1741959336000},"page":"607-618","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Global prevalence, metabolic characteristics, and outcomes of lean-MAFLD: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5448-232X","authenticated-orcid":false,"given":"Mark C. 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Mark Cheah and Harry Crane have no financial or non-financial disclosures.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}