{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T21:12:59Z","timestamp":1788901979476,"version":"build-2803163510"},"reference-count":43,"publisher":"Elsevier BV","issue":"6","license":[{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jcehepatology.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical and Experimental Hepatology"],"published-print":{"date-parts":[[2026,11]]},"DOI":"10.1016\/j.jceh.2026.103632","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T23:28:15Z","timestamp":1785281295000},"page":"103632","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of Structured Lifestyle Intervention in Normal Body Mass Index Non-alcoholic Fatty Liver Disease"],"prefix":"10.1016","volume":"16","author":[{"family":"Sharanabasava","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabhat N.","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0488-562X","authenticated-orcid":false,"given":"Sudhir","family":"Maharshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamlesh K.","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3175-5296","authenticated-orcid":false,"given":"Vijyant","family":"Tak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupesh","family":"Pokharna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Nijhawan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyam S.","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jceh.2026.103632_bib1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology"},{"key":"10.1016\/j.jceh.2026.103632_bib2","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/S2468-1253(20)30077-7","article-title":"Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis","volume":"5","author":"Ye","year":"2020","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib3","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/nrgastro.2017.109","article-title":"Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention","volume":"15","author":"Younossi","year":"2018","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib4","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1002\/hep.30908","article-title":"Lean NAFLD: a distinct entity shaped by differential metabolic adaptation","volume":"71","author":"Chen","year":"2020","journal-title":"Hepatology"},{"key":"10.1016\/j.jceh.2026.103632_bib5","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jhep.2014.08.041","article-title":"Incidence of non-alcoholic fatty liver disease in Hong Kong: a population study with paired proton-magnetic resonance spectroscopy","volume":"62","author":"Wong","year":"2015","journal-title":"J Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib6","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/joim.13069","article-title":"Prevalence, characteristics and mortality outcomes of obese, nonobese and lean NAFLD in the United States, 1999-2016","volume":"288","author":"Zou","year":"2020","journal-title":"J Intern Med"},{"key":"10.1016\/j.jceh.2026.103632_bib7","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1097\/MCG.0000000000001270","article-title":"The prevalence of lean\/nonobese nonalcoholic fatty liver disease: a systematic review and meta-analysis","volume":"54","author":"Shi","year":"2020","journal-title":"J Clin Gastroenterol"},{"key":"10.1016\/j.jceh.2026.103632_bib8","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1002\/hep.23567","article-title":"Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease","volume":"51","author":"Das","year":"2010","journal-title":"Hepatology"},{"key":"10.1016\/j.jceh.2026.103632_bib9","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jceh.2015.02.006","article-title":"Non-alcoholic fatty liver disease and metabolic syndrome-position paper of the Indian National Association for the Study of the Liver","volume":"5","author":"Duseja","year":"2015","journal-title":"J Clin Exp Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib10","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.cgh.2015.07.024","article-title":"Body fat distribution and risk of incident and regressed nonalcoholic fatty liver disease","volume":"14","author":"Kim","year":"2016","journal-title":"Clin Gastroenterol Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib11","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1038\/ajg.2016.318","article-title":"Clinical and metabolic characterization of lean Caucasian subjects with non-alcoholic fatty liver","volume":"112","author":"Feldman","year":"2017","journal-title":"Am J Gastroenterol"},{"key":"10.1016\/j.jceh.2026.103632_bib12","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1002\/hep4.1124","article-title":"Risk for development of severe liver disease in lean patients with nonalcoholic fatty liver disease: a long-term follow-up study","volume":"2","author":"Hagstr\u00f6m","year":"2018","journal-title":"Hepatol Commun"},{"key":"10.1016\/j.jceh.2026.103632_bib13","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.cgh.2016.08.028","article-title":"Nonobese fatty liver disease","volume":"15","author":"Kim","year":"2017","journal-title":"Clin Gastroenterol Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib14","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1002\/hep.28697","article-title":"Histological severity and clinical outcomes of nonalcoholic fatty liver disease in nonobese patients","volume":"65","author":"Leung","year":"2017","journal-title":"Hepatology"},{"key":"10.1016\/j.jceh.2026.103632_bib15","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/MD.0b013e3182779d49","article-title":"Nonalcoholic fatty liver disease in lean individuals in the United States","volume":"91","author":"Younossi","year":"2012","journal-title":"Medicine (Baltim)"},{"key":"10.1016\/j.jceh.2026.103632_bib16","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1111\/1751-2980.12871","article-title":"Epidemiology of nonalcoholic fatty liver disease in Non-obese populations: meta-analytic assessment","volume":"21","author":"Zou","year":"2020","journal-title":"J Dig Dis"},{"key":"10.1016\/j.jceh.2026.103632_bib17","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the AASLD","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"10.1016\/j.jceh.2026.103632_bib18","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1016\/j.jhep.2015.11.004","article-title":"Clinical practice guidelines for the management of non-alcoholic fatty liver disease","volume":"64","year":"2016","journal-title":"J Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib19","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1053\/j.gastro.2015.04.005","article-title":"Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis","volume":"149","author":"Vilar-Gomez","year":"2015","journal-title":"Gastroenterology"},{"key":"10.1016\/j.jceh.2026.103632_bib20","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1002\/hep.23276","article-title":"Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis","volume":"51","author":"Promrat","year":"2010","journal-title":"Hepatology"},{"key":"10.1016\/j.jceh.2026.103632_bib21","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1016\/j.jhep.2011.12.011","article-title":"Predictors for incidence and remission of NAFLD in the general population","volume":"56","author":"Zelber-Sagi","year":"2012","journal-title":"J Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib22","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgast-2017-000139","article-title":"Efficacy of dietary and physical activity intervention in NAFLD: a systematic review","volume":"4","author":"Kenneally","year":"2017","journal-title":"BMJ Open Gastroenterol"},{"key":"10.1016\/j.jceh.2026.103632_bib23","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.jhep.2013.02.012","article-title":"The mediterranean diet improves hepatic steatosis and insulin sensitivity in NAFLD","volume":"59","author":"Ryan","year":"2013","journal-title":"J Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib24","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.jhep.2012.02.023","article-title":"Exercise and NAFLD: a systematic review and meta-analysis","volume":"57","author":"Keating","year":"2012","journal-title":"J Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib25","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1002\/hep.27544","article-title":"Moderate to vigorous physical activity volume is important in NAFLD","volume":"61","author":"Oh","year":"2015","journal-title":"Hepatology"},{"key":"10.1016\/j.jceh.2026.103632_bib26","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S0140-6736(03)15268-3","article-title":"Appropriate body-mass index for Asian populations","volume":"363","year":"2004","journal-title":"Lancet"},{"key":"10.1016\/j.jceh.2026.103632_bib27","first-page":"163","article-title":"Consensus statement for diagnosis of obesity in Asian Indians","volume":"57","author":"Misra","year":"2009","journal-title":"J Assoc Phys India"},{"key":"10.1016\/j.jceh.2026.103632_bib28","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1002\/hep.24452","article-title":"Diagnostic accuracy of ultrasonography for fatty liver: a meta-analysis","volume":"54","author":"Hernaez","year":"2011","journal-title":"Hepatology"},{"key":"10.1016\/j.jceh.2026.103632_bib29","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.3390\/ijms17122082","article-title":"Pathophysiology of non alcoholic fatty liver disease","volume":"17","author":"Petta","year":"2016","journal-title":"Int J Mol Sci"},{"key":"10.1016\/j.jceh.2026.103632_bib30","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.3390\/nu5051544","article-title":"NAFLD and its connection with insulin resistance and cardiovascular disease","volume":"5","author":"Gaggini","year":"2013","journal-title":"Nutrients"},{"key":"10.1016\/j.jceh.2026.103632_bib31","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.1172\/JCI31021","article-title":"Obesity-associated improvements in metabolic profile through adipose expansion","volume":"117","author":"Kim","year":"2007","journal-title":"J Clin Investig"},{"key":"10.1016\/j.jceh.2026.103632_bib32","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1002\/hep.23129","article-title":"Aerobic exercise reduces hepatic lipids without weight loss","volume":"50","author":"Johnson","year":"2009","journal-title":"Hepatology"},{"key":"10.1016\/j.jceh.2026.103632_bib33","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.jhep.2017.05.016","article-title":"Treatment of NAFLD with diet, physical activity and exercise.","volume":"67","author":"Romero-G\u00f3mez","year":"2017","journal-title":"J Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib34","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1136\/gut.2011.242073","article-title":"Resistance exercise reduces liver fat independent of weight loss","volume":"60","author":"Hallsworth","year":"2011","journal-title":"Gut"},{"key":"10.1016\/j.jceh.2026.103632_bib35","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1038\/ajg.2010.488","article-title":"Physical activity and histological severity of NAFLD","volume":"106","author":"Kistler","year":"2011","journal-title":"Am J Gastroenterol"},{"key":"10.1016\/j.jceh.2026.103632_bib36","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1111\/j.1440-1746.2012.07165.x","article-title":"Exercise and diet modification in non-obese NAFLD","volume":"27","author":"Jin","year":"2012","journal-title":"J Gastroenterol Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib37","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.jhep.2013.04.013","article-title":"Community-based lifestyle modification programme for NAFLD: a randomized trial","volume":"59","author":"Wong","year":"2013","journal-title":"J Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib38","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1016\/j.jhep.2018.08.011","article-title":"Lifestyle intervention in non-obese NAFLD","volume":"69","author":"Wong","year":"2018","journal-title":"J Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib39","first-page":"51","article-title":"Metabolic profile of lean vs obese NAFLD","volume":"68","author":"Shah","year":"2020","journal-title":"J Assoc Phys India"},{"key":"10.1016\/j.jceh.2026.103632_bib40","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1038\/s41366-023-01346-w","article-title":"Lean Indian NAFLD: similar severity despite fewer metabolic risk factors","volume":"47","author":"De","year":"2023","journal-title":"Int J Obes"},{"key":"10.1016\/j.jceh.2026.103632_bib41","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.jhep.2011.06.010","article-title":"Lifestyle interventions for NAFLD: a systematic review","volume":"56","author":"Thoma","year":"2012","journal-title":"J Hepatol"},{"key":"10.1016\/j.jceh.2026.103632_bib42","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1053\/j.gastro.2020.11.051","article-title":"AGA clinical practice update on lifestyle modification in NAFLD","volume":"160","author":"Younossi","year":"2021","journal-title":"Gastroenterology"},{"key":"10.1016\/j.jceh.2026.103632_bib43","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.jhep.2016.12.022","article-title":"Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis","volume":"66","author":"Karlas","year":"2017","journal-title":"J Hepatol"}],"container-title":["Journal of Clinical and Experimental Hepatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0973688326001647?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0973688326001647?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T20:56:13Z","timestamp":1788900973000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0973688326001647"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,11]]},"references-count":43,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["S0973688326001647"],"URL":"https:\/\/doi.org\/10.1016\/j.jceh.2026.103632","relation":{},"ISSN":["0973-6883"],"issn-type":[{"value":"0973-6883","type":"print"}],"subject":[],"published":{"date-parts":[[2026,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Efficacy of Structured Lifestyle Intervention in Normal Body Mass Index Non-alcoholic Fatty Liver Disease","name":"articletitle","label":"Article Title"},{"value":"Journal of Clinical and Experimental Hepatology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jceh.2026.103632","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"103632"}}