{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T12:19:46Z","timestamp":1781871586973,"version":"3.54.5"},"reference-count":39,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Pathology - Research and Practice"],"published-print":{"date-parts":[[2022,10]]},"DOI":"10.1016\/j.prp.2022.154112","type":"journal-article","created":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T00:06:36Z","timestamp":1662509196000},"page":"154112","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":6,"special_numbering":"C","title":["Non-alcoholic fatty liver disease (NAFLD) in lean individuals \u2013 Single centre large cohort clinicopathologic and immunophenotypic study"],"prefix":"10.1016","volume":"238","author":[{"given":"Archana","family":"Rastogi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indira","family":"Rath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annapoorani","family":"Varadarajan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayatri","family":"Ramakrishna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chhagan","family":"Bihari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakhi","family":"Maiwall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.prp.2022.154112_bib1","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1002\/hep4.1519","article-title":"Prevalence and profile of non-alcoholic fatty liver disease in lean adults: systematic review and meta\u2010analysis","volume":"4","author":"Young","year":"2020","journal-title":"Hepatol. Commun."},{"key":"10.1016\/j.prp.2022.154112_bib2","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1111\/j.1440-1746.2007.05042.x","article-title":"Asia\u2013Pacific Working Party on NAFLD. How common is non-alcoholic fatty liver disease in the Asia\u2013Pacific region and are there local differences?","volume":"22","author":"AmarapurkarDN","year":"2007","journal-title":"J. Gastroenterol. Hepatol."},{"issue":"7","key":"10.1016\/j.prp.2022.154112_bib3","first-page":"448","article-title":"Study of prevalence of non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes patients in India (SPRINT)","volume":"61","author":"Kalra","year":"2013","journal-title":"J. Assoc. Physicians India"},{"key":"10.1016\/j.prp.2022.154112_bib4","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of non-alcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"10.1016\/j.prp.2022.154112_bib5","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"},{"issue":"2","key":"10.1016\/j.prp.2022.154112_bib6","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1007\/s11901-016-0302-1","article-title":"Lean NAFLD: an underrecognized outlier","volume":"15","author":"Wattacheril","year":"2016","journal-title":"Curr. Hepatol. Rep."},{"key":"10.1016\/j.prp.2022.154112_bib7","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."},{"issue":"5","key":"10.1016\/j.prp.2022.154112_bib8","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.2337\/diacare.26.5.1380","article-title":"Cut-off values for normal anthropometric variables in Asian Indian adults","volume":"26","author":"Snehalatha","year":"2003","journal-title":"Diabetes Care"},{"key":"10.1016\/j.prp.2022.154112_bib9","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1111\/apt.14327","article-title":"Significant burden of non-alcoholic fatty liver disease with advanced fibrosis in the US: a cross-sectional analysis of 2011\u20132014 National Health and Nutrition Examination Survey","volume":"4","author":"Wong","year":"2017","journal-title":"Aliment. Pharmacol. Ther."},{"key":"10.1016\/j.prp.2022.154112_bib10","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1007\/s00535-012-0533-z","article-title":"Prevalence and associated metabolic factors of non-alcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: a multicenter large retrospective study","volume":"47","author":"Eguchi","year":"2012","journal-title":"J. Gastroenterol."},{"key":"10.1016\/j.prp.2022.154112_bib11","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s00535-014-0948-9","article-title":"Prevalence of and risk factors for non- alcoholic fatty liver disease in a non-obese Japanese population, 2011-2012","volume":"50","author":"Nishioji","year":"2015","journal-title":"J. Gastroenterol."},{"key":"10.1016\/j.prp.2022.154112_bib12","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/MD.0b013e3182779d49","article-title":"Younossi Yet al. Nonalcoholic fatty liver disease in lean individuals in the United States","volume":"91","author":"Younossi","year":"2012","journal-title":"Medicine"},{"key":"10.1016\/j.prp.2022.154112_bib13","article-title":"Search strategies to identify diagnostic accuracy studies in MEDLINE and EMBASE","volume":"11","author":"Beynon","year":"2013","journal-title":"Cochrane Database Syst. Rev."},{"key":"10.1016\/j.prp.2022.154112_bib14","doi-asserted-by":"crossref","first-page":"4574","DOI":"10.2174\/1381612825666190117102111","article-title":"Diagnosis of non-alcoholic fatty liver disease (NAFLD): current concepts","volume":"24","author":"Papatheodoridi","year":"2018","journal-title":"Curr. Pharm. Des."},{"issue":"8","key":"10.1016\/j.prp.2022.154112_bib15","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."},{"issue":"1","key":"10.1016\/j.prp.2022.154112_bib16","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/apt.14401","article-title":"Systematic review with meta-analysis: the significance of histological disease severity in lean patients with non-alcoholic fatty liver disease","volume":"47","author":"Sookoian","year":"2018","journal-title":"Aliment Pharm. Ther."},{"issue":"11","key":"10.1016\/j.prp.2022.154112_bib17","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1111\/apm.12742","article-title":"Non\u2010alcoholic fatty liver disease \u2013 histological scoring systems: a large cohort single\u2010center, evaluation study","volume":"125","author":"Rastogi","year":"2017","journal-title":"APMIS"},{"issue":"5","key":"10.1016\/j.prp.2022.154112_bib18","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1007\/s12664-014-0488-5","article-title":"Alam A. Clinical, anthropometric, biochemical, and histological characteristics of nonobese nonalcoholic fatty liver disease patients of Bangladesh","volume":"33","author":"Alam","year":"2014","journal-title":"Indian J. Gastroenterol."},{"issue":"1","key":"10.1016\/j.prp.2022.154112_bib19","first-page":"45","article-title":"Non-alcoholic fatty liver disease may develop in individuals with normal body mass index","volume":"25","author":"Margariti","year":"2012","journal-title":"Ann. Gastroenterol."},{"key":"10.1016\/j.prp.2022.154112_bib20","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1002\/hep.28697","article-title":"Histological severity and clinical outcomes of non-alcoholic fatty liver disease in nonobese patients","volume":"65","author":"Leung","year":"2017","journal-title":"Hepatology"},{"issue":"12","key":"10.1016\/j.prp.2022.154112_bib21","doi-asserted-by":"crossref","first-page":"562","DOI":"10.3390\/jcm7120562","article-title":"Lean patients with non-alcoholic fatty liver disease have a severe histological phenotype similar to obese patients","volume":"7","author":"Denkmayr","year":"2018","journal-title":"J. Clin. Med."},{"key":"10.1016\/j.prp.2022.154112_bib22","doi-asserted-by":"crossref","first-page":"665","DOI":"10.4103\/2230-8210.113758","article-title":"Clinicopathological characteristics and metabolic profiles of non-alcoholic fatty liver disease in Indian patients with normal body mass index: do they differ from obese or overweight non-alcoholic fatty liver disease?","volume":"17","author":"Kumar","year":"2013","journal-title":"Indian J. Endocrinol. Metab."},{"key":"10.1016\/j.prp.2022.154112_bib23","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1016\/j.cgh.2017.04.045","article-title":"Liver and cardiovascular damage in patients with lean non-alcoholic fatty liver disease, and association with visceral obesity","volume":"15","author":"Fracanzani","year":"2017","journal-title":"Clin. Gastroenterol. Hepatol."},{"issue":"4","key":"10.1016\/j.prp.2022.154112_bib24","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1254\/fpj.154.203","article-title":"Mechanisms of hepatic stellate cell activation as a therapeutic target for the treatment of non-alcoholic steatohepatitis","volume":"154","author":"Tsuchida","year":"2019","journal-title":"Folia Pharmacol. Jpn."},{"issue":"4","key":"10.1016\/j.prp.2022.154112_bib25","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1007\/s00428-012-1291-2","article-title":"Hepatic stellate cells are involved in the pathogenesis of acute-on-chronic liver failure (ACLF)","volume":"461","author":"Rastogi","year":"2012","journal-title":"Virchows Arch."},{"key":"10.1016\/j.prp.2022.154112_bib26","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1111\/liv.12100","article-title":"Heterogeneity of fibrosis patterns in non-alcoholic fatty liver disease supports the presence of multiple fibrogenic pathways","volume":"33","author":"Skoien","year":"2013","journal-title":"Liver Int."},{"issue":"10","key":"10.1016\/j.prp.2022.154112_bib27","doi-asserted-by":"crossref","first-page":"20112","DOI":"10.3390\/ijms141020112","article-title":"Role of hepatic progenitor cells in non-alcoholic fatty liver disease development: cellular cross-talks and molecular networks","volume":"14","author":"Carpino","year":"2013","journal-title":"Int. J. Mol. Sci."},{"key":"10.1016\/j.prp.2022.154112_bib28","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1053\/j.gastro.2007.05.012","article-title":"Progressive fibrosis in non-alcoholic steatohepatitis: association with altered regeneration and a ductular reaction","volume":"133","author":"Richardson","year":"2007","journal-title":"Gastroenterology"},{"issue":"3","key":"10.1016\/j.prp.2022.154112_bib29","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1002\/hep.27332","article-title":"Hepatic inflammation and fibrosis: functional links and key pathways","volume":"61","author":"Seki","year":"2015","journal-title":"Hepatology"},{"issue":"5","key":"10.1016\/j.prp.2022.154112_bib30","doi-asserted-by":"crossref","DOI":"10.1007\/s00428-014-1547-0","article-title":"Two-tier regenerative response in liver failure in humans","volume":"464","author":"Rastogi","year":"2014","journal-title":"Virchows Arch."},{"key":"10.1016\/j.prp.2022.154112_bib31","doi-asserted-by":"crossref","DOI":"10.1155\/2017\/8162421","article-title":"The role of tissue macrophage-mediated inflammation on NAFLD pathogenesis and its clinical implications","author":"Alisi","year":"2017","journal-title":"Mediat. Inflamm."},{"issue":"3","key":"10.1016\/j.prp.2022.154112_bib32","doi-asserted-by":"crossref","first-page":"590","DOI":"10.3390\/cells9030590","article-title":"Hepatocyte injury and hepatic stem cell niche in the progression of non-alcoholic steatohepatitis","volume":"9","author":"Overi","year":"2020","journal-title":"Cells"},{"key":"10.1016\/j.prp.2022.154112_bib33","doi-asserted-by":"crossref","first-page":"2467","DOI":"10.1111\/j.1572-0241.1999.01377.x","article-title":"Non-alcoholic steatohepatitis: a proposal for grading and staging the histological lesions","volume":"94","author":"Brunt","year":"1999","journal-title":"Am. J. Gastroenterol."},{"key":"10.1016\/j.prp.2022.154112_bib34","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S0140-6736(03)15268-3","article-title":"Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies","volume":"363","author":"WHO Expert Consultation","year":"2004","journal-title":"Lancet"},{"key":"10.1016\/j.prp.2022.154112_bib35","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1002\/hep.20701","article-title":"Non-alcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for non-alcoholic fatty liver disease","volume":"41","author":"Kleiner","year":"2005","journal-title":"Hepatology"},{"key":"10.1016\/j.prp.2022.154112_sbref36","first-page":"389","article-title":"Lean non-alcoholic fatty liver disease (Lean-NAFLD): a major cause of cryptogenic liver disease","volume":"74","author":"Vos","year":"2011","journal-title":"Acta Gastroenterol."},{"key":"10.1016\/j.prp.2022.154112_sbref37","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1016\/j.jhep.2011.01.010","article-title":"No need for a large belly to have NASH","volume":"54","author":"Machado","year":"2011","journal-title":"J Hepatol."},{"issue":"1","key":"10.1016\/j.prp.2022.154112_bib37","doi-asserted-by":"crossref","first-page":"18","DOI":"10.7869\/tg.2012.86","article-title":"Insulin resistance and metabolic syndrome in nonobese Indian patients with non-alcoholic fatty liver disease","volume":"34","author":"Bhat","year":"2013","journal-title":"Trop. Gastroenterol."},{"issue":"1","key":"10.1016\/j.prp.2022.154112_bib38","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1055\/s-0038-1677517","article-title":"NASH in lean Individuals","volume":"39","author":"Younes","year":"2019","journal-title":"Semin Liver Dis."}],"container-title":["Pathology - Research and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0344033822003569?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0344033822003569?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T06:56:35Z","timestamp":1759733795000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0344033822003569"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10]]},"references-count":39,"alternative-id":["S0344033822003569"],"URL":"https:\/\/doi.org\/10.1016\/j.prp.2022.154112","relation":{},"ISSN":["0344-0338"],"issn-type":[{"value":"0344-0338","type":"print"}],"subject":[],"published":{"date-parts":[[2022,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Non-alcoholic fatty liver disease (NAFLD) in lean individuals \u2013 Single centre large cohort clinicopathologic and immunophenotypic study","name":"articletitle","label":"Article Title"},{"value":"Pathology - Research and Practice","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.prp.2022.154112","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2022 Elsevier GmbH. All rights reserved.","name":"copyright","label":"Copyright"}],"article-number":"154112"}}