{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:39:19Z","timestamp":1787315959068,"version":"build-2736575974"},"reference-count":51,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T00:00:00Z","timestamp":1677110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005347","name":"American Association for the Study of Liver Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005347","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["K08 DK132312"],"award-info":[{"award-number":["K08 DK132312"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background &amp; Aims<\/jats:title>\n                    <jats:p>Non\u2010alcoholic fatty liver disease (NAFLD) can develop in individuals who are not overweight. Whether lean persons with NAFLD have lower mortality and lower incidence of cirrhosis, cardiovascular diseases (CVD), diabetes mellitus (DM) and cancer than overweight\/obese persons with NAFLD remains inconclusive. We compared mortality and incidence of cirrhosis, CVD, DM and cancer between lean versus non\u2010lean persons with NAFLD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective study of adults with NAFLD in a single centre from 2012 to 2021. Primary outcomes were mortality and new diagnosis of cirrhosis, CVD, DM and cancer. Outcomes were modelled using competing risk analysis and Cox proportional hazards regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 18,594 and 13,420 patients were identified for cross\u2010sectional and longitudinal analysis respectively: approximately 11% lean, 25% overweight, 28% class 1 obesity and 35% class 2\u20133 obesity. The median age was 51.0\u2009years, 54.6% were women. The median follow\u2010up was 49.3\u00a0months. Lean patients had lower prevalence of metabolic diseases at baseline and lower incidence of cirrhosis and DM than non\u2010lean patients and no difference in CVD, any cancer or obesity\u2010related cancer during follow\u2010up. However, lean patients had significantly higher mortality with incidence per 1000 person\u2010years of 16.67, 10.11, 7.37 and 8.99, respectively, in lean, overweight, obesity class 1 and obesity class 2\u20133 groups respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lean patients with NAFLD had higher mortality despite lower incidence of cirrhosis and DM, and similar incidence of CVD and cancer and merit similar if not more attention as non\u2010lean patients with NAFLD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.17424","type":"journal-article","created":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T04:51:06Z","timestamp":1677127866000},"page":"1014-1027","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["Higher mortality among lean patients with non\u2010alcoholic fatty liver disease despite fewer metabolic comorbidities"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6232-6343","authenticated-orcid":false,"given":"Karn","family":"Wijarnpreecha","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine University of Michigan Health System  Ann Arbor Michigan USA"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine University of Arizona College of Medicine  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8865-7717","authenticated-orcid":false,"given":"Fang","family":"Li","sequence":"additional","affiliation":[{"name":"School of Biomedical Informatics The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1388-7029","authenticated-orcid":false,"given":"Sori K.","family":"Lundin","sequence":"additional","affiliation":[{"name":"School of Public Health The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepika","family":"Suresh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Michigan Health System  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Michigan Health System  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4267-1924","authenticated-orcid":false,"given":"Cui","family":"Tao","sequence":"additional","affiliation":[{"name":"School of Biomedical Informatics The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0157-6066","authenticated-orcid":false,"given":"Vincent L.","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine University of Michigan Health System  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5811-6845","authenticated-orcid":false,"given":"Anna S. 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