{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:40:02Z","timestamp":1791402002912,"version":"4.3.3"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T00:00:00Z","timestamp":1700006400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["5UL1TR001442"],"award-info":[{"award-number":["5UL1TR001442"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["P01HL147835"],"award-info":[{"award-number":["P01HL147835"]}],"id":[{"id":"10.13039\/100000050","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":["K23DK119460"],"award-info":[{"award-number":["K23DK119460"]}],"id":[{"id":"10.13039\/100000062","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":["P30DK120515"],"award-info":[{"award-number":["P30DK120515"]}],"id":[{"id":"10.13039\/100000062","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":["R01DK106419"],"award-info":[{"award-number":["R01DK106419"]}],"id":[{"id":"10.13039\/100000062","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":["R01DK121378"],"award-info":[{"award-number":["R01DK121378"]}],"id":[{"id":"10.13039\/100000062","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":["R01DK124318"],"award-info":[{"award-number":["R01DK124318"]}],"id":[{"id":"10.13039\/100000062","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":["U01DK061734"],"award-info":[{"award-number":["U01DK061734"]}],"id":[{"id":"10.13039\/100000062","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":["U01DK130190"],"award-info":[{"award-number":["U01DK130190"]}],"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":[[2024,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Progression to cirrhosis in non\u2010alcoholic steatohepatitis (NASH) is associated with a decrease in liver fat. However, the prognostic significance of liver fat content in NASH\u2010related significant fibrosis and cirrhosis is unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To investigate the risk of decompensation, hepatocellular carcinoma (HCC) and mortality stratified by liver fat content in NASH\u2010related significant fibrosis and cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this meta\u2010analysis of individual participant data, 456 patients with both magnetic resonance elastography (MRE) and MRI\u2010derived protein density fat fraction (MRI\u2010PDFF) were enrolled, and 296 patients with longitudinal follow\u2010up were analysed. MRE combined with fibrosis\u20104 (MEFIB\u2010index), and MRI\u2010PDFF were used to measure liver fibrosis and fat, respectively. MEFIB\u2010negative, MEFIB\u2010positive+\u2009MRI\u2010PDFF \u22655% and MEFIB\u2010positive+\u2009MRI\u2010PDFF &lt;5% were defined as no significant liver fibrosis, NASH with significant fibrosis and higher liver fat content, and NASH with significant fibrosis and low liver fat content groups, respectively. The primary outcome was hepatic decompensation, HCC and death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The rates of decompensation, HCC and mortality were highest in the NASH with significant fibrosis and low liver fat group (33%, 17% and 17%, respectively), followed by the NASH with significant fibrosis and higher liver fat group (18%, 13% and 13% respectively), and lowest in the no significant fibrosis (MEFIB\u2010negative) group (0%, 1% and 2% respectively). In multivariable\u2010adjusted analysis, low liver fat content was strongly associated (HR\u2009=\u200942.2 [95% CI: 7.5\u2013235.5, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001]) with HCC, decompensation and death. Sensitivity analyses for patients with cirrhosis (MRE \u22655\u2009kPa) determined consistent findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Low liver fat content in patients with burnt\u2010out NASH\u2010related significant fibrosis and cirrhosis is associated with an increase in hepatic decompensation, HCC and mortality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.17783","type":"journal-article","created":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T03:54:53Z","timestamp":1700106893000},"page":"80-88","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Low liver fat in non\u2010alcoholic steatohepatitis\u2010related significant fibrosis and cirrhosis is associated with <scp>hepatocellular carcinoma<\/scp>, decompensation and mortality"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5194-5130","authenticated-orcid":false,"given":"Sung Won","family":"Lee","sequence":"first","affiliation":[{"name":"NAFLD Research Center, Division of Gastroenterology and Hepatology University of California at San Diego  La Jolla California USA"},{"name":"Division of Hepatology, Department of Internal Medicine, College of Medicine The Catholic University of Korea  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5165-5061","authenticated-orcid":false,"given":"Daniel Q.","family":"Huang","sequence":"additional","affiliation":[{"name":"NAFLD Research Center, Division of Gastroenterology and Hepatology University of California at San Diego  La Jolla California USA"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine National University of Singapore  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricki","family":"Bettencourt","sequence":"additional","affiliation":[{"name":"NAFLD Research Center, Division of Gastroenterology and Hepatology University of California at San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5626-0942","authenticated-orcid":false,"given":"Veeral","family":"Ajmera","sequence":"additional","affiliation":[{"name":"NAFLD Research Center, Division of Gastroenterology and Hepatology University of California at San Diego  La Jolla California USA"},{"name":"Division of Gastroenterology University of California at San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9954-8548","authenticated-orcid":false,"given":"Monica","family":"Tincopa","sequence":"additional","affiliation":[{"name":"NAFLD Research Center, Division of Gastroenterology and Hepatology University of California at San Diego  La Jolla California USA"},{"name":"Division of Gastroenterology University of California at San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabil","family":"Noureddin","sequence":"additional","affiliation":[{"name":"NAFLD Research Center, Division of Gastroenterology and Hepatology University of California at San Diego  La Jolla California USA"},{"name":"Division of Gastroenterology University of California at San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maral","family":"Amangurbanova","sequence":"additional","affiliation":[{"name":"NAFLD Research Center, Division of Gastroenterology and Hepatology University of California at San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harris","family":"Siddiqi","sequence":"additional","affiliation":[{"name":"NAFLD Research Center, Division of Gastroenterology and Hepatology University of California at San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Egbert","family":"Madamba","sequence":"additional","affiliation":[{"name":"NAFLD Research Center, Division of Gastroenterology and Hepatology University of California at San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul M.","family":"Majzoub","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek","family":"Nayfeh","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4634-6616","authenticated-orcid":false,"given":"Nobuharu","family":"Tamaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Musashino Red Cross Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namiki","family":"Izumi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Musashino Red Cross Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6263-1436","authenticated-orcid":false,"given":"Atsushi","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Yokohama City University  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Yoneda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Yokohama City University  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramzan","family":"Idilman","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Ankara University School of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mesut","family":"Gumussoy","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Ankara University School of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Digdem Kuru","family":"Oz","sequence":"additional","affiliation":[{"name":"Department of Radiology Ankara University School of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayse","family":"Erden","sequence":"additional","affiliation":[{"name":"Department of Radiology Ankara University School of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4845-9991","authenticated-orcid":false,"given":"Rohit","family":"Loomba","sequence":"additional","affiliation":[{"name":"NAFLD Research Center, Division of Gastroenterology and Hepatology University of California at San Diego  La Jolla California USA"},{"name":"Division of Gastroenterology University of California at San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(22)00165-0"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2029349"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-023-00807-x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12719"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-004-1475-x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-021-10205-7"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000323"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-322976"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29797"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.7569924"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.23731"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.22580"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2022.0426"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31884"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01481.x"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000466"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2002.33324"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1053\/gast.2002.34168"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840110114"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.13536"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2021.100350"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.2147\/JHC.S355540"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiaa739"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-021-10218-2"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2022.0422"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2004.02.013"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.164.5.7717220"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00494.2003"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26072"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20280"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2006.02527.x"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-021-03974-6"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15103"}],"updated-by":[{"DOI":"10.1111\/apt.17854","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T00:00:00Z","timestamp":1704153600000}}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.17783","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,29]],"date-time":"2023-12-29T05:55:38Z","timestamp":1703829338000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.17783"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,15]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1111\/apt.17783"],"URL":"https:\/\/doi.org\/10.1111\/apt.17783","archive":["Portico"],"relation":{"correction":[{"id-type":"doi","id":"10.1111\/apt.17854","asserted-by":"object"}]},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,15]]},"assertion":[{"value":"2023-09-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}