{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:57:44Z","timestamp":1790859464854,"version":"4.1.0"},"reference-count":69,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prevalence, incidence, and associated factors of liver disease (LD) in Turner syndrome (TS) remain uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>A meta\u2010analysis was performed to quantify LD burden in TS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Four electronic databases were searched through June 2025 for observational studies involving karyotype\u2010confirmed individuals with TS. LD was defined by raised serum liver enzymes (RLE), International Classification of Diseases codes, imaging, or histology. Pooled prevalence, incidence, and odds ratios (OR) with 95% confidence intervals (CI) were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty studies from 19 countries with aggregate data on 9728 young TS individuals (median age 25.5\u2009years, IQR 16.8\u201330.7) were included. Prevalences of RLE, steatotic LD (SLD), and significant\/advanced liver fibrosis were 26.9% (95% CI 19.7\u201335.6), 22.3% (9.9\u201342.9), and 12.2% (2.6\u201341.7), respectively. Incidence of RLE was 16.7 per 1000 person\u2010years (7.6\u201336.8). Compared to age\u2010matched healthy controls, TS individuals had higher odds of RLE (OR 3.96 [95% CI 1.45\u201310.84]), SLD (OR 4.03 [1.86\u20138.70]), and significant\/advanced fibrosis (OR 5.74 [2.99\u201311.01]). Compared to X monosomy, isochromosome Xq conferred a higher risk of RLE (OR 1.55 [1.15\u20132.10]), while mosaicism without structural abnormalities was protective (OR 0.54 [0.32\u20130.89]). Ring X or Y chromosome material carried risks like X monosomy. Hormone replacement therapy was not associated with an increased risk of RLE (OR 1.10 [0.79\u20131.53]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Liver disease is common in individuals with TS, with a 4\u20136 times higher risk than age\u2010matched healthy females. X chromosome abnormalities are more strongly associated with an increased liver disease risk than hypogonadism.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.70457","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T14:05:14Z","timestamp":1763129114000},"page":"468-482","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Meta\u2010Analysis: Liver Disease Burden and Associated Factors in Turner Syndrome"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1645-9989","authenticated-orcid":false,"given":"Mohamad","family":"Jamalinia","sequence":"first","affiliation":[{"name":"Gastroenterohepatology Research Center Shiraz University of Medical Sciences  Shiraz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Zare","sequence":"additional","affiliation":[{"name":"Gastroenterohepatology Research Center Shiraz University of Medical Sciences  Shiraz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Mantovani","sequence":"additional","affiliation":[{"name":"Metabolic Diseases Research Unit, IRCCS Sacro Cuore \u2010 Don Calabria Hospital  Verona Italy"},{"name":"Department of Medicine University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4325-3900","authenticated-orcid":false,"given":"Giovanni","family":"Targher","sequence":"additional","affiliation":[{"name":"Metabolic Diseases Research Unit, IRCCS Sacro Cuore \u2010 Don Calabria Hospital  Verona Italy"},{"name":"Department of Medicine University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amedeo","family":"Lonardo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Azienda Ospedaliero\u2010Universitaria Di Modena (\u22122023)  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.c.31805"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvae050"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20026"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.16277"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001186"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-025-03121-x"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2023-330595"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-18-0878"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2017.02.040"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15840"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.04.043"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0000000000001353"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.15.2008"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S181242"},{"key":"e_1_2_10_17_1","first-page":"1542","article-title":"FIB\u20104\u2010Based Referral Pathways Have Suboptimal Accuracy to Identify Increased Liver Stiffness and Incident Advanced Liver Disease","volume":"25","author":"Kleef L. A.","year":"2025","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2011.11.014"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2017.12.004"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-021-01381-z"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-021-01310-0"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.10008"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/00042737-199909000-00015"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad108"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13811"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1089\/met.2013.0075"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13394"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.63341"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.c.32128"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2007.03166.x"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ando.2009.12.013"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.2001.01321.x"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.EJ15-0288"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2022.08.011"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1530\/EC-19-0418"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2008.03203.x"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004310050038"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2362.2010.02397.x"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2023.11.013"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.4158\/EP11059.OR"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1080\/13697137.2017.1325461"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.EJ16-0370"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ten.0000257435.71801.c1"},{"issue":"622","key":"e_1_2_10_44_1","first-page":"284","article-title":"The Frequency of Anatomical Renal, Thyroid, Hepatic, and Cardiac Abnormalities in Patients With Turner Syndrome","volume":"39","author":"Riahinezhad M.","year":"2021","journal-title":"J Isfahan Med Sch"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvaf059"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13175105"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.14740\/gr778w"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.3109\/09513590.2011.652249"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad337"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1447-0756.2010.01448.x"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004310051163"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15358"},{"issue":"4","key":"e_1_2_10_53_1","first-page":"359","article-title":"Middle\u2010Aged Women With Turner's Syndrome. Medical Status, Hormonal Treatment and Social Life","volume":"125","author":"Sylv\u00e9n L.","year":"1991","journal-title":"Acta Endocrinologica"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1324160"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03347555"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.4274\/jcrpe.galenos.2019.2018.0271"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.4274\/jcrpe.1771"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvae099"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-02137"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13148-018-0477-0"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.1159\/000512904"},{"key":"e_1_2_10_62_1","doi-asserted-by":"publisher","DOI":"10.1097\/MS9.0000000000002146"},{"key":"e_1_2_10_63_1","doi-asserted-by":"publisher","DOI":"10.70322\/fibrosis.2024.10006"},{"key":"e_1_2_10_64_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms26136382"},{"key":"e_1_2_10_65_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-1049"},{"key":"e_1_2_10_66_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-88133-x"},{"key":"e_1_2_10_67_1","doi-asserted-by":"publisher","DOI":"10.3390\/biom15020213"},{"key":"e_1_2_10_68_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2412865"},{"key":"e_1_2_10_69_1","doi-asserted-by":"publisher","DOI":"10.1080\/17474124.2024.2435504"},{"key":"e_1_2_10_70_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.06.004"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.70457","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/apt.70457","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.70457","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T19:28:42Z","timestamp":1771010922000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.70457"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,14]]},"references-count":69,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1111\/apt.70457"],"URL":"https:\/\/doi.org\/10.1111\/apt.70457","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,14]]},"assertion":[{"value":"2025-09-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}