{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T15:44:47Z","timestamp":1775835887100,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>MASLD, defined as a steatotic liver disease in the presence of one or more cardiometabolic risk factors and the absence of harmful alcohol intake, exhibits substantial heterogeneity complicating risk stratification. A prior clustering model proposed liver\u2010specific and cardiometabolic subtypes, yet its generalizability and prognostic relevance remain unclear in the broader population. We aim to validate and replicate the prior approach in a nationally representative U.S. cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We included 3300 participants with MASLD from NHANES III. For validation, participants were assigned to previously defined clusters using published medoids. For replication, de novo clusters were derived using the Partitioning Around Medoids algorithm. Cox proportional hazards models accounting for the complex survey design of NHANES III were used to estimate hazard ratios for all\u2010cause, cardiovascular\u2010related, and diabetes\u2010related mortality across clusters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Individual cluster assignments showed limited reproducibility between the validation and replication analyses, although the overall clustering pattern was preserved. Based on clinical profiles, clusters were categorized into cardiometabolic, liver\u2010specific, and other subtypes. The cardiometabolic cluster consistently showed higher risks in both analyses, while the liver\u2010specific cluster showed no significant associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The subtyping model demonstrated limited generalizability. Nonetheless, the consistent identification of broad cardiometabolic and liver\u2010specific patterns suggests potential value for risk stratification, pending further validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70448","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T04:00:13Z","timestamp":1767844813000},"page":"2735-2743","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Population\u2010based cohort validation and replication reveals limited generalizability of cluster\u2010based\n                    <scp>MASLD<\/scp>\n                    subtypes"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0026-2641","authenticated-orcid":false,"given":"Junjie","family":"Wu","sequence":"first","affiliation":[{"name":"Utrecht University  Utrecht the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0909-4006","authenticated-orcid":false,"given":"Weiwei","family":"Xu","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care University Medical Center Utrecht  Utrecht the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guyu","family":"Zeng","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5157-5355","authenticated-orcid":false,"given":"Junfeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology CAPHRI Care and Public Health Research Institute, Maastricht University  Maastricht the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000004"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2468\u20101253(22)00165\u20100"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(20)32511\u20103"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2213\u20108587(22)00003\u20101"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102023\u2010330595"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.04.043"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.07.027"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23314"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591\u2010024\u201003283\u20101"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_2_10_12_1","volume-title":"National Health and Nutrition Examination Survey Data, NHANES III, 1988\u20131994","author":"Centers for Disease Control and Prevention (CDC). 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