{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T13:46:47Z","timestamp":1792504007653,"version":"4.5.0"},"reference-count":33,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"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":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Metabolic dysfunction\u2010associated steatotic liver disease (MASLD) is closely linked to obesity and insulin resistance, and sustained weight loss is associated with histological improvement. Whether different obesity\u2010management modalities exert weight\u2010independent hepatic effects remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a systematic review and network meta\u2010analysis (NMA) of randomised controlled trials evaluating lifestyle intervention, obesity management medications, endoscopic sleeve gastroplasty and metabolic and bariatric surgery in adults with BMI \u2265\u200927\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and biopsy\u2010confirmed MASH. The primary endpoint was MASH resolution without worsening of fibrosis. Study\u2010level meta\u2010regressions explored associations between total body weight loss (TBWL%) and histologic outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six RCTs (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091379) met inclusion criteria. Tirzepatide, semaglutide, sleeve gastrectomy and Roux\u2010en\u2010Y gastric bypass were superior to placebo or standard care for achieving MASH resolution. Because the network was weakly connected and largely placebo\u2010anchored, indirect estimates were imprecise. Across study arms, greater TBWL% was associated with higher rates of MASH resolution and fibrosis improvement; however, these associations were strongly influenced by a small number of high\u2010weight\u2010loss surgical arms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Weight loss was consistently associated with histologic improvement across available RCTs. However, the limited evidence base, sparse network structure and ecological nature of the meta\u2010regression preclude causal inference. These findings should be considered exploratory and hypothesis\u2010generating, underscoring the need for adequately powered head\u2010to\u2010head trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70617","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T06:37:03Z","timestamp":1773124623000},"page":"4253-4260","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Weight Loss as a Determinant of Histological Improvement in Metabolic Dysfunction\u2010Associated Steatotic Liver Disease in People With Obesity. A Systematic Review and Network Meta\u2010Analysis of Randomised Clinical Trials"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9349-828X","authenticated-orcid":false,"given":"Matteo","family":"Monami","sequence":"first","affiliation":[{"name":"Careggi Teaching Hospital and University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Belluzzi","sequence":"additional","affiliation":[{"name":"Rovigo Hospital, ULSS5 Polesana  Rovigo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0730-7649","authenticated-orcid":false,"given":"Silvio","family":"Buscemi","sequence":"additional","affiliation":[{"name":"Department of Promozione della Salute Materno\u2010Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo  Palermo 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