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This study examines associations between changes in muscle mass and incident LRE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cohort study included 19\u2009660 participants with baseline and first follow\u2010up body composition data. Appendicular skeletal muscle mass (ASM) was estimated using bioelectrical impedance analysis and the Janssen equation, and was indexed to body mass index as ASM\/BMI. \u0394ASM\/BMI was calculated as ASM\/BMI at first follow\u2010up minus ASM\/BMI at baseline. Follow\u2010up for incident LRE started at the first follow\u2010up assessment. Cox proportional hazards models, restricted cubic spline analyses, subgroup analyses, competing\u2010risk models, and sensitivity analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a median follow\u2010up of 9.87\u2009years, 101 incident LRE were identified. In the fully adjusted model, higher \u0394ASM\/BMI was associated with a lower risk of incident LRE. Compared with participants in the lowest tertile, those in the intermediate and highest tertiles had lower LRE risk, with HRs of 0.59 (95% CI, 0.37\u20130.94) and 0.44 (95% CI, 0.27\u20130.72), respectively. The association was more pronounced among participants younger than 60\u2009years (\n                      <jats:italic>p<\/jats:italic>\n                      for interaction\u2009=\u20090.042). Restricted cubic spline analysis showed a significant nonlinear association between \u0394ASM\/BMI and LRE risk (P\u2010overall\u2009=\u20090.012;\n                      <jats:italic>p<\/jats:italic>\n                      \u2010non\u2010linear\u2009=\u20090.029). Results were generally consistent in competing\u2010risk, sensitivity, propensity score\u2010based, and nested case\u2013control analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Greater preservation or increase in muscle mass was associated with a lower risk of incident LRE, particularly among participants younger than 60\u2009years. These findings support the potential relevance of maintaining muscle mass for liver risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71127","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T01:46:17Z","timestamp":1784511977000},"page":"9143-9154","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Changes in Muscle Mass and the Risk of Liver\u2010Related Events: A Prospective Cohort Study"],"prefix":"10.1111","volume":"28","author":[{"given":"Zihao","family":"Gui","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism The Eighth Affiliated Hospital, Southern Medical University (The First People's Hospital of Shunde)  Foshan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hualin","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism The Eighth Affiliated Hospital, Southern Medical University (The First People's Hospital of Shunde)  Foshan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingtao","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism The Eighth Affiliated Hospital, Southern Medical University (The First People's Hospital of Shunde)  Foshan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junnian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9650-9017","authenticated-orcid":false,"given":"Huanyi","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Guangdong Cardiovascular 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