{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T10:36:59Z","timestamp":1769510219864,"version":"3.49.0"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T00:00:00Z","timestamp":1593993600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1R01HL120960"],"award-info":[{"award-number":["1R01HL120960"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Non\u2010alcoholic steatohepatitis (NASH), which can lead to liver failure, requires liver biopsies to follow and is difficult to treat. Our goal was to assess metabolic syndrome (MetS) severity as a predictor of treatment success and a marker of response.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We assessed data from the Pioglitazone, Vitamin E, or Placebo for NASH Study, in which individuals with biopsy\u2010confirmed NASH were randomized to receive pioglitazone, vitamin E, or placebo for 96\u00a0weeks. We assessed associations of a sex\u2010specific and race\/ethnicity\u2010specific MetS severity <jats:italic>Z<\/jats:italic>\u2010score (MetS\u2010Z) at baseline and 48\u00a0weeks with biopsy\u2010determined endpoint of NASH resolution at 96\u00a0weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Baseline MetS\u2010Z was inversely associated with odds of NASH resolution (odds ratio [OR] per 1 SD of MetS<jats:italic>\u2010<\/jats:italic>Z: 0.47, 95% confidence interval [CI] 0.28, 0.79). Decrease in MetS\u2010Z during initial 48\u2010week intervention was greatest for pioglitazone treatment (effect size: \u22120.31, 95% CI \u22120.15, \u22120.48) and for vitamin E tended toward being greater for those with <jats:italic>versus<\/jats:italic> without NASH resolution (\u22120.18 <jats:italic>vs<\/jats:italic> \u22120.05). Overall, 48\u2010week change in MetS\u2010Z was associated with NASH resolution (OR per 1\u2010SD change: 0.53, 95% CI 0.33, 0.85), although this was attenuated in models that included transaminases, which remained linked to treatment success (OR by change\u2010in\u2010aspartate aminotransferase <jats:italic>Z<\/jats:italic>\u2010score: 0.38, 95% CI 0.19, 0.76).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Individuals with more severe metabolic derangement at baseline were less likely to exhibit NASH resolution, suggesting that individuals may have a threshold of MetS severity beyond which successful treatment is unlikely. As an integrated marker of metabolic abnormalities, MetS\u2010Z was correlated with successful treatment, although transaminases were a more consistent marker of NASH resolution.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.15131","type":"journal-article","created":{"date-parts":[[2020,6,7]],"date-time":"2020-06-07T13:30:42Z","timestamp":1591536642000},"page":"249-256","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Use of metabolic syndrome severity to assess treatment with vitamin E and pioglitazone for non\u2010alcoholic steatohepatitis"],"prefix":"10.1111","volume":"36","author":[{"given":"Matthew J","family":"Gurka","sequence":"first","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics, College of Medicine University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasmine A","family":"Mack","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics, College of Medicine University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaofei","family":"Chi","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics, College of Medicine University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1462-591X","authenticated-orcid":false,"given":"Mark D","family":"DeBoer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Endocrinology University of Virginia  Charlottesville Virginia 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