{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:20:46Z","timestamp":1791537646471,"version":"4.3.4"},"reference-count":70,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T00:00:00Z","timestamp":1757721600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR002377"],"award-info":[{"award-number":["UL1TR002377"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background &amp; Aims<\/jats:title>\n                    <jats:p>\n                      Steatotic liver disease (SLD) is characterised by liver fat accumulation exceeding 5%. Lean body weight (BMI\u2009\u2264\u200925\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) with non\u2010alcoholic SLD is a rare phenotype, and the balance of risks related to metabolic conditions or genetic predisposition, or the risk of progressive liver disease, is not known. This study evaluates clinical and genetic predictors of non\u2010alcoholic SLD and advanced liver disease in lean individuals.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used International Classification of Disease codes, radiology and pathology review to identify 177 lean non\u2010alcoholic SLD cases (47 cryptogenic, 130 MASLD), 677 matched lean controls, and 3090 overweight\/obese SLD cases in the Mayo Clinic Biobank and Tapestry databases. We performed case\u2013control and cross\u2010sectional comparisons of clinical and genetic factors between these groups, using univariable and multivariable analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Lean individuals with non\u2010alcoholic SLD exhibited metabolic and genetic profiles that were intermediate between those of lean controls without SLD and overweight\/obese SLD individuals, including intermediate rates of diabetes, hypertension, hyperlipidaemia and of homozygosity for the risk allele of\n                      <jats:italic>PNPLA3<\/jats:italic>\n                      . Multivariable analysis indicated that diabetes was an independent predictor of SLD among lean individuals. Among lean individuals with non\u2010alcoholic SLD, those with metabolic\u2010associated SLD (MASLD), as compared to those with cryptogenic SLD (without metabolic risk factor), were more likely to be homozygous for risk alleles in\n                      <jats:italic>GCKR<\/jats:italic>\n                      . The Fib\u20104 score, a tool for screening advanced liver disease in SLD, accurately predicted advanced fibrosis among lean individuals with non\u2010alcoholic SLD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Diabetes serves as a primary predictor of non\u2010alcoholic SLD in lean individuals. These results support the recommendation to screen for SLD in patients with diabetes, regardless of BMI. The\n                      <jats:italic>GCKR<\/jats:italic>\n                      risk allele is associated with MASLD in lean individuals, and the risk factors for cryptogenic SLD remain unclear.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70300","type":"journal-article","created":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T09:10:12Z","timestamp":1757754612000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical and Genetic Predictors of Non\u2010Alcoholic Steatotic Liver Disease and Fibrosis in Lean Individuals"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1725-5865","authenticated-orcid":false,"given":"Karina","family":"Sato\u2010Espinoza","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology and Hepatology Mayo Clinic  Rochester Minnesota 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