{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T17:42:13Z","timestamp":1793900533074,"version":"4.8.0"},"reference-count":28,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T00:00:00Z","timestamp":1669161600000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["214185\/Z\/18\/Z"],"award-info":[{"award-number":["214185\/Z\/18\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,11,7]]},"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Non-alcoholic fatty liver disease (NAFLD) is a non-communicable disease with a rising prevalence worldwide and with large burden for patients and health systems. To date, the presence of unique phenotypes in patients with NAFLD has not been studied, and their identification could inform precision medicine and public health with pragmatic implications in personalised management and care for patients with NAFLD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional and prospective (up to 31 December 2019) analysis of National Health and Nutrition Examination Survey III (1988\u20131994).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcomes measures<\/jats:title>\n                    <jats:p>NAFLD diagnosis was based on liver ultrasound. The following predictors informed an unsupervised machine learning algorithm (k-means): body mass index, waist circumference, systolic blood pressure (SBP), plasma glucose, total cholesterol, triglycerides, liver enzymes alanine aminotransferase, aspartate aminotransferase and gamma glutamyl transferase. We summarised (means) and compared the predictors across clusters. We used Cox proportional hazard models to quantify the all-cause mortality risk associated with each cluster.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>1652 patients with NAFLD (mean age 47.2 years and 51.5%\u2009women) were grouped into 3 clusters: anthro-SBP-glucose (6.36%; highest levels of anthropometrics, SBP and glucose), lipid-liver (10.35%; highest levels of lipid and liver enzymes) and average (83.29%; predictors at average levels). Compared with the average phenotype, the anthro-SBP-glucose phenotype had higher all-cause mortality risk (aHR=2.88; 95%\u2009CI: 2.26 to 3.67); the lipid-liver phenotype was not associated with higher all-cause mortality risk (aHR=1.11; 95%\u2009CI: 0.86 to 1.42).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is heterogeneity in patients with NAFLD, whom can be divided into three phenotypes with different mortality risk. These phenotypes could guide specific interventions and management plans, thus advancing precision medicine and public health for patients with NAFLD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-067203","type":"journal-article","created":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T14:10:50Z","timestamp":1669212650000},"page":"e067203","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Phenotypes of non-alcoholic fatty liver disease (NAFLD) and all-cause mortality: unsupervised machine learning analysis of NHANES III"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2090-1856","authenticated-orcid":false,"given":"Rodrigo M","family":"Carrillo-Larco","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK"},{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"},{"name":"CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru"},{"name":"Universidad Continental, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2194-8496","authenticated-orcid":false,"given":"Wilmer Cristobal","family":"Guzman-Vilca","sequence":"additional","affiliation":[{"name":"CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru"},{"name":"School of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru"},{"name":"Sociedad Cient\u00edfica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Universidad Peruana Cayetano Heredia, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2990-7090","authenticated-orcid":false,"given":"Manuel","family":"Castillo-Cara","sequence":"additional","affiliation":[{"name":"Ontology Engineering Group, Artificial Intelligence Department, Universidad Polit\u00e9cnica de Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Alvizuri-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hospital Nacional Cayetano Heredia, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleh","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0003-1988","authenticated-orcid":false,"given":"Vanessa","family":"Garcia-Larsen","sequence":"additional","affiliation":[{"name":"Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,11,23]]},"reference":[{"key":"2025121605420779000_12.11.e067203.1","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/S2213-8587(22)00003-1","article-title":"A global view of the interplay between non-alcoholic fatty liver disease and diabetes","volume":"10","author":"Stefan","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2025121605420779000_12.11.e067203.2","doi-asserted-by":"crossref","first-page":"533","DOI":"10.2147\/DMSO.S146339","article-title":"Obesity and nonalcoholic 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