{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T10:50:58Z","timestamp":1781866258220,"version":"3.54.5"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":169,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mediators of Inflammation"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Metabolic dysfunction\u2010associated steatotic liver disease (MASLD) is increasingly prevalent. Life\u2019s Crucial 9 (LC9) combines cardiometabolic and mental health metrics linked to MASLD pathogenesis, but its association with liver fibrosis and prognosis in MASLD remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using National Health and Nutrition Examination Survey (NHANES) data, we performed a prospective cohort analysis for mortality (2005\u20132016,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092524) and a cross\u2010sectional analysis for liver fibrosis (2017\u20132018,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091277). Significant fibrosis was defined as liver stiffness measurement (LSM) \u22658.0\u2009kPa by vibration\u2010controlled transient elastography. Systemic inflammation was assessed using the systemic immune\u2010inflammation index (SII) and pan\u2010immune\u2010inflammation value (PIV). Multivariable regression and mediation analyses were conducted.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Higher LC9 scores were associated with lower liver stiffness (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.07, 95% CI: \u22120.12 to \u22120.01). Each 1\u2010point increase in LC9 reduced fibrosis risk by 5% (OR\u2009=\u20090.95), with the highest quartile showing the lowest risk (OR\u2009=\u20090.21). Over a median follow\u2010up of 98 months, each 1\u2010point LC9 increase was associated with a 3% reduction in all\u2010cause mortality (HR\u2009=\u20090.97). Lower systemic inflammation partially mediated the LC9\u2010mortality relationship (SII: 5%, PIV: 6.3%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher LC9 scores are associated with reduced liver fibrosis and improved survival in MASLD, with systemic inflammation partially mediating the mortality association.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/mi\/2700500","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T09:53:39Z","timestamp":1781862819000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Life\u2019s Crucial 9 Score With Liver Fibrosis and Mortality in U.S. Adults With MASLD: Evidence From NHANES and the Mediating Role of Systemic Inflammation"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9380-732X","authenticated-orcid":false,"given":"Zhuo","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6572-5884","authenticated-orcid":false,"given":"Lin","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3229-1351","authenticated-orcid":false,"given":"Junjie","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6212-7376","authenticated-orcid":false,"given":"Jing","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.03.039"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.06.003"},{"key":"e_1_2_12_3_2","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1097\/HEP.0000000000000913","article-title":"Epidemiology, 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