{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T17:56:20Z","timestamp":1793987780559,"version":"4.8.0"},"reference-count":49,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"DOI":"10.1186\/s12876-025-04277-0","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T17:15:37Z","timestamp":1759166137000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A chitinase-3-like protein-1-based nomogram for identification of significant liver fibrosis in the general population"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2220-8959","authenticated-orcid":false,"given":"Piaopiao","family":"Jin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenbing","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Sheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihong","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenzhao","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"issue":"1","key":"4277_CR1","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.jhep.2018.09.014","volume":"70","author":"SK Asrani","year":"2019","unstructured":"Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70(1):151\u201371.","journal-title":"J Hepatol"},{"issue":"11","key":"4277_CR2","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1038\/nrgastro.2013.197","volume":"10","author":"K Ray","year":"2013","unstructured":"Ray K. NAFLD-the next global epidemic. Nat Rev Gastroenterol Hepatol. 2013;10(11):621.","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"5","key":"4277_CR3","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1136\/gutjnl-2014-306842","volume":"64","author":"YA Lee","year":"2015","unstructured":"Lee YA, Wallace MC, Friedman SL. Pathobiology of liver fibrosis: a translational success story. Gut. 2015;64(5):830\u201341.","journal-title":"Gut"},{"issue":"6","key":"4277_CR4","doi-asserted-by":"publisher","first-page":"702","DOI":"10.3109\/00365521.2012.661759","volume":"47","author":"A Dam Fialla","year":"2012","unstructured":"Dam Fialla A, Schaffalitzky de Muckadell OB, Touborg Lassen A. Incidence, etiology and mortality of cirrhosis: a population-based cohort study. Scand J Gastroenterol. 2012;47(6):702\u20139.","journal-title":"Scand J Gastroenterol"},{"issue":"10406","key":"4277_CR5","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1016\/S0140-6736(23)01174-1","volume":"402","author":"M Serra-Burriel","year":"2023","unstructured":"Serra-Burriel M, Juanola A, Serra-Burriel F, Thiele M, Graupera I, Pose E, et al. Development, validation, and prognostic evaluation of a risk score for long-term liver-related outcomes in the general population: a multicohort study. Lancet. 2023;402(10406):988\u201396.","journal-title":"Lancet"},{"issue":"Suppl 1","key":"4277_CR6","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1016\/j.jhep.2020.11.042","volume":"75","author":"P Jepsen","year":"2021","unstructured":"Jepsen P, Younossi ZM. The global burden of cirrhosis: a review of disability-adjusted life-years lost and unmet needs. J Hepatol. 2021;75(Suppl 1):S3-13.","journal-title":"J Hepatol"},{"issue":"1","key":"4277_CR7","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1002\/hep.29367","volume":"67","author":"N Chalasani","year":"2018","unstructured":"Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, Harrison SA, Brunt EM, Sanyal AJ. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American association for the study of liver diseases. Hepatology. 2018;67(1):328\u201357.","journal-title":"Hepatology"},{"issue":"7","key":"4277_CR8","doi-asserted-by":"publisher","first-page":"1592","DOI":"10.1053\/j.gastro.2012.04.001","volume":"142","author":"N Chalasani","year":"2012","unstructured":"Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. D: The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012;142(7):1592\u2013609.","journal-title":"Gastroenterology"},{"issue":"6","key":"4277_CR9","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1002\/hep.20701","volume":"41","author":"DE Kleiner","year":"2005","unstructured":"Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, Ferrell LD, Liu YC, Torbenson MS, Unalp-Arida A, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41(6):1313\u201321.","journal-title":"Hepatology"},{"issue":"10319","key":"4277_CR10","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/S0140-6736(21)01701-3","volume":"399","author":"TH Karlsen","year":"2022","unstructured":"Karlsen TH, Sheron N, Zelber-Sagi S, Carrieri P, Dusheiko G, Bugianesi E, et al. The EASL-Lancet liver commission: protecting the next generation of Europeans against liver disease complications and premature mortality. Lancet. 2022;399(10319):61\u2013116.","journal-title":"Lancet"},{"issue":"10308","key":"4277_CR11","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1016\/S0140-6736(21)01374-X","volume":"398","author":"P Gines","year":"2021","unstructured":"Gines P, Krag A, Abraldes JG, Sola E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet. 2021;398(10308):1359\u201376.","journal-title":"Lancet"},{"issue":"3","key":"4277_CR12","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/S2468-1253(16)30081-4","volume":"1","author":"P Gines","year":"2016","unstructured":"Gines P, Graupera I, Lammert F, Angeli P, Caballeria L, Krag A, et al. Screening for liver fibrosis in the general population: a call for action. The Lancet Gastroenterology & Hepatology. 2016;1(3):256\u201360.","journal-title":"The Lancet Gastroenterology & Hepatology"},{"issue":"11","key":"4277_CR13","doi-asserted-by":"publisher","first-page":"2567","DOI":"10.1016\/j.cgh.2021.12.034","volume":"20","author":"I Graupera","year":"2022","unstructured":"Graupera I, Thiele M, Serra-Burriel M, Caballeria L, Roulot D, Wong GL, Fabrellas N, Guha IN, Arslanow A, Exposito C, et al. Low accuracy of FIB-4 and NAFLD fibrosis scores for screening for liver fibrosis in the population. Clin Gastroenterol Hepatol. 2022;20(11):2567\u201376. e2566.","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"4277_CR14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2023.100925","volume":"6","author":"ND Parikh","year":"2024","unstructured":"Parikh ND, Mehta M, Tapper EB. FIB-4 and APRI for cirrhosis detection in a privately insured National cohort. JHEP Rep. 2024;6(1):100925.","journal-title":"JHEP Rep"},{"key":"4277_CR15","doi-asserted-by":"publisher","first-page":"2255","DOI":"10.2147\/DMSO.S417754","volume":"16","author":"F Zhang","year":"2023","unstructured":"Zhang F, Han Y, Zheng L, Liu J, Wu Y, Bao Z, et al. Association of non-invasive markers with significant fibrosis in patients with nonalcoholic fatty liver disease: a cross-sectional study. Diabetes Metab Syndr Obes. 2023;16:2255\u201368.","journal-title":"Diabetes Metab Syndr Obes"},{"issue":"1","key":"4277_CR16","doi-asserted-by":"publisher","DOI":"10.1038\/s41392-020-00303-7","volume":"5","author":"T Zhao","year":"2020","unstructured":"Zhao T, Su Z, Li Y, Zhang X, You Q. Chitinase-3 like-protein-1 function and its role in diseases. Signal Transduct Target Ther. 2020;5(1):201.","journal-title":"Signal Transduct Target Ther"},{"issue":"3","key":"4277_CR17","doi-asserted-by":"publisher","first-page":"E283","DOI":"10.1111\/hepr.12982","volume":"48","author":"L Wang","year":"2018","unstructured":"Wang L, Liu T, Zhou J, You H, Jia J. Changes in serum chitinase 3-like 1 levels correlate with changes in liver fibrosis measured by two established quantitative methods in chronic hepatitis B patients following antiviral therapy. Hepatol Res. 2018;48(3):E283-90.","journal-title":"Hepatol Res"},{"issue":"6","key":"4277_CR18","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1016\/S0168-8278(00)80095-1","volume":"32","author":"JS Johansen","year":"2000","unstructured":"Johansen JS, Christoffersen P, Moller S, Price PA, Henriksen JH, Garbarsch C, et al. Serum YKL-40 is increased in patients with hepatic fibrosis. J Hepatol. 2000;32(6):911\u201320.","journal-title":"J Hepatol"},{"issue":"2","key":"4277_CR19","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/S0168-8278(03)00184-3","volume":"39","author":"C Nojgaard","year":"2003","unstructured":"Nojgaard C, Johansen JS, Christensen E, Skovgaard LT, Price PA, Becker U, Group E. Serum levels of YKL-40 and PIIINP as prognostic markers in patients with alcoholic liver disease. J Hepatol. 2003;39(2):179\u201386.","journal-title":"J Hepatol"},{"key":"4277_CR20","doi-asserted-by":"publisher","first-page":"35282","DOI":"10.1038\/srep35282","volume":"6","author":"E Kumagai","year":"2016","unstructured":"Kumagai E, Mano Y, Yoshio S, Shoji H, Sugiyama M, Korenaga M, Ishida T, Arai T, Itokawa N, Atsukawa M, et al. Serum YKL-40 as a marker of liver fibrosis in patients with non-alcoholic fatty liver disease. Sci Rep. 2016;6:35282.","journal-title":"Sci Rep"},{"issue":"11","key":"4277_CR21","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1016\/S2468-1253(20)30252-1","volume":"5","author":"SA Harrison","year":"2020","unstructured":"Harrison SA, Ratziu V, Boursier J, Francque S, Bedossa P, Majd Z, et al. A blood-based biomarker panel (NIS4) for non-invasive diagnosis of non-alcoholic steatohepatitis and liver fibrosis: a prospective derivation and global validation study. The Lancet Gastroenterol Hepatol. 2020;5(11):970\u201385.","journal-title":"The Lancet Gastroenterol Hepatol"},{"issue":"6","key":"4277_CR22","first-page":"484","volume":"15","author":"Chinese Society of Endocrinology","year":"2023","unstructured":"Chinese Society of Endocrinology, Chinese Diabetes Society, Chinese Endocrinologist Association. Intervention for adults with pre-diabetes: a Chinese expert consensus (2023 edition). Chin J Diabetes. 2023;15(6):484\u201394.","journal-title":"Chin J Diabetes"},{"issue":"7","key":"4277_CR23","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1007\/BF00280883","volume":"28","author":"DR Matthews","year":"1985","unstructured":"Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412\u20139.","journal-title":"Diabetologia"},{"issue":"9","key":"4277_CR24","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1111\/1751-2980.12924","volume":"21","author":"WJ Duan","year":"2020","unstructured":"Duan WJ, Wang XZ, Ma AL, Shang J, Nan YM, Gao ZL, et al. Multicenter prospective study to validate a new transient elastography device for staging liver fibrosis in patients with chronic hepatitis B. J Dig Dis. 2020;21(9):519\u201325.","journal-title":"J Dig Dis"},{"issue":"6","key":"4277_CR25","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1111\/hepr.12405","volume":"45","author":"Y Takahashi","year":"2015","unstructured":"Takahashi Y, Kurosaki M, Tamaki N, Yasui Y, Hosokawa T, Tsuchiya K, et al. Non-alcoholic fatty liver disease fibrosis score and FIB-4 scoring system could identify patients at risk of systemic complications. Hepatol Res. 2015;45(6):667\u201375.","journal-title":"Hepatol Res"},{"issue":"4","key":"4277_CR26","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1002\/hep.21496","volume":"45","author":"P Angulo","year":"2007","unstructured":"Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45(4):846\u201354.","journal-title":"Hepatology"},{"issue":"6","key":"4277_CR27","doi-asserted-by":"publisher","first-page":"1542","DOI":"10.1016\/j.jhep.2023.06.003","volume":"79","author":"ME Rinella","year":"2023","unstructured":"Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542\u201356.","journal-title":"J Hepatol"},{"issue":"1","key":"4277_CR28","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1053\/j.gastro.2019.09.008","volume":"158","author":"H Hagstrom","year":"2020","unstructured":"Hagstrom H, Talback M, Andreasson A, Walldius G, Hammar N. Ability of noninvasive scoring systems to identify individuals in the population at risk for severe liver disease. Gastroenterology. 2020;158(1):200\u201314.","journal-title":"Gastroenterology"},{"issue":"6","key":"4277_CR29","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1002\/hep.21178","volume":"43","author":"RK Sterling","year":"2006","unstructured":"Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV\/HCV coinfection. Hepatology. 2006;43(6):1317\u201325.","journal-title":"Hepatology"},{"issue":"9","key":"4277_CR30","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1016\/j.dld.2022.03.013","volume":"54","author":"P Coste","year":"2022","unstructured":"Coste P, Llop E, Perello C, Hernandez M, Lopez M, Abad J, et al. Comparison of non-invasive fibrosis scores to predict increased liver stiffness in the general population with unknown liver disease: searching for the primary physician\u2019s best friend. Dig Liver Dis. 2022;54(9):1209\u201314.","journal-title":"Dig Liver Dis"},{"issue":"7","key":"4277_CR31","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1136\/gut.2010.221382","volume":"60","author":"D Roulot","year":"2011","unstructured":"Roulot D, Costes JL, Buyck JF, Warzocha U, Gambier N, Czernichow S, Le Clesiau H, Beaugrand M. Transient elastography as a screening tool for liver fibrosis and cirrhosis in a community-based population aged over 45 years. Gut. 2011;60(7):977\u201384.","journal-title":"Gut"},{"issue":"9","key":"4277_CR32","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1097\/00042737-200012090-00004","volume":"12","author":"A Tran","year":"2000","unstructured":"Tran A, Benzaken S, Saint-Paul MC, Guzman-Granier E, Hastier P, Pradier C, et al. Chondrex (YKL-40), a potential new serum fibrosis marker in patients with alcoholic liver disease. Eur J Gastroenterol Hepatol. 2000;12(9):989\u201393.","journal-title":"Eur J Gastroenterol Hepatol"},{"issue":"5","key":"4277_CR33","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.23200","volume":"34","author":"Z Jiang","year":"2020","unstructured":"Jiang Z, Wang S, Jin J, Ying S, Chen Z, Zhu D, et al. The clinical significance of serum chitinase 3-like 1 in hepatitis B-related chronic liver diseases. J Clin Lab Anal. 2020;34(5):e23200.","journal-title":"J Clin Lab Anal"},{"issue":"6","key":"4277_CR34","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1089\/omi.2015.0037","volume":"19","author":"H Huang","year":"2015","unstructured":"Huang H, Wu T, Mao J, Fang Y, Zhang J, Wu L, et al. CHI3L1 is a liver-enriched, noninvasive biomarker that can be used to stage and diagnose substantial hepatic fibrosis. OMICS. 2015;19(6):339\u201345.","journal-title":"OMICS"},{"issue":"4","key":"4277_CR35","doi-asserted-by":"publisher","first-page":"476","DOI":"10.3748\/wjg.v11.i4.476","volume":"11","author":"Y Saitou","year":"2005","unstructured":"Saitou Y, Shiraki K, Yamanaka Y, Yamaguchi Y, Kawakita T, Yamamoto N, et al. Noninvasive estimation of liver fibrosis and response to interferon therapy by a serum fibrogenesis marker, YKL-40, in patients with HCV-associated liver disease. World J Gastroenterol. 2005;11(4):476\u201381.","journal-title":"World J Gastroenterol"},{"issue":"3","key":"4277_CR36","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1097\/MEG.0000000000001291","volume":"31","author":"S Mushtaq","year":"2019","unstructured":"Mushtaq S, Ghani E, Azam K, Hussain T. Comparison of chitinase-3-like protein 1, aspartate aminotransferase-to-platelet ratio index, and fibrosis-4 index with shear-wave elastography. Eur J Gastroenterol Hepatol. 2019;31(3):357\u201362.","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"4277_CR37","doi-asserted-by":"publisher","first-page":"3227957","DOI":"10.1155\/2022\/3227957","volume":"2022","author":"X Huang","year":"2022","unstructured":"Huang X, Zhuang J, Yang Y, Jian J, Ai W, Liu C, et al. Diagnostic value of serum chitinase-3-like protein 1 for liver fibrosis: a meta-analysis. Biomed Res Int. 2022;2022:3227957.","journal-title":"Biomed Res Int"},{"issue":"4","key":"4277_CR38","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1053\/j.gastro.2023.05.053","volume":"165","author":"S Man","year":"2023","unstructured":"Man S, Deng Y, Ma Y, Fu J, Bao H, Yu C, et al. Prevalence of liver steatosis and fibrosis in the general population and various high-risk populations: a nationwide study with 5.7 million adults in China. Gastroenterology. 2023;165(4):1025\u201340.","journal-title":"Gastroenterology"},{"key":"4277_CR39","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/1471-230X-10-40","volume":"10","author":"T Poynard","year":"2010","unstructured":"Poynard T, Lebray P, Ingiliz P, Varaut A, Varsat B, Ngo Y, Norha P, Munteanu M, Drane F, Messous D, et al. Prevalence of liver fibrosis and risk factors in a general population using non-invasive biomarkers (FibroTest). BMC Gastroenterol. 2010;10:40.","journal-title":"BMC Gastroenterol"},{"issue":"3","key":"4277_CR40","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1016\/j.cgh.2018.07.006","volume":"17","author":"Y Kim","year":"2019","unstructured":"Kim Y, Chang Y, Cho YK, Ahn J, Shin H, Ryu S. Obesity and weight gain are associated with progression of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2019;17(3):543-e550542.","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"8","key":"4277_CR41","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1111\/jgh.14595","volume":"34","author":"H Fujii","year":"2019","unstructured":"Fujii H, Imajo K, Yoneda M, Nakahara T, Hyogo H, Takahashi H, et al. HOMA-IR: an independent predictor of advanced liver fibrosis in nondiabetic non-alcoholic fatty liver disease. J Gastroenterol Hepatol. 2019;34(8):1390\u20135.","journal-title":"J Gastroenterol Hepatol"},{"issue":"7","key":"4277_CR42","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1016\/j.cgh.2017.12.048","volume":"16","author":"L Caballeria","year":"2018","unstructured":"Caballeria L, Pera G, Arteaga I, Rodriguez L, Aluma A, Morillas RM, de la Ossa N, Diaz A, Exposito C, Miranda D, et al. High prevalence of liver fibrosis among European adults with unknown liver disease: A Population-Based study. Clin Gastroenterol Hepatol. 2018;16(7):1138\u201345. e1135.","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"8","key":"4277_CR43","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1038\/sj.ijo.0800929","volume":"23","author":"T Rankinen","year":"1999","unstructured":"Rankinen T, Kim SY, Perusse L, Despres JP, Bouchard C. The prediction of abdominal visceral fat level from body composition and anthropometry: ROC analysis. Int J Obes Relat Metab Disord. 1999;23(8):801\u20139.","journal-title":"Int J Obes Relat Metab Disord"},{"issue":"2","key":"4277_CR44","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1002\/hep.24694","volume":"55","author":"K Das","year":"2012","unstructured":"Das K, Sarkar R, Ahmed SM, Mridha AR, Mukherjee PS, Das K, et al. Normal liver stiffness measure (LSM) values are higher in both lean and obese individuals: a population-based study from a developing country. Hepatology. 2012;55(2):584\u201393.","journal-title":"Hepatology"},{"issue":"7","key":"4277_CR45","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1111\/jvh.12879","volume":"25","author":"M Hedenstierna","year":"2018","unstructured":"Hedenstierna M, Nangarhari A, El-Sabini A, Weiland O, Aleman S. Cirrhosis, high age and high body mass index are risk factors for persisting advanced fibrosis after sustained virological response in chronic hepatitis C. J Viral Hepat. 2018;25(7):802\u201310.","journal-title":"J Viral Hepat"},{"issue":"6","key":"4277_CR46","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1007\/s40292-022-00542-5","volume":"29","author":"JG Gonzalez-Gonzalez","year":"2022","unstructured":"Gonzalez-Gonzalez JG, Violante-Cumpa JR, Zambrano-Lucio M, Burciaga-Jimenez E, Castillo-Morales PL, Garcia-Campa M, et al. HOMA-IR as a predictor of health outcomes in patients with metabolic risk factors: a systematic review and meta-analysis. High Blood Press Cardiovasc Prev. 2022;29(6):547\u201364.","journal-title":"High Blood Press Cardiovasc Prev"},{"issue":"5","key":"4277_CR47","doi-asserted-by":"publisher","first-page":"G697","DOI":"10.1152\/ajpgi.00426.2010","volume":"300","author":"DJ Chiang","year":"2011","unstructured":"Chiang DJ, Pritchard MT, Nagy LE. Obesity, diabetes mellitus, and liver fibrosis. Am J Physiol Gastrointest Liver Physiol. 2011;300(5):G697\u2013702.","journal-title":"Am J Physiol Gastrointest Liver Physiol"},{"issue":"6","key":"4277_CR48","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1038\/s41575-023-00759-2","volume":"20","author":"DQ Huang","year":"2023","unstructured":"Huang DQ, Terrault NA, Tacke F, Gluud LL, Arrese M, Bugianesi E, Loomba R. Global epidemiology of cirrhosis - aetiology, trends and predictions. Nat Rev Gastroenterol Hepatol. 2023;20(6):388\u201398.","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"2","key":"4277_CR49","doi-asserted-by":"publisher","first-page":"163","DOI":"10.3350\/cmh.2012.18.2.163","volume":"18","author":"KS Jung","year":"2012","unstructured":"Jung KS, Kim SU. Clinical applications of transient elastography. Clin Mol Hepatol. 2012;18(2):163\u201373.","journal-title":"Clin Mol Hepatol"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-025-04277-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-025-04277-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-025-04277-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T18:08:22Z","timestamp":1759169302000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-025-04277-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,29]]},"references-count":49,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4277"],"URL":"https:\/\/doi.org\/10.1186\/s12876-025-04277-0","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,29]]},"assertion":[{"value":"13 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang University School of Medicine. All the participants had read and signed informed consent prior to the physical examination. Procedures related to the study were performed in accordance with the ethical standards of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"688"}}