{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:15:43Z","timestamp":1791252943888,"version":"4.1.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background\/Objectives<\/jats:title><jats:p>Metabolic dysfunction-associated fatty liver disease (MAFLD) is highly prevalent in China. Clinical evidence supporting the role of polyenyl phosphatidylcholine (PPC) in delaying liver fibrosis in patients with MAFLD is limited. Hence this study evaluated the effectiveness of PPC and its association with delaying progression of liver fibrosis in patients with MAFLD in China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This multicenter, retrospective observational study included patients with type 2 diabetes mellitus or \u22652 metabolic dysregulations. Patients from the MAFLD cohort were divided into two groups to receive either PPC or control (no hepatoprotective treatment). The primary endpoint was the change in baseline fibrosis (FIB)-4 index at 12 and 24\u202fweeks. The secondary endpoint involved comparison of changes in liver enzymes and blood lipid levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 22,705 patients with MAFLD who were treated with hepatoprotective drugs, 7,093 received PPC. Significant reduction in baseline fibrosis was observed at 24\u202fweeks (PPC: \u22120.12\u202f\u00b1\u202f0.62 vs. control: 0.11\u202f\u00b1\u202f0.50, <jats:italic>p<\/jats:italic>\u202f=\u202f0.034). Baseline aspartate aminotransferase (AST) levels significantly improved at 12\u202fweeks (PPC: \u22126.25\u202f\u00b1\u202f15.18 vs. control: \u22122.41\u202f\u00b1\u202f15.40; <jats:italic>p<\/jats:italic>\u202f=\u202f0.0392). In the PPC group, baseline alanine transaminase (ALT) levels decreased at 12- and 24-weeks compared to those of the control group, but results were not significant. PPC significantly reduced baseline total bilirubin at 12\u202fweeks (<jats:italic>p<\/jats:italic>\u202f=\u202f0.0122) and 24\u202fweeks (<jats:italic>p<\/jats:italic>\u202f=\u202f0.0010), and low-density lipoprotein cholesterol levels at 12\u202fweeks (<jats:italic>p<\/jats:italic>\u202f=\u202f0.0442).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PPC treatment can lower the risk of liver fibrosis and improve liver function and lipid profiles. Further validation is warranted in other ethnic groups in larger cohorts.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1610083","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T05:27:06Z","timestamp":1757482026000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["A real-world study of polyenyl phosphatidylcholine in the management of patients with metabolic dysfunction-associated fatty liver disease in China clinical practice"],"prefix":"10.3389","volume":"12","author":[{"given":"Yi","family":"Pan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanshan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bihui","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutao","family":"Zhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youqing","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiying","family":"Rao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqiang","family":"Mi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuemin","family":"Nan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyuan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branko","family":"Popovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Scarpellini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Tong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lai","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"329","DOI":"10.14218\/JCTH.2021.00178","article-title":"Metabolic-associated Fatty Liver Disease (MAFLD): A multi-systemic disease beyond the liver","volume":"10","author":"Kaya","year":"2022","journal-title":"J Clin Transl Hepatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1016\/S2468-1253(22)00165-0","article-title":"The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis","volume":"7","author":"Riazi","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1111\/dom.15014","article-title":"Epidemiological characteristics and management of nonalcoholic fatty liver disease\/nonalcoholic steatohepatitis in China: a narrative review","volume":"25","author":"Lu","year":"2023","journal-title":"Diabetes Obes Metab"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1002\/hep.30702","article-title":"Unexpected rapid increase in the burden of NAFLD in China from 2008 to 2018: a systematic review and meta-analysis","volume":"70","author":"Zhou","year":"2019","journal-title":"Hepatology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1016\/j.jhep.2018.05.036","article-title":"Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030","volume":"69","author":"Estes","year":"2018","journal-title":"J Hepatol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"9488","DOI":"10.3748\/wjg.v22.i43.9488","article-title":"Nonalcoholic fatty liver disease - a multisystem disease?","volume":"22","author":"Mikolasevic","year":"2016","journal-title":"World J Gastroenterol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2212","DOI":"10.1016\/S0140-6736(20)32511-3","article-title":"Non-alcoholic fatty liver disease","volume":"397","author":"Powell","year":"2021","journal-title":"Lancet"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1007\/s11892-020-01349-1","article-title":"Role of agents for the treatment of diabetes in the management of nonalcoholic fatty liver disease","volume":"20","author":"Budd","year":"2020","journal-title":"Curr Diab Rep"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1053\/j.gastro.2023.04.025","article-title":"Fibrosis progression rate in biopsy-proven nonalcoholic fatty liver disease among people with diabetes versus people without diabetes: a multicenter study","volume":"165","author":"Huang","year":"2023","journal-title":"Gastroenterol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2082","DOI":"10.1111\/liv.14548","article-title":"Comparison of MAFLD and NAFLD diagnostic criteria in real world","volume":"40","author":"Lin","year":"2020","journal-title":"Liver Int"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"3018","DOI":"10.1111\/liv.14675","article-title":"MAFLD identifies patients with significant hepatic fibrosis better than NAFLD","volume":"40","author":"Yamamura","year":"2020","journal-title":"Liver Int"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1097\/MEG.0000000000002288","article-title":"Healthcare practitioners\u2019 diagnostic and treatment practice patterns of nonalcoholic fatty liver disease in Poland: a cross-sectional survey","volume":"34","author":"Hartleb","year":"2022","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"29","DOI":"10.2337\/dsi23-0014","article-title":"Making sense of the nonalcoholic fatty liver disease clinical practice guidelines: What clinicians need to know","volume":"37","author":"Cusi","year":"2024","journal-title":"Diabetes Spectr"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1016\/j.eprac.2022.03.010","article-title":"American Association of Clinical Endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: Co-sponsored by the American Association for the Study of Liver Diseases (AASLD)","volume":"28","author":"Cusi","year":"2022","journal-title":"Endocr Pract"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1053\/j.gastro.2023.06.013","article-title":"AGA clinical practice update on the role of noninvasive biomarkers in the evaluation and management of nonalcoholic fatty liver disease: expert review","volume":"165","author":"Wattacheril","year":"2023","journal-title":"Gastroenterology"},{"key":"ref16","year":"2024"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"418","DOI":"10.3760\/cma.j.cn501113-20240327-00163","article-title":"Guidelines for the prevention and treatment of metabolic dysfunction-associated (non-alcoholic) fatty liver disease (Version 2024)","volume":"32","year":"2024","journal-title":"Zhonghua Gan Zang Bing Za Zhi"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"105","DOI":"10.2147\/CEG.S96362","article-title":"Essential phospholipids in fatty liver: a scientific update","volume":"9","author":"Gundermann","year":"2016","journal-title":"Clin Exp Gastroenterol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.ajg.2015.09.001","article-title":"Essential phospholipids as a supportive adjunct in the management of patients with NAFLD","volume":"16","author":"Dajani","year":"2015","journal-title":"Arab J Gastroenterol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"5235","DOI":"10.12998\/wjcc.v8.i21.5235","article-title":"Essential phospholipids for nonalcoholic fatty liver disease associated with metabolic syndrome: A systematic review and network meta-analysis","volume":"8","author":"Dajani","year":"2020","journal-title":"World J Clin Cases"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e000307","DOI":"10.1136\/bmjgast-2019-000307","article-title":"Real-world comorbidities and treatment patterns among patients with non-alcoholic fatty liver disease receiving phosphatidylcholine as adjunctive therapy in Russia","volume":"6","author":"Maev","year":"2019","journal-title":"BMJ Open Gastroenterol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e000368","DOI":"10.1136\/bmjgast-2019-000368","article-title":"Effectiveness of phosphatidylcholine as adjunctive therapy in improving liver function tests in patients with non-alcoholic fatty liver disease and metabolic comorbidities: real-life observational study from Russia","volume":"7","author":"Maev","year":"2020","journal-title":"BMJ Open Gastroenterol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"E44","DOI":"10.1097\/HEP.0000000000001193","article-title":"Essential phospholipids efficacy in improving hepatic steatosis in patients with MASLD associated with type 2 diabetes mellitus and\/or hyperlipidemia and\/or obesity - A randomized and controlled, double-blind, phase IV study","volume":"81","author":"Stefan","year":"2025","journal-title":"Hepatology"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1016\/s1734-1140(11)70576-x","article-title":"Activity of essential phospholipids (EPL) from soybean in liver diseases","volume":"63","author":"Gundermann","year":"2011","journal-title":"Pharmacol Rep"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e000341","DOI":"10.1136\/bmjgast-2019-000341","article-title":"Effectiveness of phosphatidylcholine in alleviating steatosis in patients with non-alcoholic fatty liver disease and cardiometabolic comorbidities (MANPOWER study)","volume":"7","author":"Maev","year":"2020","journal-title":"BMJ Open Gastroenterol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"24","DOI":"10.22416\/1382-4376-2016-26-2-24-42","article-title":"Diagnostics and treatment of non-alcoholic fatty liver disease: Clinical guidelines of the Russian Scientific liver society and the Russian gastroenterological association","volume":"26","author":"Ivashkin","year":"2016","journal-title":"Russian J Gastroenterol Hepatol Coloproctol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"955","DOI":"10.14218\/JCTH.2024.00311","article-title":"Guideline for the prevention and treatment of metabolic dysfunction-associated fatty liver disease (version 2024)","volume":"12","author":"Fan","year":"2024","journal-title":"J Clin Transl Hepatol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1016\/j.jhep.2021.05.003","article-title":"The Chinese Society of Hepatology position statement on the redefinition of fatty liver disease","volume":"75","author":"Nan","year":"2021","journal-title":"J Hepatol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1089\/met.2019.0107","article-title":"The morbidity and comorbidity of nonalcoholic fatty liver disease and different glucose intolerance strata in a community-based chinese population","volume":"18","author":"Zhang","year":"2020","journal-title":"Metab Syndr Relat Disord"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"A216.3","DOI":"10.1136\/gutjnl-2012-302514c.80","article-title":"PTU-080 Polyunsaturated phosphatidilcholine and sibutramin decrease the liver fibrosis progress in patients with non-alcoholic liver disease","volume":"61","author":"Sas","year":"2012","journal-title":"Gut"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"S549","DOI":"10.1016\/S0168-8278(13)61365-3","article-title":"1366 beneficial influence of polyunsaturated phosphatidylcholine enhances functional liver condition and liver structure in patients with nonalcoholic steatohepatitis. Results of prolonged randomized blinded prospective clinical study","volume":"58","author":"Sas","year":"2013","journal-title":"J Hepatol"},{"key":"ref32","first-page":"1109","article-title":"Clinical observation of pyrazone combined with polyene phosphatidylcholine capsules in the treatment of type 2 diabetes with nonalcoholic fatty liver","volume":"24","author":"Changrong","year":"2021","journal-title":"China Pharm"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1067\/mlc.2002.121853","article-title":"Dilinoleoylphosphatidylcholine prevents transforming growth factor-beta1-mediated collagen accumulation in cultured rat hepatic stellate cells","volume":"139","author":"Cao","year":"2002","journal-title":"J Lab Clin Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1002\/hep.1840150303","article-title":"Polyunsaturated lecithin prevents acetaldehyde-mediated hepatic collagen accumulation by stimulating collagenase activity in cultured lipocytes","volume":"15","author":"Li","year":"1992","journal-title":"Hepatology"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1038\/s41420-020-00316-9","article-title":"Mitochondrial dysfunction in fibrotic diseases","volume":"6","author":"Li","year":"2020","journal-title":"Cell Death Discov"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"772174","DOI":"10.3389\/fmolb.2021.772174","article-title":"Mitochondrial dysfunction in advanced liver disease: emerging concepts","volume":"8","author":"Zhang","year":"2021","journal-title":"Front Mol Biosci"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/s12944-022-01698-8","article-title":"Essential phospholipids decrease apoptosis and increase membrane transport in human hepatocyte cell lines","volume":"21","author":"Wupperfeld","year":"2022","journal-title":"Lipids Health Dis"},{"key":"ref38","first-page":"1097","article-title":"Assessment of liver fibrosis in HCV infection in Egyptian patients","volume":"8","author":"S\u00e2mia","year":"2011","journal-title":"Life Sci J"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e30527","DOI":"10.1097\/MD.0000000000030527","article-title":"Association between small dense LDL levels and hepatic fibrosis in patients with nonalcoholic fatty liver disease","volume":"101","author":"Young","year":"2022","journal-title":"Medicine"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1053\/j.gastro.2020.01.043","article-title":"Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis","volume":"158","author":"Taylor","year":"2020","journal-title":"Gastroenterology"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1610083\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T05:27:08Z","timestamp":1757482028000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1610083\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,10]]},"references-count":40,"alternative-id":["10.3389\/fmed.2025.1610083"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1610083","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,10]]},"article-number":"1610083"}}