{
  "abstract": "Background Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are at increased risk of both hepatic and extrahepatic adverse outcomes. However, the evidence regarding lean MASLD and its prognosis remains controversial.Objective To comprehensively investigate the long-term prognosis of lean patients with MASLD versus non-lean MASLD in Western and Asian populations.Design This prospective multicohort study included 153 192 patients with MASLD from UK Biobank (UKB), 29 700 from Kailuan cohort and 3329 from China Kadoorie Biobank (CKB). Lean MASLD was defined as body mass index (BMI)<23 kg/m² in Kailuan and CKB and <25 kg/m² in UKB. Primary endpoints were liver-related events (LREs), all-cause mortality, liver-related mortality (LRM), cardiovascular disease (CVD) mortality, CVD, hepatocellular carcinoma (HCC) and extrahepatic cancer.Results Overall, 181 191 non-lean and 5030 lean patients with MASLD were included. During a median of 14.2-year follow-up (median 14.1, 14.8 and 13.4 years in UKB, Kailuan and CKB), 2501 incident LREs, 22 482 all-cause deaths, 28 722 incident CVD cases, 326 HCC and 25 258 extrahepatic cancer cases were identified, with 375 LRM and 4511 CVD deaths. Pooled analysis of three cohorts showed lean MASLD had higher risks of LREs (HR=2.14; 95% CI 1.27 to 3.62), all-cause mortality (HR=1.26; 95% CI 1.14 to 1.39), LRM (HR=2.31; 95% CI 1.54 to 3.46) and CVD mortality (HR=1.22; 95% CI 1.05 to 1.41). By contrast, lean MASLD exhibited comparable HCC risk (HR=1.76; 95% CI 0.84 to 3.71) and extrahepatic cancer risk (HR=1.14; 95% CI 0.88 to 1.48), but reduced CVD risk (HR=0.89; 95% CI 0.83 to 0.95) versus non-lean MASLD.Conclusion Lean patients with MASLD have worse liver outcomes and greater risk of all-cause mortality, but similar risk of HCC and extrahepatic cancer, and lower CVD risk.",
  "authors": [
    {
      "affiliations": [
        "Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing, China"
      ],
      "name": "Zhenyu Huo"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing, China"
      ],
      "name": "Yijun Chen"
    },
    {
      "affiliations": [
        "Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China"
      ],
      "name": "Yating Huang"
    },
    {
      "affiliations": [
        "Department of Computational Biology and Medical Big Data, Faculty of Computer Science and Control Engineering, Shenzhen University of Advanced Technology, Shenzhen, China",
        "Center for AI in Medicine, Artificial Intelligence Research Institute, Shenzhen University of Advanced Technology, Shenzhen, China",
        "Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China"
      ],
      "name": "Zhirong Yang"
    },
    {
      "affiliations": [
        "Department of Computational Biology and Medical Big Data, Faculty of Computer Science and Control Engineering, Shenzhen University of Advanced Technology, Shenzhen, China",
        "Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China"
      ],
      "name": "Yujun Long"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing, China"
      ],
      "name": "Qian Zhang"
    },
    {
      "affiliations": [
        "Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Road, Tangshan, China"
      ],
      "name": "Shuohua Chen"
    },
    {
      "affiliations": [
        "Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Road, Tangshan, China"
      ],
      "name": "Guodong Wang"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing, China"
      ],
      "name": "Shengtao Zhu"
    },
    {
      "affiliations": [
        "Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China",
        "Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China",
        "Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China"
      ],
      "name": "Dianjianyi Sun"
    },
    {
      "affiliations": [
        "Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China",
        "Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China",
        "Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China"
      ],
      "name": "Canqing Yu"
    },
    {
      "affiliations": [
        "Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China",
        "Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China",
        "Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China",
        "State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China"
      ],
      "name": "Jun Lv"
    },
    {
      "affiliations": [
        "Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China",
        "Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China",
        "Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China"
      ],
      "name": "Liming Li"
    },
    {
      "affiliations": [
        "MAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China",
        "Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China"
      ],
      "name": "Ming-Hua Zheng"
    },
    {
      "affiliations": [
        "Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Road, Tangshan, China"
      ],
      "name": "Shouling Wu"
    },
    {
      "affiliations": [
        "Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China",
        "Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China",
        "Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China"
      ],
      "name": "Yuanjie Pang"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing, China"
      ],
      "name": "Shanshan Wu"
    }
  ],
  "title": "Long-term prognosis of lean MASLD: evidence from three population-based prospective cohorts",
  "uid": "892fe376-1ead-5b27-96f7-4864a96e1c28"
}