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This population-based cohort study compared risks of cause-specific mortality between lean and nonlean MASLD patients and assessed how advanced fibrosis influences mortality. Using NHANES data (14,740 adults), advanced fibrosis was identified by NFS or FIB-4. Cox and competing-risk models evaluated outcomes across follow-up.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/cause-specific-mortality-in-lean-individuals-with-metabolic-dysfunction-associated-steatotic-liver-disease/422714/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/cause-specific-mortality-in-lean-individuals-with-metabolic-dysfunction-associated-steatotic-liver-disease/422714.png","ImageObject",300,407,{"name":92,"@type":93},"RuangKosong","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What was the main aim of the study?","Question",{"text":113,"@type":114},"To compare the risk of cause-specific mortality between lean and nonlean MASLD patients and to examine the impact of advanced fibrosis on mortality.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did researchers identify advanced fibrosis?",{"text":118,"@type":114},"They used the NAFLD Fibrosis Score (NFS) or the Fibrosis-4 score (FIB-4) to identify advanced fibrosis in the cohort.",{"name":120,"@type":111,"acceptedAnswer":121},"Which mortality outcomes were higher in lean MASLD patients?",{"text":122,"@type":114},"Lean MASLD patients had increased risks of all-cause mortality and diabetes-specific mortality compared with nonlean MASLD patients.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},422714,1790695661,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146,"preview_page_count":4},962090883219,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Zhang et al. Lipids in Health and Disease (2026) 25:6 Lipids in Health and Disease  \n[https://doi.org/10.1186/s12944-025-02784-3](https://doi.org/10.1186/s12944-025-02784-3)  \nRESEARCH Open Access  \nCause-specific mortality in lean individuals with metabolic dysfunction-associated steatotic liver disease  \nZiqi Zhang 1, Jiying Lu 1, Milian Chen 1, Liang Dai2, Yingying Xiang 1, Zhidong Liu 1, Ying Cao 1, Wei Sheng 1, Chunlin Li 1, Deji Song 1, Li Zhang 1,3* and Guang Ji 1,3*  \nAbstract  \nBackground Metabolic dysfunction-associated steatotic liver disease (MASLD) can occur in both nonlean and lean individuals. This study aimed to compare the risk of cause-specific mortality between lean and nonlean MASLD patients and investigate the impact of advanced fibrosis on mortality.  \nMethod This population-based cohort study included 14,740 adults from the National Health and Nutrition Examination Survey (NHANES). The NAFLD Fibrosis Score (NFS) or Fibrosis-4 score (FIB-4) was employed to identify advanced fibrosis. Cox proportional hazard models were utilized to analyze all-cause mortality, whereas competing risk models were applied to analyze cause-specific mortality.  \nResults During a median follow-up of 7.3 (4 .1–10. 7) years, lean MASLD patients presented increased risks for all-cause mortality (HR = 2 . 50, 95% CI = 1 .70–3. 66) and diabetes-specific mortality (sHR = 5 . 00, 95% CI = 1 .40–17. 8) compared with nonlean MASLD patients. No significant differences were observed in cardiovascular-specific or cancer-specific mortality risk between the two groups. Stratified analyses revealed a significant interaction effect between lean MASLD and advanced fibrosis on all-cause mortality risk. Among lean MASLD patients with advanced fibrosis, the incidence rates per 1,000 person-years were 110.6 (95% CI = 58 .5-185. 2) for all-cause mortality, 27.7 (5 .7–78. 7) for cardiovascular-specific mortality, 9.2 (0 .2–50. 3) for cancer-specific mortality and 9.2 (0 .2–50. 3) for diabetes-specific mortality. An FIB-4 score > 2.67 and NFS >0.676 could indicate an increased risk of all-cause mortality in lean MASLD patients, with no significant difference in performance.  \nConclusion Lean MASLD patients had greater risks of all-cause and diabetes-specific mortality than nonlean MASLD patients, and regular noninvasive fibrosis evaluation is recommended for lean MASLD patients.  \nKeywords Non alcoholic fatty liver disease, Mortality, Fibrosis, Cohort study, Body mass index  \n*Correspondence:  \nLi Zhang [lzhang0706@shutcm.edu.cn](lzhang0706@shutcm.edu.cn)[ ](lzhang0706@shutcm.edu.cn)Guang Ji  \n[jiliver@vip.sina.com](jiliver@vip.sina.com)  \n1Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road,  \nShanghai 200032, China  \n2School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China  \n3State Key Laboratory of Integration and Innovation of Classical Formula and Modern Chinese Medicine, Shanghai, China  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a","cbCaifiig72o70SR","https://ap.wps.com/l/cbCaifiig72o70SR","pdf",1968324,11,"English","# Abstract\n## Background\n## Method\n## Results\n## Conclusion\n# Introduction","[{\"question\":\"What was the main aim of the study?\",\"answer\":\"To compare the risk of cause-specific mortality between lean and nonlean MASLD patients and to examine the impact of advanced fibrosis on mortality.\"},{\"question\":\"How did researchers identify advanced fibrosis?\",\"answer\":\"They used the NAFLD Fibrosis Score (NFS) or the Fibrosis-4 score (FIB-4) to identify advanced fibrosis in the cohort.\"},{\"question\":\"Which mortality outcomes were higher in lean MASLD patients?\",\"answer\":\"Lean MASLD patients had increased risks of all-cause mortality and diabetes-specific mortality compared with nonlean MASLD patients.\"}]","Cause-specific mortality in lean individuals with metabolic dysfunction-associated steatotic liver disease | PDF",1790628521,28]