Effect of lean status on the mortality of patients with non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis
Bibliographic record
Abstract
Objective: To investigate the impact of lean status as per body mass index (BMI) on mortality in cases of non-alcoholic fatty liver disease (NAFLD). Methods: A systematic search was conducted in PubMed, Embase, and Scopus to identify relevant studies published from the inception of each database up to July 31, 2024. Observational studies that reported data on the mortality outcomes of NAFLD patients with different BMI, and provided adjusted estimates were included. The Newcastle-Ottawa Scale (NOS) was used for quality assessment. Pooled effect sizes were reported as hazard ratio (HR) with 95% confidence intervals (CI). Results: Fourteen studies were included, of which majority were retrospective cohort studies (n=10). Objective assessment method for NAFLD i.e., imaging and/or biopsy was used in 10 studies. Compared to NAFLD patients with high BMI, lean patients had higher risk of all-cause mortality (HR 1.34, 95% CI: 1.23, 1.47), with no publication bias for any of the outcomes. Lean status correlated with elevated risk of liver disease-related mortality (HR 2.14, 95% CI: 1.18, 3.87) but had similar risk of cardiovascular (HR 0.92, 95% CI: 0.65, 1.30) and cancer-related mortality (HR 1.20, 95% CI: 0.90, 1.60). Conclusion: Lean status of NAFLD patients correlates with higher risk of all-cause and liver disease-related mortality compared to patients with high BMI. There is a need for tailored interventions and further research to understand specific mortality risks in this subgroup of patients. Registration No.: (PROSPERO CRD42024512065). doi: https://doi.org/10.12669/pjms.41.6.12044 How to cite this: Miao P, Shao Z, Jiang J. Effect of lean status on the mortality of patients with non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis. Pak J Med Sci. 2025;41(6):1845-1853. doi: https://doi.org/10.12669/pjms.41.6.12044 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.023 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.032 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".