ArticleBMJ open gastroenterology2025
Liver fibrosis with persistently normal alanine transaminase levels exhibits a distinct treatment response in MASLD.
Article in BMJ open gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Mapping GLP-1 receptor agonist research across the MASLD-MASH-HCC continuum: a bibliometric and translational analysis.Frontiers in medicine · 2026Pooled it
- MRI in MASLD: technical foundations and guideline-based applications.BMJ open gastroenterology · 2026Review
- Providing holistic care for patients with metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis: Key aspects of clinical assessment and how to develop individualised care plans for surveillance and interventions.Diabetes, obesity & metabolism · 2026Review
- MASLD In Children - A Distinct Phenotype?Current obesity reports · 2026Review
- Article
- Association of MASLD with chronic kidney disease according to metabolic profiles and fibrosis severity: a KNHANES analysis.Frontiers in endocrinology · 2026Article
- Association between oral microbiome alpha and beta diversity and MASLD risk: a large-scale, population-based retrospective study.Frontiers in cellular and infection microbiology · 2026Article
- Risk stratification of MASLD/MASH in type 2 diabetes: a pragmatic endocrinology outpatient pathway.Frontiers in endocrinology · 2026Review
- Efficacy ofFrontiers in immunology · 2025Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveMetabolic dysfunction-associated steatotic liver disease (MASLD) presents considerable variability in disease progression and treatment outcomes. We aimed to determine whether specific patterns of liver inflammatory flares are correlated with distinct treatment responses.
methodsWe conducted an analysis of a well-characterised prospective cohort involving treatment-naïve MASLD patients from January 2015 to November 2023 at The First Affiliated Hospital of Sun Yat-sen University. Participants underwent a standardised 48-week lifestyle modification programme, with follow-up extending through December 2024. Liver fat content (LFC) was assessed using MRI-based proton density fat fraction (MRI-PDFF), whereas liver stiffness measurements (LSMs) were performed using two-dimensional shear wave elastography at baseline and after 48 weeks.
resultsParticipants were stratified by alanine transaminase (ALT) and liver fibrosis status: normal ALT/no fibrosis (n=149), elevated ALT/no fibrosis (n=264), normal ALT/fibrosis (n=91) and elevated ALT/fibrosis (n=178). While MRI-PDFF (≥30% LFC decline) and ALT responses (≥17 U/L decrease) did not differ between groups, the elevated ALT/fibrosis group exhibited a significantly higher probability of LSM response (≥1 fibrosis stage improvement) than in the normal ALT/ fibrosis group (53.4% vs 31.9%, p=0.001; OR=2.53, 95% CI: 1.31 to 4.85, p=0.006). Receiver operating characteristic analysis revealed that the cut-offs for weight loss (8.55% vs 4.94%, p=0.023) and LFC reduction (39.85% vs 20.57%, p=0.062) associated with LSM response were higher in patients with normal ALT/fibrosis than in those with elevated ALT/fibrosis.
conclusionMASLD patients with liver fibrosis and persistently normal ALT levels exhibited a less favourable treatment response to fibrosis than those with elevated ALT levels, necessitating more substantial reductions in steatosis and weight to achieve the desired outcomes.
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