Mapouka M, Pabingui E, Tazinkeng NN, Gurmessa M, Vickos U, Ndemazie NB, Camengo Police SM. Outcomes of liver and cardiovascular metabolic diseases among lean vs non-lean individuals with metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2026; 32(13): 114657 [DOI: 10.3748/wjg.v32.i13.114657]
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April 26, 2026, 03:16
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Reader Comments:
The meta-analysis by Mapouka et al., involving 10.7 million participants, provides critical evidence that lean MASLD patients share comparable risks for MASH, cardiovascular disease, and mortality with non-lean individuals. While non-lean patients show higher odds of fibrosis and steatosis, lean patients demonstrate lower risks of cirrhosis and hypertension. These findings reinforce that BMI alone is an insufficient standalone screening metric.
Methodologically, however, extreme heterogeneity was observed for outcomes including fibrosis (94%), MASH (91%), and mortality (90.9%), suggesting substantial variance in study populations. Classification bias remains a concern due to inconsistent BMI thresholds (<23 vs. <25 kg/m²) used across the 31 included studies. Additionally, significant gaps in reporting sociodemographic data—specifically age, sex, and race—limit robust subgroup stratification. While the authors effectively advocate for a transition toward multidimensional metabolic risk assessment, these data inconsistencies highlight the need for more standardized, prospective longitudinal research.
Ultimately, this study serves as a vital reminder to maintain vigilance for MASLD complications regardless of patient weight.
Reader's ID:
03769692
Submitted on:
March 29, 2026, 08:34
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Reader Comment Standards for Published Articles:
1 Title
Does the title reflect the main subject/hypothesis of the manuscript?
2 Abstract
Does the abstract summarize and reflect the work described in the manuscript?
3 Key Words
Do the key words reflect the focus of the manuscript?
4 Background
Does the manuscript adequately describe the background, present status and significance of the study?
5 Methods
Does the manuscript describe methods (e.g., experiments, data analysis, surveys, and clinical trials, etc.) in adequate detail?
6 Results
Are the research objectives achieved by the experiments used in this study?
Has the study made meaningful contributions towards research progress in this field?
7 Discussion
Does the manuscript interpret the findings adequately and appropriately, highlighting the key points concisely, clearly and logically?
Are the findings and their applicability/relevance to the literature stated in a clear and definite manner?
Is the Discussion accurate and does it discuss the paper’s scientific significance and/or relevance to clinical practice sufficiently?
8 Illustrations and Tables
Are the figures, diagrams and tables sufficient, good quality and appropriately illustrative of the paper contents?
Do figures require labeling with arrows, asterisks, etc., or better legends?
9 Biostatistics
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10 Units
Does the manuscript meet the requirements of use of SI units?
11 References
Does the manuscript appropriately cite the latest, important and authoritative references in the Introduction and Discussion sections?
Does the author self-cite, omit, incorrectly cite and/or over-cite references?
12 Quality of manuscript organization and presentation
Is the manuscript concisely and coherently organized and presented?
Are the style, language and grammar accurate and appropriate?
13 Ethics statements
For all manuscripts involving human studies and/or animal experiments, author(s) must submit the related formal ethics documents that were reviewed and approved by their local ethical review committee. Did the manuscript meet the requirements of ethics?
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The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories
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Reader Comments:
The important value of this study lies in its clear finding that lean MASLD patients show no statistically significant differences from non-lean MASLD patients in terms of MASH, cardiovascular disease, and mortality risk, while their risks of cirrhosis, hypertension, and liver fibrosis are actually lower. The core clinical implication of this finding is that normal BMI should not be a reason to relax screening and risk assessment for MASLD and its complications. Of course, the study also has limitations: the definition of 'lean' varies across studies, which may introduce classification bias; and some outcomes (e.g., mortality, MASH, fibrosis) show high heterogeneity (I² > 90%), requiring cautious interpretation. Nevertheless, this is a study with direct practical guidance for clinical practice, particularly suitable for readers in hepatology, cardiology, endocrinology, and general medicine, as it helps shift MASLD screening strategies from an obesity-centered approach to multidimensional metabolic risk assessment.