Clinical assessment of malnutrition among patients with alcoholic liver cirrhosis: A single-center study in Southern China

doi:10.3748/wjg.v32.i26.118957

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Jul 14, 2026; 32(26): 118957
Published online Jul 14, 2026. doi: 10.3748/wjg.v32.i26.118957

Table 1 Patients’ overall characteristics, n (%)/median (interquartile range)

Variables	HCs (n = 83)	HBV-C (n = 103)	ALC (n = 249)	P value
Age (year)	50.00 (35.00-62.50)	53.00 (47.00-58.50)	53.00 (46.00-60.00)	0.122
Height (m)	1.68 (1.63-1.73)	1.68 (1.62-1.71)	1.68 (1.64-1.71)	0.769
Weight (kg)	65.00 (54.15-75.25)	64.00 (59.60-70.65)	64.00 (57.90-71.00)	0.910
BMI (kg/m²)	23.24 (19.74-25.88)	23.32 (20.99-25.84)	23.03 (20.98-25.06)	0.835
WBC (× 10⁹/L)	5.89 (5.12-7.29)	3.98 (2.96-4.99)^a	4.85 (3.54-6.40)^a^,^b	< 0.001
RBC (× 10¹²/L)	4.72 (3.89-5.08)	3.72 (3.08-4.22)^a	3.44 (2.84-4.04)^a^,^b	< 0.001
Hb (g/L)	137.00 (118.50-150.00)	109.00 (83.50-131.00)^a	101.00 (76.00-119.00)^a^,^b	< 0.001
MCV (fL)	89.80 (85.05-92.35)	89.30 (79.25-94.15)	88.70 (77.70-96.10)	0.987
PLT (× 10⁹/L)	231.00 (189.00-288.00)	77.00 (51.50-120.00)^a	104.00 (72.00-155.00)^a^,^b	< 0.001
NEUT	0.56 (0.51-0.65)	0.60 (0.51-0.69)	0.60 (0.49-0.68)	0.383
LYMPH	0.32 (0.25-0.37)	0.25 (0.18-0.33)^a	0.27 (0.17-0.34)^a	0.002
MONO	0.08 (0.06-0.09)	0.10 (0.08-0.12)^a	0.11 (0.09-0.13)^a	< 0.001
NLR	1.79 (1.39-2.54)	2.42 (1.52-3.89)^a	2.18 (1.38-3.88)	0.031
PLR	118.60 (97.19-164.77)	88.31 (65.12-128.85)^a	86.37 (67.07-117.62)^a	< 0.001
SII	419.67 (299.52-635.94)	220.73 (113.15-350.83)^a	256.81 (133.52-387.29)^a	< 0.001
SIRI	0.91 (0.60-1.24)	0.87 (0.47-1.84)	0.99 (0.64-2.06)	0.185
AST (U/L)	20.00 (16.50-27.00)	35.00 (26.00-56.50)^a	42.00 (29.00-65.00)^a	< 0.001
ALT (U/L)	18.00 (12.50-30.00)	28.00 (18.00-38.50)^a	25.00 (17.00-37.00)^a	0.002
AST/ALT	1.06 (0.76-1.52)	1.43 (1.09-1.79)^a	1.74 (1.21-2.44)^a^,^b	< 0.001
GGT (U/L)	22.00 (16.00-42.00)	50.00 (22.50-91.50)^a	85.00 (45.00-196.25)^a^,^b	< 0.001
ALP (U/L)	67.00 (56.50-81.00)	97.00 (77.50-136.50)^a	120.00 (85.75-174.75)^a^,^b	< 0.001
ALB (g/L)	41.85 (39.00-45.50)	35.30 (31.90-39.70)^a	34.10 (29.40-38.40)^a	< 0.001
TBIL (μmol/L)	9.45 (6.53-13.65)	15.20 (11.15-20.20)^a	20.80 (12.20-40.80)^a^,^b	< 0.001
DBILI (μmol/L)	2.20 (1.50-3.10)	4.80 (3.50-9.35)^a	6.90 (3.60-17.50)^a	< 0.001
IBILI (μmol/L)	6.80 (3.45-10.05)	9.60 (7.00-12.95)^a	10.40 (7.20-17.60)^a	< 0.001
BUN (mmol/L)	5.07 (4.28-5.97)	5.09 (3.97-6.67)	4.69 (3.40-6.36)	0.074
Cr (μmol/L)	67.00 (57.50-83.00)	71.00 (58.50-81.00)	65.00 (55.00-81.00)	0.215
GLU (mmol/L)	5.16 (4.66-6.29)	5.85 (4.83-8.18)^a	5.84 (4.71-7.98)^a	0.010
CHOL (mmol/L)	4.68 (4.08-5.54)	3.85 (3.34-4.60)^a	3.79 (2.84-4.67)^a	< 0.001
TG (mmol/L)	1.26 (0.83-1.92)	0.91 (0.68-1.40)^a	1.03 (0.75-1.44)	0.002
HDL (mmol/L)	1.02 (0.87-1.18)	0.93 (0.68-1.14)^a	0.89 (0.68-1.14)^a	0.008
LDL (mmol/L)	2.83 (2.20-3.54)	2.15 (1.61-2.71)^a	2.06 (1.45-2.73)^a	< 0.001
UA (μmol/L)	349.00 (277.00-426.00)	311.00 (240.50-388.00)	360.50 (291.75-452.25)^b	0.001
TyG	8.59 (8.11-9.20)	8.48 (8.01-8.97)	8.50 (8.09-9.06)	0.323
PT (second)	13.10 (12.78-13.80)	15.50 (14.75-17.00)^a	16.00 (14.80-18.05)^a	< 0.001
PTA (%)	101.50 (94.00-111.00)	73.00 (62.00-80.50)^a	68.00 (53.00-81.00)^a	< 0.001
INR	0.99 (0.95-1.06)	1.23 (1.14-1.37)^a	1.27 (1.15-1.49)^a	< 0.001
Ascites				0.082
No or mild		79 (78.22)	162 (67.22)
Clinically overt ascites		22 (21.78)	79 (32.78)
CTP				< 0.001
A		51 (49.51)	108 (43.37)
B/C		52 (50.49)	141 (56.63)

^aP < 0.05 for alcoholic liver cirrhosis or hepatitis B virus-related cirrhosis vs healthy controls.

^bP < 0.05 for alcoholic liver cirrhosis vs hepatitis B virus-related cirrhosis.

ALC: Alcoholic liver cirrhosis; HBV-C: Hepatitis B virus-related cirrhosis; HCs: Healthy controls; BMI: Body mass index; WBC: White blood cell; RBC: Red blood cell; Hb: Hemoglobin; MCV: Mean corpuscular volume; PLT: Platelet; NEUT: Neutrophil; LYMPH: Lymphocyte; MONO: Monocyte; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; SII: Systemic immune-inflammation index; SIRI: Systemic inflammatory response index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transferase; ALB: Albumin; TBIL: Total bilirubin; DBILI: Direct bilirubin; IBILI: Indirect bilirubin; BUN: Blood urea nitrogen; Cr: Creatinine; GLU: Glucose; CHOL: Cholesterol; TG: Triglycerides; HDL: High density lipoprotein; LDL: Low density lipoprotein; UA: Uric acid; TyG: Triglyceride-glucose index; PT: Prothrombin time; PTA: Prothrombin activity; INR: International normalized ratio; CTP: Child-Pugh classification.

Full Size Table

Table 2 Nutritional status analysis with hepatitis B virus-related cirrhosis, and alcoholic liver cirrhosis and healthy controls, n (%)/median (interquartile range)

Variables	HCs (n = 83)	HBV-C (n = 103)	ALC (n = 249)	P value
Anthropometric
WC (cm)	76.50 (74.00-86.00)	80.50 (76.00-86.00)	85.00 (80.00-89.00)^a^,^b	0.002
HC (cm)	88.00 (80.00-91.00)	82.00 (80.00-87.00)	90.00 (84.00-93.00)^b	< 0.001
WHR	0.92 (0.89-0.97)	0.97 (0.95-1.01)^a	0.95 (0.92-1.01)^a^,^b	0.002
AC (cm)	26.00 (24.00-28.00)	24.00 (22.00-25.00)^a	25.00 (23.00-28.00)^b	< 0.001
AMC (cm)	21.00 (19.20-22.30)	20.20 (18.20-21.50)	21.90 (20.10-24.50)^b	< 0.001
TSF (mm)	12.00 (10.00-18.00)	10.00 (8.00-12.00)	10.00 (8.00-13.00)	0.142
AFT (mm)	18.00 (12.00-28.00)	10.00 (10.00-16.00)^a	18.50 (10.25-30.00)^b	< 0.001
Serum trace elements
Fe (μmol/L)	14.50 (10.12-20.35)	9.70 (5.60-17.70)^a	8.75 (4.00-16.33)^a	0.002
Zn (μmol/L)	10.20 (7.65-11.70)	8.60 (7.00-10.30)	9.80 (7.97-11.27)	0.096
Mg (mmol/L)	0.88 (0.84-0.93)	0.84 (0.79-0.89)^a	0.79 (0.72-0.86)^a^,^b	< 0.001
Cu (μmol/L)	15.50 (12.80-18.75)	13.10 (11.50-18.20)	14.90 (13.05-18.00)	0.343
AdCa (mmol/L)	2.29 (2.23-2.36)	2.29 (2.23-2.36)	2.35 (2.27-2.44)^a^,^b	< 0.001
Serum vitamins
VA (μmol/L)	1.36 (1.26-1.49)	1.32 (1.21-1.43)	1.39 (1.22-1.58)	0.185
VB1 (nmol/L)	78.54 (55.85-93.38)	88.42 (70.96-98.37)	72.98 (60.79-87.23)^a^,^b	0.017
VB2 (μg/L)	326.70 (294.21-358.53)	322.07 (297.53-359.03)	291.85 (270.09-352.24)^a^,^b	0.008
VB6 (μmol/L)	19.09 (13.68-25.98)	20.70 (13.95-26.19)	20.60 (15.37-25.37)	0.565
VB9 (nmol/L)	20.55 (17.57-22.43)	18.56 (16.56-21.79)	19.45 (17.47-22.19)	0.238
VC (μmol/L)	37.61 (32.64-42.04)	42.90 (36.32-51.75)^a	46.29 (43.16-49.36)^a	< 0.001
VE (μg/mL)	12.79 (11.73-14.07)	15.06 (13.60-16.86)^a	15.20 (13.51-16.44)^a	< 0.001
VB12 (pg/mL)	279.94 (215.12-319.18)	281.12 (211.05-356.19)	279.21 (201.41-349.65)	0.713
VD (nmol/L)	57.65 (44.53-68.67)	57.85 (48.75-67.03)	46.20 (37.66-57.25)^a^,^b	< 0.001
Nutritional assessment tools
SGA				0.153
1 (well-nourished)	74 (89.16)	89 (86.41)	195 (80.91)
2 (malnourished)	9 (10.84)	14 (13.59)	46 (19.09)
NRS-2002				0.243
1 (no nutritional risk)	73 (87.95)	86 (83.50)	183 (79.91)
2 (at nutritional risk)	10 (12.05)	17 (16.50)	46 (20.09)

^aP < 0.05 for alcoholic liver cirrhosis or hepatitis B virus-related cirrhosis vs healthy controls.

^bP < 0.05 for alcoholic liver cirrhosis vs hepatitis B virus-related cirrhosis.

ALC: Alcoholic liver cirrhosis; HBV-C: Hepatitis B virus-related cirrhosis; HCs: Healthy controls; WC: Waist circumference; HC: Hip circumference; WHR: Waist-to-hip ratio; AC: Mid-arm circumference; AMC: Mid-arm muscular circumference; TSF: Triceps skinfold; AFT: Abdominal fat thickness; Fe: Iron; Zn: Zinc; Mg: Magnesium; Cu: Copper; AdCa: Adjusted calcium; VB: Vitamin B; VA: Vitamin A; VC: Vitamin C; VD: Vitamin D; VE: Vitamin E; SGA: Subjective global assessment; NRS-2002: Nutritional risk screening 2002.

Full Size Table

Table 3 Nutritional indicator analysis in cirrhosis patients with different Child-Pugh classifications, n (%)/median (interquartile range)

Variables	HBV-C (n = 103)		ALC (n = 249)
Variables	Child A	Child B/C	Child A	Child B/C
Anthropometric
Height (m)	1.68 (1.64-1.71)	1.68 (1.62-1.71)	1.68 (1.65-1.71)	1.68 (1.63-1.70)
Weight (kg)	63.00 (58.40-70.75)	64.25 (60.00-70.47)	63.10 (58.62-69.88)	65.00 (57.80-71.00)
BMI (kg/m²)	22.48 (20.76-25.15)	24.04 (21.61-25.97)	22.63 (20.99-24.67)	23.41 (21.00-25.41)
WC (cm)	78.00 (75.50-83.25)	82.50 (77.00-89.25)	85.00 (82.62-88.25)	85.00 (80.00-90.00)
HC (cm)	80.00 (80.00-83.50)	85.50 (80.00-88.00)^a	92.00 (85.38-93.25)^b	89.00 (84.00-93.00)^b
WHR	0.97 (0.95-0.99)	0.98 (0.95-1.01)	0.95 (0.92-0.99)	0.94 (0.92-1.01)
AC (cm)	24.00 (22.00-24.60)	24.00 (22.00-25.00)	26.00 (24.00-28.40)^b	24.50 (22.00-28.00)
AMC (cm)	20.55 (19.25-21.42)	20.15 (18.17-22.25)	22.20 (20.25-24.65)^b	21.50 (19.70-23.90)^b
TSF (mm)	10.00 (8.00-12.25)	10.00 (7.50-12.00)	10.00 (8.00-14.00)	10.00 (6.00-13.00)
AFT (mm)	10.00 (10.00-14.50)	12.00 (10.00-17.00)	20.00 (11.50-30.00)^b	18.00 (10.00-29.50)^b
Serum trace elements
Fe (μmol/L)	9.70 (5.65-17.62)	9.70 (5.50-17.80)	8.05 (3.10-14.02)	9.10 (5.20-17.72)^a
Zn (μmol/L)	9.00 (7.40-11.40)	8.25 (5.62-9.57)	11.20 (9.80-13.35)^b	8.00 (6.60-9.50)^a
Mg (mmol/L)	0.84 (0.80-0.92)	0.84 (0.77-0.88)	0.83 (0.78-0.88)	0.77 (0.69-0.83)^a^,^b
Cu (μmol/L)	12.90 (11.70-16.50)	14.85 (11.50-19.65)	13.55 (12.00-15.35)	17.20 (14.70-20.00)^a
AdCa (mmol/L)	2.26 (2.15-2.37)	2.14 (2.03-2.25)^a	2.29 (2.21-2.39)	2.21 (2.07-2.32)^a
Serum vitamins
VA (μmol/L)	1.37 (1.25-1.46)	1.27 (1.17-1.33)^a	1.36 (1.16-1.54)	1.42 (1.29-1.62)^b
VB1 (nmol/L)	86.26 (67.93-94.52)	93.28 (71.57-103.50)	71.59 (58.27-83.61)^b	73.42 (62.73-91.45)^b
VB2 (μg/L)	319.38 (288.84-362.23)	322.23 (301.15-335.15)	302.25 (280.30-355.48)	281.66 (261.11-338.71)^b
VB6 (μmol/L)	20.70 (13.80-25.20)	20.74 (16.81-31.34)	22.52 (16.29-27.41)	18.48 (14.18-23.72)^a
VB9 (nmol/L)	19.50 (16.36-22.17)	18.02 (16.82-21.29)	18.95 (17.56-21.38)	20.13 (17.43-22.29)
VC (μmol/L)	43.82 (36.48-51.80)	42.03 (36.12-51.70)	46.01 (42.11-49.07)	46.71 (45.18-49.81)
VE (μg/mL)	14.95 (12.70-16.89)	15.15 (14.59-16.72)	14.84 (13.13-16.18)	15.39 (13.72-16.77)^a
VB12 (pg/mL)	282.28 (205.37-380.36)	272.09 (218.83-328.35)	263.32 (195.96-338.30)	284.14 (220.64-356.33)^a
VD (nmol/L)	63.25 (51.85-67.70)	51.20 (46.42-61.45)^a	48.70 (42.70-60.25)^b	41.10 (34.80-55.64)^a^,^b
Nutritional assessment tools
SGA
1 (well-nourished)	46 (90.20)	43 (82.69)	95 (89.62)	100 (74.07)
2 (malnourished)	5 (9.80)	9 (17.31)	11 (10.38)	35 (25.93)^a
NRS-2002
1 (no nutritional risk)	46 (90.20)	40 (76.92)	89 (85.58)	94 (75.20)
2 (at nutritional risk)	5 (9.80)	12 (23.08)	15 (14.42)	31 (24.80)^a

^aP < 0.05 for Child B/C vs Child A in hepatitis B virus-related cirrhosis or alcoholic liver cirrhosis.

^bP < 0.05 for alcoholic liver cirrhosis vs hepatitis B virus-related cirrhosis in the same Child phase.

ALC: Alcoholic liver cirrhosis; HBV-C: Hepatitis B virus-related cirrhosis; BMI: Body mass index; WC: Waist circumference; HC: Hip circumference; WHR: Waist-to-hip ratio; AC: Mid-arm circumference; AMC: Mid-arm muscular circumference; TSF: Triceps skinfold; AFT: Abdominal fat thickness; Fe: Iron; Zn: Zinc; Mg: Magnesium; Cu: Copper; AdCa: Adjusted calcium; VB: Vitamin B; VA: Vitamin A; VC: Vitamin C; VD: Vitamin D; VE: Vitamin E; SGA: Subjective global assessment; NRS-2002: Nutritional risk screening 2002.

Full Size Table

Table 4 Nutritional indicator analysis with mortality, n (%)/median (interquartile range)

Variables	Survivors (n = 202)	Non-survivors (n = 39)	P value
Age (year)	53.00 (45.00-60.00)	55.00 (48.00-60.00)	0.431
Height (m)	1.68 (1.64-1.71)	1.66 (1.63-1.70)	0.192
Weight (kg)	65.00 (58.40-72.10)	60.90 (56.75-67.62)	0.048
BMI (kg/m²)	23.42 (21.00-25.37)	22.41 (20.78-24.35)	0.121
ALB (g/L)	34.60 (30.45-38.55)	30.00 (26.70-35.95)	0.004
TBIL (μmol/L)	18.00 (11.53-34.17)	38.70 (21.95-72.35)	< 0.001
PT (second)	15.80 (14.80-17.42)	17.70 (15.85-19.05)	< 0.001
Fe (μmol/L)	8.40 (3.80-16.00)	12.35 (6.07-18.55)	0.099
Zn (μmol/L)	9.80 (8.50-12.25)	6.60 (6.20-8.60)	0.013
Mg (mmol/L)	0.80 (0.74-0.86)	0.76 (0.64-0.83)	0.005
Cu (μmol/L)	14.45 (12.28-18.70)	16.20 (14.50-17.20)	0.701
AdCa (mmol/L)	2.37 (2.28-2.44)	2.36 (2.24-2.44)	0.382
VA (μmol/L)	1.39 (1.21-1.57)	1.53 (1.36-1.65)	0.080
VB1 (nmol/L)	71.80 (58.72-86.04)	75.26 (63.32-94.57)	0.369
VB2 (μg/L)	291.38 (260.70-351.60)	313.61 (280.28-355.67)	0.237
VB6 (μmol/L)	20.79 (15.35-25.70)	21.48 (17.86-25.35)	0.876
VB9 (nmol/L)	19.45 (17.62-22.19)	19.72 (17.43-22.74)	0.955
VC (μmol/L)	46.29 (43.89-49.24)	50.77 (40.90-53.84)	0.139
VE (μg/mL)	15.13 (13.52-16.37)	15.39 (14.51-17.24)	0.329
VB12 (pg/mL)	278.57 (197.57-344.99)	304.80 (217.81-361.57)	0.203
VD (nmol/L)	48.00 (39.65-57.90)	36.40 (32.20-41.50)	0.007
WC (cm)	85.00 (80.00-88.00)	85.50 (80.50-92.00)	0.471
HC (cm)	89.50 (84.00-93.00)	89.00 (84.25-93.50)	0.763
WHR	0.95 (0.92-1.01)	0.95 (0.93-1.01)	0.576
AC (cm)	26.00 (23.50-28.10)	23.00 (21.75-24.56)	< 0.001
AMC (cm)	22.20 (20.30-24.70)	20.25 (19.65-21.80)	0.009
TSF (mm)	10.00 (8.00-14.00)	10.00 (7.50-11.25)	0.175
AFT (mm)	20.00 (11.50-31.00)	15.00 (10.00-22.00)	0.175
Ascites			0.409
No or mild	138 (68.32)	24 (61.54)
Clinically overt ascites	64 (31.68)	15 (38.46)
Child			< 0.001
A	98 (48.51)	6 (15.38)
B	83 (41.09)	16 (41.03)
C	21 (10.40)	17 (43.59)
SGA			0.015
1 (well-nourished)	162 (83.51)	26 (66.67)
2 (malnourished)	32 (16.49)	13 (33.33)
NRS-2002			0.026
1 (no nutritional risk)	153 (82.26)	23 (65.71)
2 (at nutritional risk)	33 (17.74)	12 (34.29)

BMI: Body mass index; ALB: Albumin; TBIL: Total bilirubin; PT: Prothrombin time; Fe: Iron; Zn: Zinc; Mg: Magnesium; Cu: Copper; AdCa: Adjusted calcium; VB: Vitamin B; VA: Vitamin A; VC: Vitamin C; VD: Vitamin D; VE: Vitamin E; WC: Waist circumference; HC: Hip circumference; WHR: Waist-to-hip ratio; AC: Mid-arm circumference; AMC: Mid-arm muscular circumference; TSF: Triceps skinfold; AFT: Abdominal fat thickness; SGA: Subjective global assessment; NRS-2002: Nutritional risk screening 2002.

Full Size Table

Table 5 Multivariate Cox analysis of the relationship between nutritional indicator and liver-related mortality

Variables	Model 1		Model 2		Model 3
Variables	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
Zn	0.65 (0.47-0.91)	0.012	0.62 (0.43-0.89)	0.009	0.51 (0.31-0.85)	0.010
Mg	0.03 (0.00-0.37)	0.005	0.02 (0.00-0.32)	0.005	0.06 (0.00-1.07)	0.056
VD	0.94 (0.90-0.99)	0.009	0.92 (0.87-0.97)	0.003	0.92 (0.86-0.99)	0.017
AC	0.83 (0.76-0.91)	< 0.001	0.83 (0.75-0.92)	< 0.001	0.85 (0.75-0.96)	0.008

Model 1 indicated crude. Model 2 adjust: Age, body mass index. Model 3 adjust: Age, body mass index, alanine aminotransferase, albumin, triglyceride, blood urea nitrogen, subjective global assessment. HR: Hazard ratio; CI: Confidence interval; Zn: Zinc; Mg: Magnesium; VD: Vitamin D; AC: Mid-arm circumference.

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Citation: Wu XQ, Liu YY, Yu HS, Abassa KK, Pan LL, Ke BL, Guo YW. Clinical assessment of malnutrition among patients with alcoholic liver cirrhosis: A single-center study in Southern China. World J Gastroenterol 2026; 32(26): 118957
URL: https://www.wjgnet.com/1007-9327/full/v32/i26/118957.htm
DOI: https://dx.doi.org/10.3748/wjg.v32.i26.118957

Wu XQ, Liu YY, Yu HS, Abassa KK, Pan LL, Ke BL, Guo YW. Clinical assessment of malnutrition among patients with alcoholic liver cirrhosis: A single-center study in Southern China. World J Gastroenterol 2026; 32(26): 118957 [DOI: 10.3748/wjg.v32.i26.118957]

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