Authors
Wen-Yue Liu, Li-You Lian, Seung Up Kim, Terry Cheuk-Fung Yip, Salvatore Petta, Atsushi Nakajima, Emmanuel Tsochatzis, Junping Shi, Wah-Kheong Chan, Jérôme Boursier, Elisabetta Bugianesi, Yusuf Yilmaz, Hannes Hagström, Manuel Romero-Gomez, Khalid Alswat, José Luis Calleja, Hirokazu Takahashi, Victor de Lédinghen, Shalimar, Laurent Castéra, Arun J Sanyal, George Boon-Bee Goh, Philip N Newsome, Jian-Gao Fan, Michelle Lai, Sandeep Aggarwal, Stergios Kechagias, Yoichi Hiasa, Bheesham Dayal, Zhongtao Zhang, Jacob George, Mohamed El-Kassas, Jinjun Chen, Hong You, Barham K Abu Dayyeh, Huiping Sheng, Leon A Adams, Jing Wang, Fangping He, Huiqing Liang, Yong-Feng Yang, Xiaoling Chi, Bihui Zhong, Yan Bi, Yuqiang Mi, Yongfen Zhu, Rixing Bai, Jing Zhang, Bingyuan Wang, Jinghai Song, Hong Deng, Qing Xie, Lang Bai, Yongning Xin, Wen Xie, Jie Li, Céline Fournier, Bing Liao, Hong-Hai Xu, Yang-Yang Li, Huai Zhang, Qin Feng, Mirko Zoncapè, Chutian Wu, Hye Won Lee, Grace Lai-Hung Wong, Angelo Armandi, Ying Shang, Grazia Pennisi, Elba Llop, Masato Yoneda, Marc de Saint-Loup, Rocio Gallego-Durán, Paloma Carrillo Fernández, Amon Asgharpour, Kevin Kim-Jun Teh, Mandy Sau-Wai Chan, Huapeng Lin, Sherlot Juan Song, Waleed K Al-Hamoudi, Hiroshi Isoda, Teruki Miyake, Sanjaya K Satapathy, Mengyi Li, Keshni Sharma, Mohammed Emadeldeen, Ling Zhou, Xiaofei Tong, Fateh Bazerbachi, Xiaotang Fan, Huanming Xiao, Junzhao Ye, Liang Xu, Xiaolin Wang, Tamadr Abdulrhman Aldoheyan, Giovanni Targher, Christopher D Byrne, Vincent Wai-Sun Wong, Ming-Hua Zheng
Published in
The American journal of gastroenterology. Jul 14, 2026. Epub Jul 14, 2026.
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver disease, and liver biopsy remains the gold standard for diagnosis. However, a subset of patients diagnosed with MASLD by imaging paradoxically exhibit steatosis grade S0 upon liver biopsy, posing a diagnostic challenge. This study investigates the outcomes and causes of "steatosis 0".
"Steatosis 0" was defined as imaging-detected MASLD with a biopsy-defined steatosis grade S0. We used global cohorts to evaluate outcomes, histologic progression via paired biopsies, and possible causes. The cause analysis included MRI-PDFF for fat distribution, pathologist consistency testing, and comparison of serial biopsy sections.
In a follow-up cohort of 3,273 biopsy individuals from 16 centers, 123 (3.8%) exhibited "steatosis 0". Of these, 29.3% of them had advanced fibrosis ("burnt-out" MASLD) and demonstrated a risk of liver-related events, while those without advanced fibrosis had no such events. In the paired-biopsy cohort of 1,865 patients, 74 (4.0%) individuals initially showed steatosis grade S0; among them, 93.2% retained no or mild steatosis on follow-up biopsy. MRI-PDFF assessments in 42 MASLD patients revealed heterogeneous hepatic fat distribution, with some segments showing steatosis grade S0 despite elevated average liver fat. Inter-pathologist variability and discrepancies across consecutive biopsy sections contributed to misclassification of steatosis grade.
"Steatosis 0" represents a potential diagnostic gray zone in MASLD. It may be caused by "burnt-out" MASLD, uneven liver fat distribution, or variability in pathological assessment. Understanding the causes and implications of "steatosis 0" is critical for diagnosis and management.
PMID:
42467969
Bibliographic data and abstract were imported from PubMed on 18 Jul 2026.
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