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    {
      "pmid": "19827166",
      "doi": "10.1002/hep.23276",
      "source_type": "primary study report",
      "study_group": "PROMRAT-LIFESTYLE",
      "access_depth": "full_text_partial",
      "consensus_aspect": "Assigned NAS response versus current resolution",
      "result_comparison": "Observed Consensus calls the NAS composite activity reversal and its minimal-criteria count resolution. Actual Methods define improvement as a three-point NAS drop or NAS at most two; actual Results show assigned NAS/steatosis benefit but nonsignificant assigned inflammation/ballooning differences. This is genuine activity efficacy, not automatically a current inflammation/ballooning resolution result.",
      "original_source": "https://pubmed.ncbi.nlm.nih.gov/19827166/",
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    {
      "pmid": "19827166",
      "doi": "10.1002/hep.23276",
      "source_type": "primary study report",
      "study_group": "PROMRAT-LIFESTYLE",
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      "consensus_aspect": "Achieved-loss component threshold",
      "result_comparison": "Provider describes an apparent seven-percent loss threshold. Actual Results place the broader component positives in achieved-at-least-seven-percent strata, while the randomized component contrasts were nonsignificant. The weight threshold is nonrandomized association; it is not assigned-dose necessity, a baseline eligibility boundary or justification to exclude nonresponders.",
      "original_source": "https://pubmed.ncbi.nlm.nih.gov/19827166/",
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    {
      "pmid": "19827166",
      "doi": "10.1002/hep.23276",
      "source_type": "primary study report",
      "study_group": "PROMRAT-LIFESTYLE",
      "access_depth": "full_text_partial",
      "consensus_aspect": "Paired-biopsy completion and histology estimand",
      "result_comparison": "Provider gives 31 randomized participants and percentages but omits actual endpoint-biopsy availability. Original Results show 28 of 31 with paired biopsy: 18 of 21 lifestyle and all 10 controls. Therefore its 72-versus-30-percent composite is an available-biopsy comparison, not a silent 31-person complete-pathology audit; missingness and small power limit certainty.",
      "original_source": "https://pubmed.ncbi.nlm.nih.gov/19827166/",
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    {
      "pmid": "38914313",
      "doi": "10.1016/j.jhep.2024.06.017",
      "source_type": "primary study report",
      "study_group": "NCT03151798",
      "access_depth": "full_text_partial",
      "consensus_aspect": "Provider claim of a single small randomized lifestyle trial",
      "result_comparison": "Provider identifies Promrat as the only small randomized lifestyle histology trial. The examined newer original Methods/Results contain a randomized ten-month energy-restriction/HIIT comparison with explicit inflammation/ballooning resolution and activity benefit. Provider corpus omission cannot establish absence. Original Results count nine resolutions but only eight ballooning-zero subjects, an unresolved internal inconsistency; retain qualitative positive without inventing a corrected fraction.",
      "original_source": "https://pubmed.ncbi.nlm.nih.gov/38914313/",
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    {
      "pmid": "25865049",
      "doi": "10.1053/j.gastro.2015.04.005",
      "source_type": "primary study report",
      "study_group": "VILAR-LIFESTYLE-293",
      "access_depth": "abstract_metadata",
      "consensus_aspect": "Achieved-loss cohort and shared prediction report",
      "result_comparison": "Provider correctly distinguishes the nonrandomized cohort and larger achieved-loss response. The examined original abstract reports 293 enrolled and 261 paired biopsies with subgroup resolution/regression associations. The follow-up prediction PMID26849287 shares that cohort; different subgroup counts or prediction models do not constitute a new causal trial. No complete cohort body was examined.",
      "original_source": "https://pubmed.ncbi.nlm.nih.gov/25865049/",
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    {
      "pmid": "37088093",
      "doi": "10.1016/S0140-6736(23)00634-7",
      "source_type": "primary study report",
      "study_group": "PMID37088093",
      "access_depth": "abstract_metadata",
      "consensus_aspect": "Surgery superiority versus standalone lifestyle causal efficacy",
      "result_comparison": "Provider correctly retains BRAVES surgery superiority. The original trial abstract distinguishes ITT and available-protocol response rates. Lifestyle plus best medical care is a comparator to surgery, so its response percentage cannot establish efficacy versus untreated patients or isolate lifestyle weight mediation. Surgery adverse events remain part of its separate evidence.",
      "original_source": "https://pubmed.ncbi.nlm.nih.gov/37088093/",
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    {
      "pmid": "32553765",
      "doi": "10.1053/j.gastro.2020.06.006",
      "source_type": "primary study report",
      "study_group": "PMID32553765",
      "access_depth": "abstract_metadata",
      "consensus_aspect": "Long-term bariatric biopsies and selection",
      "result_comparison": "Provider treats five-year surgery biopsy benefit as distinct from lifestyle and reports incomplete biopsy availability. The examined original abstract supports substantial observed resolution/regression with 64 of 94 five-year-eligible patients biopsied. It is selected uncontrolled long-term surgery, outside the registered 24–104-week lifestyle primary; absence of statistically different observed groups does not rule out unmeasured nonresponse bias.",
      "original_source": "https://pubmed.ncbi.nlm.nih.gov/32553765/",
      "source_examination_receipts": [
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    {
      "pmid": "36934740",
      "doi": "10.1016/S2468-1253(23)00068-7",
      "source_type": "primary study report",
      "study_group": "PMID36934740",
      "access_depth": "full_text_partial",
      "consensus_aspect": "Fat/weight improvement versus actual clinical histology in cirrhosis",
      "result_comparison": "Provider discusses component dissociation largely through older trials and reviews, with recent originals absent from its indexed text. The selected F4 semaglutide original Methods/Results directly show significant weight/MRI-fat reduction but null biopsy resolution/fibrosis at 48 weeks, differential biopsy availability and no decompensation events. This is a stage/drug boundary; it neither proves lifestyle failure nor event prevention from biomarkers.",
      "original_source": "https://pubmed.ncbi.nlm.nih.gov/36934740/",
      "source_examination_receipts": [
        "deliverables\\hsef_v53_traffic_ranks_11_15_2026-10-13\\weight-loss-mash-reversal\\examinations\\original-22-30-10000.json"
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      ]
    },
    {
      "pmid": "40305708",
      "doi": "10.1056/NEJMoa2413258",
      "source_type": "primary study report",
      "study_group": "PMID40305708",
      "access_depth": "abstract_metadata",
      "consensus_aspect": "Provider corpus cutoff and modern positive trials",
      "result_comparison": "Provider explicitly lacks ESSENCE, SYNERGY-NASH and MAESTRO-NASH primary details. Examined original abstracts PMID40305708,38856224,38324483 retain genuine respective clinical-pathology positives. A review search cutoff is not the present evidence cutoff, and those drug effects cannot be borrowed as lifestyle or isolated-weight causal lines.",
      "original_source": "https://pubmed.ncbi.nlm.nih.gov/40305708/",
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  "grade_changed": false,
  "grade_change_note": "Source-based adjudication; no independent blinded regrade claimed.",
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  "cutoff": "2026-10-13",
  "completed_utc": "2026-10-13T17:02:53.663494+00:00",
  "conclusion": "Endpoint hierarchy, experimental scope and original-source limits determine the evidence cards; provider wording does not override them."
}