Lean fatty liver still needs a fibrosis check

The edition in brief

Lean MASLD: in 18,326 adults with biopsy-proven MASLD across 41 countries, the 6.7% who were lean had milder histology but no lower adjusted risk of death (aHR 0.90, 0.69–1.16) or liver events (aHR 0.94, 0.76–1.17). Fibrosis stage, not weight, tracked prognosis: F3–F4 was linked to more than three times the rate of liver events. FIB-4 performed slightly worse in lean patients (AUC 0.76) while transient elastography performed better (AUC 0.87). Retatrutide: in TRIUMPH-2, 1,152 adults with obesity and type 2 diabetes lost 16.8% (9 mg) and 18.8% (12 mg) of body weight at 80 weeks against 5.1% on placebo. Gastrointestinal effects were common, and hypotension, dysaesthesia and discontinuation for adverse events rose with dose. It is not approved anywhere. Sleep in type 1: among 963 DCCT/EDIC participants averaging 64 years old and 43 years of diabetes, 64% screened at intermediate or high risk of obstructive sleep apnoea and 43% reported poor sleep; each 1% higher HbA1c was associated with 15–20% higher odds of a sleep problem. Foot ulcers: in a 170-patient trial of ulcers that had failed four weeks of standard care, a collagen matrix with PHMB antimicrobial closed 42% of wounds at 12 weeks against 27% with standard care alone, with a lower confidence limit barely above zero.