Publication Name	World Journal of Hepatology
Manuscript ID	121019
DOI	10.4254/wjh.121019
Country	Mexico

Category	Gastroenterology & Hepatology
Manuscript Type	Opinion Review
Article Title	Rethinking metabolic risk in primary biliary cholangitis: The prognostic impact of lean type 2 diabetes mellitus
Manuscript Source	Invited Manuscript
All Author List	Fernanda M Martínez-Díaz, Elsie A Jiménez-Cuevas, Mariana Montoya-López, Mariana M Ramírez-Mejía and Nahum Méndez-Sánchez
Funding Agency and Grant Number
Corresponding Author	Nahum Méndez-Sánchez, Liver Research Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, Col. Toriello Guerra, Mexico City 14050, Mexico. nmendez@medicasur.org.mx
Key Words	Type 2 diabetes mellitus; Primary biliary cholangitis; Body mass index; Mortality; Metabolic dysfunction
Core Tip	Primary biliary cholangitis presents marked clinical heterogeneity that is not fully explained by the current prognostic models. These models are primarily based on the biochemical response to ursodeoxycholic acid and the fibrosis stage. Emerging evidence suggests that metabolic dysfunction, particularly type 2 diabetes mellitus in lean individuals, is an underrecognized modifier of disease progression and mortality. Recent findings indicate synergistic adverse effects between the thin phenotype and diabetes, which challenges traditional body mass index-based assumptions regarding metabolic risk in patients with primary biliary cholangitis. Thus, beyond weight, comprehensive metabolic assessment should be incorporated into risk stratification strategies. In addition, future prospective studies should evaluate whether integrating lean type 2 diabetes mellitus into existing prognostic models can improve individualized patient management.
Citation	Martínez-Díaz FM, Jiménez-Cuevas EA, Montoya-López M, Ramírez-Mejía MM, Méndez-Sánchez N. Rethinking metabolic risk in primary biliary cholangitis: The prognostic impact of lean type 2 diabetes mellitus. World J Hepatol 2026; In press DOI: https://doi.org/10.4254/wjh.121019
PDF	121019-in-press.pdf

Received	2026-03-13 02:51
Peer-Review Started	2026-03-13 02:52
First Decision by Editorial Office Director	2026-03-20 11:45
Return for Revision	2026-03-22 00:59
Revised	2026-07-16 00:30
Publication Fee Transferred
Second Decision by Editor	2026-08-28 02:55
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-08-28 09:12
Articles in Press	2026-08-28 09:12
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1948-5182 (online)
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