{
  "schema_version": "chamgap-public-evidence-check-1.0",
  "public_id": "v2985-s0",
  "verdict_number": "2985",
  "title": "Psyllium × Ten-week ALT and FibroScan findings: signals, effect size and measurement gaps",
  "view_version": "1.0",
  "view_created_date": "2026-10-15",
  "criteria_version": "1.0",
  "criteria_date": "2026-10-06",
  "review_date": null,
  "legacy_evidence_date": "2026-09-07",
  "review_scope": {
    "materials_read": "Existing review summaries and stored records of methodological application",
    "clinical_papers_directly_read": false,
    "new_clinical_search": false,
    "limitation": "The whole stored parent-verdict summary and selected subclaim were read for production. External papers, abstracts, full texts, registry, protocol, SAP and funding disclosures were not separately read or accessed. Historical review records are not inherited as current clinical verification or a new verdict.",
    "date_meaning": "This is the date the stored materials were checked, not the date of a new search of the clinical literature."
  },
  "claim_context": {
    "population": "80 adults with overweight or obesity and MASLD were randomized; 78 completed. Group/test denominators and detailed eligibility are unverified.",
    "intervention": "Psyllium 10 g/day added to a weight-loss diet and physical-activity advice",
    "dose": "Psyllium10g/day and ten weeks identify the original study. No new total quantities, product, intake, diet or liver-disease-management advice is created.",
    "comparator": "Ground wheat10g/day. Both groups received the same weight-loss-diet and physical-activity advice. Actual concurrent exposure and adherence details are unverified.",
    "endpoint": "Actual ten-week ALT and FibroScan measures, distinguished from AST, MRI, histologic and clinical outcomes.",
    "duration": "A ten-week efficacy trial. MRI was not directly measured; post-trial follow-up and direct long-term clinical evidence are unverified.",
    "excluded_extensions": [
      "Transferring ALT/FibroScan findings into direct MRI/MRS or histologic liver-fat outcomes",
      "Combining null AST and unmeasured MRI into the same zero-effect claim",
      "Deriving exact between-group effects/CIs, fibrosis reversal, disease improvement or event prevention from P values",
      "Certifying common advice as identical actual diet/activity/weight or psyllium-alone efficacy",
      "Counting the supporting seed safety citation as identical efficacy replication or copying its harms into the current trial",
      "Adding the same reports, time points, conditions or participants as new independent trials or people",
      "New calculations, hypothetical quantities, grades, independence certification, product intake, diets, liver-disease management or treatment-replacement instructions"
    ]
  },
  "requirements": [
    {
      "item_id": "N01",
      "question_type": "Evidence condition",
      "question": "What is the selected ten-week test question?",
      "needed": "Original ten-week ALT and FibroScan improvement",
      "role": "Required",
      "role_reason": "This condition connects Original ten-week ALT and FibroScan improvement with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Original ten-week ALT and FibroScan improvement must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Exact ALT/FibroScan endpoints, population, comparator, time points and denominators, and review of the question boundary. Parent scores or axes are not inserted into subclaim values. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The selected original wording concerns improved ALT and FibroScan measures over ten weeks, with original grade C. Its note records some positive between-group P values but unclear effect size and prespecified hierarchy. Absent subclaim scores, status and axes are distinguished from parent C50.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Exact ALT/FibroScan endpoints, population, comparator, time points and denominators, and review of the question boundary. Parent scores or axes are not inserted into subclaim values.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Exact ALT/FibroScan endpoints, population, comparator, time points and denominators, and review of the question boundary. Parent scores or axes are not inserted into subclaim values."
    },
    {
      "item_id": "N02",
      "question_type": "Evidence condition",
      "question": "What was the original ALT result?",
      "needed": "Ten-week covariate-adjusted between-group ALT test",
      "role": "Required",
      "role_reason": "This condition connects Ten-week covariate-adjusted between-group ALT test with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Ten-week covariate-adjusted between-group ALT test must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original ALT tables, units, assay, baseline/follow-up/change values, covariates, model, group denominators, effects and CIs. No effect sizes or normalization rates are derived from P values. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The original reader answer and research description record covariate-adjusted ALT favoring psyllium, P=.006. Exact group values, changes, adjusted effects, units and 95% CIs are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original ALT tables, units, assay, baseline/follow-up/change values, covariates, model, group denominators, effects and CIs. No effect sizes or normalization rates are derived from P values.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original ALT tables, units, assay, baseline/follow-up/change values, covariates, model, group denominators, effects and CIs. No effect sizes or normalization rates are derived from P values."
    },
    {
      "item_id": "N03",
      "question_type": "Evidence condition",
      "question": "What was the original FibroScan measure?",
      "needed": "FibroScan fibrosis score P=.001",
      "role": "Required",
      "role_reason": "This condition connects FibroScan fibrosis score P=.001 with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for FibroScan fibrosis score P=.001 must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: The actual FibroScan measure and score definition, units, measurement conditions, validity criteria, group tables, denominators, between-group effects and CIs. No particular measurement name or value is invented. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The stored summary describes a favorable FibroScan fibrosis score or fibrosis-related measure, P=.001. Exact measure names, units, equipment, algorithms, test validity and baseline/follow-up/change values cannot be established from the stored summary.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "The actual FibroScan measure and score definition, units, measurement conditions, validity criteria, group tables, denominators, between-group effects and CIs. No particular measurement name or value is invented.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The actual FibroScan measure and score definition, units, measurement conditions, validity criteria, group tables, denominators, between-group effects and CIs. No particular measurement name or value is invented."
    },
    {
      "item_id": "N04",
      "question_type": "Evidence condition",
      "question": "Are FibroScan and MRI/MRS liver-fat measurements the same?",
      "needed": "Distinguishing elastography-related measures from MRI and other tests",
      "role": "Required",
      "role_reason": "This condition connects Distinguishing elastography-related measures from MRI and other tests with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Distinguishing elastography-related measures from MRI and other tests must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Actual FibroScan measures and separately measured or defined MRI/MRS, other imaging or histology, with their denominators and estimates. A device name alone does not establish liver-fat quantity or histologic improvement. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "Original product information states that FibroScan is not the same measurement as MRI liver fat; the advertising interpretation limits the signal to enzymes and elastography-related measures. Other tests do not fill the unmeasured MRI outcome.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Actual FibroScan measures and separately measured or defined MRI/MRS, other imaging or histology, with their denominators and estimates. A device name alone does not establish liver-fat quantity or histologic improvement.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Actual FibroScan measures and separately measured or defined MRI/MRS, other imaging or histology, with their denominators and estimates. A device name alone does not establish liver-fat quantity or histologic improvement."
    },
    {
      "item_id": "N05",
      "question_type": "Evidence condition",
      "question": "Is the null AST result retained?",
      "needed": "Separate ALT and AST tests",
      "role": "Required",
      "role_reason": "This condition connects Separate ALT and AST tests with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Separate ALT and AST tests must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: AST baseline/follow-up/change values, group denominators, adjustment models, effects, CIs and prespecified hierarchy. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "Original AST P=.98 is recorded as null. ALT P=.006 and FibroScan P=.001 are not transferred into AST efficacy or success across every liver-function test. Null AST is not proof of zero effect or equivalence.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "AST baseline/follow-up/change values, group denominators, adjustment models, effects, CIs and prespecified hierarchy.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "AST baseline/follow-up/change values, group denominators, adjustment models, effects, CIs and prespecified hierarchy."
    },
    {
      "item_id": "N06",
      "question_type": "Evidence condition",
      "question": "Are within-group improvement and adjusted between-group comparison the same?",
      "needed": "Target effect, covariate adjustment and change estimates",
      "role": "Required",
      "role_reason": "This condition connects Target effect, covariate adjustment and change estimates with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Target effect, covariate adjustment and change estimates must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original ANCOVA or analysis model, covariates, prespecification, baseline/follow-up/change values, direct effects, CIs and denominators. No new within-group or between-group values are calculated. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The original research description records favorable covariate-adjusted ALT and FibroScan findings. Exact covariates, baseline values, within-group changes and adjusted between-group estimates are unavailable, so P values alone do not reconstruct either effect.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original ANCOVA or analysis model, covariates, prespecification, baseline/follow-up/change values, direct effects, CIs and denominators. No new within-group or between-group values are calculated.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original ANCOVA or analysis model, covariates, prespecification, baseline/follow-up/change values, direct effects, CIs and denominators. No new within-group or between-group values are calculated."
    },
    {
      "item_id": "N07",
      "question_type": "Evidence condition",
      "question": "What were the actual comparator and common advice?",
      "needed": "Psyllium versus ground wheat with common lifestyle advice",
      "role": "Required",
      "role_reason": "This condition connects Psyllium versus ground wheat with common lifestyle advice with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Psyllium versus ground wheat with common lifestyle advice must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Control products and composition, diet/activity advice in both arms, actual intake, activity, weight changes and co-treatment records. Identical advice and identical actual behavior are distinguished. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The original intervention was psyllium 10g/day versus ground wheat 10g/day; both groups received weight-loss-diet and physical-activity advice. This add-on contrast is not changed into no treatment, psyllium alone or the same effect without a diet.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Control products and composition, diet/activity advice in both arms, actual intake, activity, weight changes and co-treatment records. Identical advice and identical actual behavior are distinguished.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Control products and composition, diet/activity advice in both arms, actual intake, activity, weight changes and co-treatment records. Identical advice and identical actual behavior are distinguished."
    },
    {
      "item_id": "N08",
      "question_type": "Evidence condition",
      "question": "Who was actually studied?",
      "needed": "Overweight/obesity, MASLD and eligibility",
      "role": "Required",
      "role_reason": "This condition connects Overweight/obesity, MASLD and eligibility with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Overweight/obesity, MASLD and eligibility must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Diagnosis, eligibility, baseline liver disease, imaging, metabolic factors, medication, group baselines, subgroups and test denominators. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The original population comprised 80 adults with overweight or obesity and MASLD. Detailed diagnosis, liver-disease stage, baseline ALT and weight, medication, comorbidity, sex and age remain separately unverified. Findings are not generalized to other liver diseases, normal weight or advanced disease.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Diagnosis, eligibility, baseline liver disease, imaging, metabolic factors, medication, group baselines, subgroups and test denominators.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Diagnosis, eligibility, baseline liver disease, imaging, metabolic factors, medication, group baselines, subgroups and test denominators."
    },
    {
      "item_id": "N09",
      "question_type": "Evidence condition",
      "question": "Do 80 randomized and 78 completers provide every test denominator?",
      "needed": "Allocation, completion, valid tests and dropout",
      "role": "Required",
      "role_reason": "This condition connects Allocation, completion, valid tests and dropout with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Allocation, completion, valid tests and dropout must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Group flow, test- and time-specific denominators, ITT/completer populations, missing-data handling and exposure/withdrawal tables. Overall n is not copied into each group or test. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The original record states 80 randomized, 78 completed and ten weeks. Group allocation/completion, valid ALT/FibroScan/AST denominators, withdrawal reasons and timing remain separately unverified. No completion differences or rates are newly calculated.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Group flow, test- and time-specific denominators, ITT/completer populations, missing-data handling and exposure/withdrawal tables. Overall n is not copied into each group or test.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Group flow, test- and time-specific denominators, ITT/completer populations, missing-data handling and exposure/withdrawal tables. Overall n is not copied into each group or test."
    },
    {
      "item_id": "N10",
      "question_type": "Evidence condition",
      "question": "Are ten-week research exposure and actual adherence verified?",
      "needed": "Oral 10g/day, duration, products and exposure",
      "role": "Required",
      "role_reason": "This condition connects Oral 10g/day, duration, products and exposure with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Oral 10g/day, duration, products and exposure must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original products, formulations, composition, actual exposure, adherence, dropout and changes in diet/activity. No psyllium, product or diet instructions are provided. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "Original psyllium 10g/day, ten weeks and control 10g/day are retained only to identify the study. Actual product quantification, manufacturing, intake, concurrent exposures, adherence and total exposure are separately unverified. No cumulative quantities or intake instructions are created.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original products, formulations, composition, actual exposure, adherence, dropout and changes in diet/activity. No psyllium, product or diet instructions are provided.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original products, formulations, composition, actual exposure, adherence, dropout and changes in diet/activity. No psyllium, product or diet instructions are provided."
    },
    {
      "item_id": "N11",
      "question_type": "Evidence condition",
      "question": "Is the prespecified primary-endpoint hierarchy verified?",
      "needed": "ALT/AST/FibroScan hierarchy, registration and SAP",
      "role": "Required",
      "role_reason": "This condition connects ALT/AST/FibroScan hierarchy, registration and SAP with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for ALT/AST/FibroScan hierarchy, registration and SAP must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Initial and amended registration, protocol/SAP, endpoints, time points, multiplicity and analysis plans. Missing registration identifiers or URLs are not invented. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The original reader answer, grading rationale and flags record unverified prespecified primary hierarchy and registration. Three test endpoints or positive P values do not make all of them prespecified primary successes.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Initial and amended registration, protocol/SAP, endpoints, time points, multiplicity and analysis plans. Missing registration identifiers or URLs are not invented.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Initial and amended registration, protocol/SAP, endpoints, time points, multiplicity and analysis plans. Missing registration identifiers or URLs are not invented."
    },
    {
      "item_id": "N12",
      "question_type": "Evidence condition",
      "question": "Are exact effect sizes, CIs and clinical importance available?",
      "needed": "P values, estimates, intervals and surrogate-test importance",
      "role": "Required",
      "role_reason": "This condition connects P values, estimates, intervals and surrogate-test importance with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for P values, estimates, intervals and surrogate-test importance must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original models, estimates, CIs, variance, denominators, prespecified importance thresholds and test units. No hypothetical quantitative examples or new effect/CI calculations are produced. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "Original P=.006, .001 and .98 are present, but exact between-group effect sizes, confidence intervals and clinical importance are unverified. Small significant P values do not establish large quantitative effects, precision or disease improvement.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original models, estimates, CIs, variance, denominators, prespecified importance thresholds and test units. No hypothetical quantitative examples or new effect/CI calculations are produced.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original models, estimates, CIs, variance, denominators, prespecified importance thresholds and test units. No hypothetical quantitative examples or new effect/CI calculations are produced."
    },
    {
      "item_id": "N13",
      "question_type": "Evidence condition",
      "question": "Does a FibroScan measure establish histologic fibrosis improvement?",
      "needed": "Separate directness for test scores, histology and disease stage",
      "role": "Required",
      "role_reason": "This condition connects Separate directness for test scores, histology and disease stage with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Separate directness for test scores, histology and disease stage must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Actual score definitions and tables, separate direct histology/disease-stage evidence, denominators, timing and CIs. Unrecorded histologic outcomes are not assumed. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The original fibrosis-score signal is not changed into histologic fibrosis reversal or reduced MRI/histologic liver fat. The original advertising interpretation cautions against adding MRI or histologic liver-fat results that were not measured.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Actual score definitions and tables, separate direct histology/disease-stage evidence, denominators, timing and CIs. Unrecorded histologic outcomes are not assumed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Actual score definitions and tables, separate direct histology/disease-stage evidence, denominators, timing and CIs. Unrecorded histologic outcomes are not assumed."
    },
    {
      "item_id": "N14",
      "question_type": "Evidence condition",
      "question": "Are ALT and FibroScan clinical liver-disease outcomes?",
      "needed": "Clinical outcomes such as cirrhosis/hospitalization versus surrogates",
      "role": "Required",
      "role_reason": "This condition connects Clinical outcomes such as cirrhosis/hospitalization versus surrogates with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Clinical outcomes such as cirrhosis/hospitalization versus surrogates must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Direct clinical-event types, definitions, adjudication, group events, time at risk, long-term denominators and CIs. Unverified information is not changed into zero events or zero effect. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The original Korean counterview says it is unknown whether the measures translate into cirrhosis or hospitalization; the English counterview says clinical liver events were not tested. Surrogate signals are not converted into disease improvement or event-prevention effects.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Direct clinical-event types, definitions, adjudication, group events, time at risk, long-term denominators and CIs. Unverified information is not changed into zero events or zero effect.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Direct clinical-event types, definitions, adjudication, group events, time at risk, long-term denominators and CIs. Unverified information is not changed into zero events or zero effect."
    },
    {
      "item_id": "N15",
      "question_type": "Evidence condition",
      "question": "Is the separate seed trial an efficacy replication?",
      "needed": "Akbarian2016 safety support and a different intervention",
      "role": "Required",
      "role_reason": "This condition connects Akbarian2016 safety support and a different intervention with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Akbarian2016 safety support and a different intervention must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: That report's original formulation, duration, population, group effects, harms, denominators and study/cohort relationships. Detailed unverified/unread status is retained. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The 2016 citation provides safety support from a Plantago psyllium/Ocimum basilicum seed-intervention and anthropometric trial. It has no separate current efficacy-evidence row and is not counted as replication of the same formulation and ten-week ALT/FibroScan outcomes.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "That report's original formulation, duration, population, group effects, harms, denominators and study/cohort relationships. Detailed unverified/unread status is retained.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "That report's original formulation, duration, population, group effects, harms, denominators and study/cohort relationships. Detailed unverified/unread status is retained."
    },
    {
      "item_id": "N16",
      "question_type": "Evidence condition",
      "question": "Are test effects after stopping or over other durations available?",
      "needed": "Ten weeks, persistence and generalization",
      "role": "Required",
      "role_reason": "This condition connects Ten weeks, persistence and generalization with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Ten weeks, persistence and generalization must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Follow-up, actual exposure, endpoint-specific denominators/CIs and matching comparator/population data. No maintenance-intake, liver-disease-management or treatment-replacement advice is created. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The current record concerns a small ten-week surrogate trial. Persistence after stopping and effects in other products, durations, populations or long-term clinical outcomes cannot be established from the stored summary.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Follow-up, actual exposure, endpoint-specific denominators/CIs and matching comparator/population data. No maintenance-intake, liver-disease-management or treatment-replacement advice is created.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Follow-up, actual exposure, endpoint-specific denominators/CIs and matching comparator/population data. No maintenance-intake, liver-disease-management or treatment-replacement advice is created."
    },
    {
      "item_id": "N17",
      "question_type": "Evidence condition",
      "question": "Are the same citation, population or time points counted as new independent evidence?",
      "needed": "Parent/subclaim and report/trial relationships",
      "role": "Required",
      "role_reason": "This condition connects Parent/subclaim and report/trial relationships with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Parent/subclaim and report/trial relationships must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Mapping efficacy/safety reports, cohorts, actual interventions, analysis populations and time points. Material-slot counts are not unique trials, participants or quality scores. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "Parent2985 and both existing subclaims share the Akbarzadeh2026 efficacy-trial context and Akbarian2016 supporting safety citation. Two tables or tests, conditions and time points from the same participants are not added as independent trials or participants. Different citations are also distinguished from unique-trial or independence certification; unique-trial and total unique-participant counts remain unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Mapping efficacy/safety reports, cohorts, actual interventions, analysis populations and time points. Material-slot counts are not unique trials, participants or quality scores.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Mapping efficacy/safety reports, cohorts, actual interventions, analysis populations and time points. Material-slot counts are not unique trials, participants or quality scores."
    },
    {
      "item_id": "N18",
      "question_type": "Evidence condition",
      "question": "What was actually read?",
      "needed": "The complete parent stored summary and external material",
      "role": "Required",
      "role_reason": "This condition connects The complete parent stored summary and external material with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for The complete parent stored summary and external material must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Actual acquisition/reading records for full texts, supplements, plans and registration. No separate external-link, screen, web or API checks were performed. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The complete parent stored summary was read for production and preserved as a complete byte copy. External abstracts, full texts, registration, protocols and SAPs are unread. URLs or PMCIDs alone do not upgrade reading, access or verification status.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Actual acquisition/reading records for full texts, supplements, plans and registration. No separate external-link, screen, web or API checks were performed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Actual acquisition/reading records for full texts, supplements, plans and registration. No separate external-link, screen, web or API checks were performed."
    },
    {
      "item_id": "N19",
      "question_type": "Evidence condition",
      "question": "Where are the original citation and registration identifiers?",
      "needed": "PMID, PMCID and DOI for each citation",
      "role": "Required",
      "role_reason": "This condition connects PMID, PMCID and DOI for each citation with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for PMID, PMCID and DOI for each citation must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Exact original citations, study/registration identifiers, content and dates. Full-text or registration URLs are not inferred from PMCIDs. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The 2026 efficacy citation has PMID42621560, PMCID PMC13489564 and DOI10.4103/ijpvm.ijpvm_254_24; the 2016 supporting citation has PMID27761216, PMCID PMC5070040 and DOI10.4103/2008-7802.191865. No separate registration identifier occurs in the two citation/evidence records.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Exact original citations, study/registration identifiers, content and dates. Full-text or registration URLs are not inferred from PMCIDs.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Exact original citations, study/registration identifiers, content and dates. Full-text or registration URLs are not inferred from PMCIDs."
    },
    {
      "item_id": "N20",
      "question_type": "Evidence condition",
      "question": "Are bilingual and historical checks distinguished from this review?",
      "needed": "Original bilingual text, subclaims and historical verification",
      "role": "Required",
      "role_reason": "This condition connects Original bilingual text, subclaims and historical verification with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Original bilingual text, subclaims and historical verification must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original-text, translation, correction and boundary review. Historical checks are not labeled current FULL/QA, new clinical calculation or independent certification. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "Original bilingual text, subclaims, notes and historical Codex PubMed/PMC/scoring checks and citation one-line verification statements are preserved. This work concerns production; external material is unread and content/model/question-boundary review remains incomplete.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original-text, translation, correction and boundary review. Historical checks are not labeled current FULL/QA, new clinical calculation or independent certification.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original-text, translation, correction and boundary review. Historical checks are not labeled current FULL/QA, new clinical calculation or independent certification."
    },
    {
      "item_id": "N21",
      "question_type": "Evidence condition",
      "question": "Are subclaim values distinguished from parent C50 and axes?",
      "needed": "Original subclaim grade/note and absent score/status/axes",
      "role": "Required",
      "role_reason": "This condition connects Original subclaim grade/note and absent score/status/axes with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Original subclaim grade/note and absent score/status/axes must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Review of selected and parent original values. No new scores, axes, efficacy grades or verdict changes. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The selected original grade/note and absence of score/status/axes are retained. Parent C50, Caution, B/S/R1/I2/EX/B2 and unrecorded precision describe parent context. They do not fill selected ten-week ALT/FibroScan scores, axes or independence certification.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Review of selected and parent original values. No new scores, axes, efficacy grades or verdict changes.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Review of selected and parent original values. No new scores, axes, efficacy grades or verdict changes."
    },
    {
      "item_id": "N22",
      "question_type": "Evidence condition",
      "question": "Are the cut-off, empty corrections and production date distinguished?",
      "needed": "Original cut-off and empty correction/deliberation records",
      "role": "Required",
      "role_reason": "This condition connects Original cut-off and empty correction/deliberation records with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Original cut-off and empty correction/deliberation records must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Subsequent/corrected material, complete pre-change originals and case history. Missing dates or correction values are not invented. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The original cut-off2026-09-07, empty corrections array and empty deliberation string are retained. They are not production/review dates or certification that no external correction exists.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Subsequent/corrected material, complete pre-change originals and case history. Missing dates or correction values are not invented.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Subsequent/corrected material, complete pre-change originals and case history. Missing dates or correction values are not invented."
    },
    {
      "item_id": "N23",
      "question_type": "Evidence condition",
      "question": "Are funding, support, employee authors and analysis roles distinguished?",
      "needed": "Four company-related areas and report-specific scope",
      "role": "Required",
      "role_reason": "This condition connects Four company-related areas and report-specific scope with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Four company-related areas and report-specific scope must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original funding/COI, product/material support, author affiliations and analysis/publication roles for each report. Parent I2 is not upgraded into new independence certification. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "Core funding information records academic Isfahan University research and no conflicts reported. This does not establish that product support, company employee authors or company analysis/reporting involvement were all verified. Detailed funding for the 2016 supporting citation is not separately present in this stored summary.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original funding/COI, product/material support, author affiliations and analysis/publication roles for each report. Parent I2 is not upgraded into new independence certification.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original funding/COI, product/material support, author affiliations and analysis/publication roles for each report. Parent I2 is not upgraded into new independence certification."
    },
    {
      "item_id": "N24",
      "question_type": "Evidence condition",
      "question": "Are randomization, measurement, missingness and reporting details available?",
      "needed": "Block allocation, covariates and completer boundaries",
      "role": "Required",
      "role_reason": "This condition connects Block allocation, covariates and completer boundaries with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Block allocation, covariates and completer boundaries must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original methods, protocol/SAP, registration/amendments, test tables, denominators and models. Design labels or objective tests do not establish official RoB/GRADE completion or completed review. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The original core design is block randomization, with limitations involving covariate adjustment and completer-focused analysis. Allocation concealment, masking, test equipment/validity, missingness, prespecification of covariates and selective-reporting details remain separately unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original methods, protocol/SAP, registration/amendments, test tables, denominators and models. Design labels or objective tests do not establish official RoB/GRADE completion or completed review.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original methods, protocol/SAP, registration/amendments, test tables, denominators and models. Design labels or objective tests do not establish official RoB/GRADE completion or completed review."
    },
    {
      "item_id": "N25",
      "question_type": "Evidence condition",
      "question": "Are identical lifestyle advice and actual concurrent exposure the same?",
      "needed": "Weight-loss diet, physical activity, adherence and co-management",
      "role": "Required",
      "role_reason": "This condition connects Weight-loss diet, physical activity, adherence and co-management with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Weight-loss diet, physical activity, adherence and co-management must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Actual concurrent exposures, weight, diet, activity, baseline/follow-up medication, exposure, adherence and denominators. No diet, intake or liver-disease-management instructions are provided. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "Weight-loss-diet and physical-activity advice common to both arms is an original condition. Actual diet, activity, weight changes, medication, product exposure, adherence and withdrawal details remain unverified; their joint contribution is not established.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Actual concurrent exposures, weight, diet, activity, baseline/follow-up medication, exposure, adherence and denominators. No diet, intake or liver-disease-management instructions are provided.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Actual concurrent exposures, weight, diet, activity, baseline/follow-up medication, exposure, adherence and denominators. No diet, intake or liver-disease-management instructions are provided."
    },
    {
      "item_id": "N26",
      "question_type": "Harm-information gaps supplementing the efficacy table",
      "question": "Which formulation and group had withdrawals in the supporting safety citation?",
      "needed": "Withdrawals and harms in the 2016 seed intervention",
      "role": "Supplementary",
      "role_reason": "This condition connects Withdrawals and harms in the 2016 seed intervention with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Withdrawals and harms in the 2016 seed intervention must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: That report's formulations/materials, group events, withdrawals, reasons, durations, harm collection and exposure denominators. Other safety citations are not transferred into independent efficacy replication or the original trial's harm rate. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "The 2016 citation records some withdrawals for constipation, nausea or abdominal pain in a separate NAFLD seed intervention. Exact groups, products, counts, exposure denominators and duration cannot be established from the stored citation. All withdrawals are not assigned to the current psyllium10g/day trial.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "That report's formulations/materials, group events, withdrawals, reasons, durations, harm collection and exposure denominators. Other safety citations are not transferred into independent efficacy replication or the original trial's harm rate.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "That report's formulations/materials, group events, withdrawals, reasons, durations, harm collection and exposure denominators. Other safety citations are not transferred into independent efficacy replication or the original trial's harm rate."
    },
    {
      "item_id": "N27",
      "question_type": "Harm-information gaps supplementing the efficacy table",
      "question": "Are caution statements, observed harms and long-term safety the same?",
      "needed": "Possible harms, collection, denominators and particular risk groups",
      "role": "Supplementary",
      "role_reason": "This condition connects Possible harms, collection, denominators and particular risk groups with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Possible harms, collection, denominators and particular risk groups must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Report-specific harm definitions, active collection, group exposures/denominators, discontinuation, dropout and long-term risk-group evidence. Caution is not replaced with safe/no harms or a newly established incidence rate. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "Original safety wording describes possible gas, bloating, abdominal pain, constipation or nausea and swallowing/narrowing/obstruction concerns. Harm collection, group events, exposure denominators, CIs and long-term/rare harms are separately unverified. Original adequate-fluid wording is preserved without creating new fluid quantities, intake instructions or treatment advice.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Report-specific harm definitions, active collection, group exposures/denominators, discontinuation, dropout and long-term risk-group evidence. Caution is not replaced with safe/no harms or a newly established incidence rate.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Report-specific harm definitions, active collection, group exposures/denominators, discontinuation, dropout and long-term risk-group evidence. Caution is not replaced with safe/no harms or a newly established incidence rate."
    },
    {
      "item_id": "N28",
      "question_type": "Evidence condition",
      "question": "What material would trigger a sheet update?",
      "needed": "Original material, conditions, observations and verdict-change events",
      "role": "Required",
      "role_reason": "This condition connects Original material, conditions, observations and verdict-change events with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms.",
      "application_exception": "Only original numbers are preserved. Distinguish actual ALT/AST/FibroScan measures, MRI/MRS/other imaging/histology/clinical liver disease, population, intervention, comparator, common advice, denominators, within- and between-group comparisons, duration, harms and unread external material. No new calculations, hypothetical examples, effects, CIs, regrading, independence certification, psyllium/product intake, diets, liver-disease management or treatment-replacement advice is created.",
      "criterion": "Material for Original material, conditions, observations and verdict-change events must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Complete pre-change preservation, original material/condition versions, separate application and content-review records. The source records no QA/tests, web/API or link/screen checks, new calculations, regrading, independence certification, product intake, diet, liver-disease-management or treatment-replacement instructions. Only material requests and research needs are recorded; no new search or clinical research is executed here.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread",
      "observation": "This is a production table of stored ten-week ALT/FibroScan material. Relevant observations can be updated after content review of original tables, actual test names/units, direct imaging/histologic/clinical outcomes, between-group effects, denominators, concurrent exposures and harms.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Complete pre-change preservation, original material/condition versions, separate application and content-review records. The source records no QA/tests, web/API or link/screen checks, new calculations, regrading, independence certification, product intake, diet, liver-disease-management or treatment-replacement instructions.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Complete pre-change preservation, original material/condition versions, separate application and content-review records. The source records no QA/tests, web/API or link/screen checks, new calculations, regrading, independence certification, product intake, diet, liver-disease-management or treatment-replacement instructions."
    }
  ],
  "reports": [
    {
      "report_id": "R01",
      "title": "Akbarzadeh Z, Nourian M, Askari G, Maracy MR, Amani R. Benefit of Psyllium with Weight Loss Diet in Preventing Liver Dysfunction in Overweight or Obese Adults with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Int J Prev Med. 2026;17:46. PMID: 42621560. PMCID: PMC13489564. DOI: 10.4103/ijpvm.ijpvm_254_24.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/42621560/",
      "report_type": "Randomized block design comparing psyllium with ground wheat",
      "existence": "Report bibliography exists in original citations; external availability/access remain unverified",
      "acquired_read": "Preserved summary read; external abstracts/full texts/registrations/plans remain unread",
      "study_family": "F01",
      "independent_replication": "Content review remains incomplete. Report identifiers or different formulations do not certify unique-trial counts or independent efficacy replication.",
      "observed_result": "ALT P=.006, FibroScan score P=.001; AST P=.98",
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      "links": [
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      "official_principle": "Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates.",
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  "status_dictionary": {
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    "Review incomplete": "Review of existing content incomplete",
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    "Inaccessible": "Not applied during this preparation because actual access was not tested",
    "Not applicable": "Use with a reason for non-applicability based on an explicit question boundary",
    "Conflicting data": "Judge after actual material comparison; review was not performed during this preparation",
    "Insufficient evidence for the conditions": "Do not use as a clinical grade encompassing currently unread materials"
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    "state": "Unverified",
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    "reason": "The Akbarzadeh2026 report concerns ten-week add-on psyllium ALT/FibroScan signals, null AST and gaps in effect size and endpoint hierarchy; MRI was not directly measured. The Akbarian2016 citation provides supporting harm/withdrawal information from a separate NAFLD seed-intervention/anthropometric study; it is not replication of current ALT/FibroScan/MRI efficacy. Parent2985 and both existing subclaims share these citations. Tables or tests, conditions and time points from the same participants are not added as new independent trials or people. Different citations do not certify unique trials or independence; unique-trial and total unique-participant counts remain unverified. Links are provisional by citation and actual cohort/independent-study relationships remain unreviewed."
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  "history": [
    {
      "date": "2026-10-15",
      "kind": "Separation of public-facing pages and materials",
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      "change": "Public reader pages and material were prepared from the existing 28 items. No new clinical searches, verification-state changes or scoring were performed."
    }
  ],
  "language": "en",
  "translation_date": "2026-10-15"
}