{
  "schema_version": "chamgap-public-evidence-check-1.0",
  "public_id": "v2985-s1",
  "verdict_number": "2985",
  "title": "Psyllium × MRI liver fat: an unmeasured outcome and gaps behind surrogate findings",
  "view_version": "1.0",
  "view_created_date": "2026-10-16",
  "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": "MRI liver fat was not directly measured. ALT, FibroScan and AST, MRS, other imaging and histology are distinguished separately.",
    "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": "Which MRI claim is selected?",
      "needed": "The existing MRI liver-fat-reduction claim and verdict record",
      "role": "Required",
      "role_reason": "This condition connects The existing MRI liver-fat-reduction claim and verdict record 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 existing MRI liver-fat-reduction claim and verdict record 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: Definitions, population, comparator, time points and denominators for direct MRI measurement, and review of the existing claim boundary, are needed. The ? does not mean zero effect, zero points or absence of all human research. This records needed materials; no new research was executed.",
      "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 claim is reduced MRI-measured liver fat. Its original grade is ? and its note says this was not an outcome measured by the trial. Subclaim score, status and axes are unrecorded and distinguished from the parent ALT/FibroScan verdict 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": "Definitions, population, comparator, time points and denominators for direct MRI measurement, and review of the existing claim boundary, are needed. The ? does not mean zero effect, zero points or absence of all human research.",
      "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": "Definitions, population, comparator, time points and denominators for direct MRI measurement, and review of the existing claim boundary, are needed. The ? does not mean zero effect, zero points or absence of all human research."
    },
    {
      "item_id": "N02",
      "question_type": "Evidence condition",
      "question": "Was MRI liver fat directly measured?",
      "needed": "Unmeasured MRI and the direct-evidence gap",
      "role": "Required",
      "role_reason": "This condition connects Unmeasured MRI and the direct-evidence gap 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 Unmeasured MRI and the direct-evidence gap 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 MRI liver-fat methods, quantification, units, baseline and follow-up measurements, comparator, denominators and CIs are needed. An unmeasured outcome is not a test showing no effect. This records needed materials; no new research was executed.",
      "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 existing crux, summary note and subclaim note record that the trial did not measure MRI liver fat. MRI values, between-group changes, CIs and measurement denominators are not filled using ALT/FibroScan findings.",
      "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": "Actual MRI liver-fat methods, quantification, units, baseline and follow-up measurements, comparator, denominators and CIs are needed. An unmeasured outcome is not a test showing no 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": "Actual MRI liver-fat methods, quantification, units, baseline and follow-up measurements, comparator, denominators and CIs are needed. An unmeasured outcome is not a test showing no effect."
    },
    {
      "item_id": "N03",
      "question_type": "Evidence condition",
      "question": "Does ALT P=.006 establish an MRI liver-fat effect?",
      "needed": "Distinguishing liver enzymes from a direct MRI endpoint",
      "role": "Required",
      "role_reason": "This condition connects Distinguishing liver enzymes from a direct MRI endpoint 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 liver enzymes from a direct MRI endpoint 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 and separate direct MRI data, definitions, models, denominators and CIs are needed. Original P values are preserved without new effect or fat-quantity calculations. This records needed materials; no new research was executed.",
      "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 ALT P=.006 is a covariate-adjusted liver-enzyme result, not MRI fat quantity, change or a CI. It is not converted into an MRI liver-fat-reduction effect or amount of normalization.",
      "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 and separate direct MRI data, definitions, models, denominators and CIs are needed. Original P values are preserved without new effect or fat-quantity calculations.",
      "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 and separate direct MRI data, definitions, models, denominators and CIs are needed. Original P values are preserved without new effect or fat-quantity calculations."
    },
    {
      "item_id": "N04",
      "question_type": "Evidence condition",
      "question": "Is FibroScan P=.001 the same measurement as MRI?",
      "needed": "Distinguishing the actual FibroScan measure from MRI methods",
      "role": "Required",
      "role_reason": "This condition connects Distinguishing the actual FibroScan measure from MRI methods 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 the actual FibroScan measure from MRI methods 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: FibroScan definitions and valid measurements, direct MRI quantification methods, and their respective denominators, models and CIs are needed. A device name alone does not establish fat measurement or histologic effects. This records needed materials; no new research was executed.",
      "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 wording of FibroScan fibrosis score P=.001 and the existing explanation that it differs from MRI are preserved. Actual measure, units and device algorithm are unverified and are not converted into MRI fat quantity.",
      "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": "FibroScan definitions and valid measurements, direct MRI quantification methods, and their respective denominators, models and CIs are needed. A device name alone does not establish fat measurement or histologic effects.",
      "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": "FibroScan definitions and valid measurements, direct MRI quantification methods, and their respective denominators, models and CIs are needed. A device name alone does not establish fat measurement or histologic effects."
    },
    {
      "item_id": "N05",
      "question_type": "Evidence condition",
      "question": "Are MRI, MRS, other imaging and histologic outcomes individually verified?",
      "needed": "Actual measurement by each imaging method and histologic indicator",
      "role": "Required",
      "role_reason": "This condition connects Actual measurement by each imaging method and histologic indicator 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 Actual measurement by each imaging method and histologic indicator 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 performance, purpose, definitions, units, time points, denominators and CIs for each method or histologic measure are needed. Unverified information is not replaced with confirmed performance or a zero result. This records needed materials; no new research was executed.",
      "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 existing advertising analysis cautions against adding unmeasured MRI or histologic liver-fat findings. Detailed MRS, other imaging and histologic results and values are also not verified as separate direct outcomes in the stored summary.",
      "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": "Actual performance, purpose, definitions, units, time points, denominators and CIs for each method or histologic measure are needed. Unverified information is not replaced with confirmed performance or a zero result.",
      "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 performance, purpose, definitions, units, time points, denominators and CIs for each method or histologic measure are needed. Unverified information is not replaced with confirmed performance or a zero result."
    },
    {
      "item_id": "N06",
      "question_type": "Evidence condition",
      "question": "Does the null AST result establish a null MRI fat result?",
      "needed": "Distinguishing AST P=.98 from other unmeasured tests",
      "role": "Required",
      "role_reason": "This condition connects Distinguishing AST P=.98 from other unmeasured 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 AST P=.98 from other unmeasured 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: Test-specific values, denominators, between-group effects, CIs, prespecified hierarchy and separate MRI data are needed. No new conversion between tests is made. This records needed materials; no new research was executed.",
      "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": "AST P=.98 is the original null liver-enzyme test result. It is not transferred into zero MRI effect or equivalence for an unmeasured outcome, or obscured by favorable ALT findings.",
      "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": "Test-specific values, denominators, between-group effects, CIs, prespecified hierarchy and separate MRI data are needed. No new conversion between tests is made.",
      "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": "Test-specific values, denominators, between-group effects, CIs, prespecified hierarchy and separate MRI data are needed. No new conversion between tests is made."
    },
    {
      "item_id": "N07",
      "question_type": "Evidence condition",
      "question": "Are clinical liver-disease outcomes and MRI measurements the same endpoint?",
      "needed": "Clinical outcomes such as cirrhosis or hospitalization and direct MRI evidence",
      "role": "Required",
      "role_reason": "This condition connects Clinical outcomes such as cirrhosis or hospitalization and direct MRI evidence 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 or hospitalization and direct MRI evidence 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: Clinical-event definitions, adjudication, long-term follow-up, group-specific time at risk, denominators, effects, CIs and direct MRI data are needed. No conversion into zero events or treatment efficacy is made. This records needed materials; no new research was executed.",
      "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 Korean text says whether marker changes lead to cirrhosis or hospitalization is unknown; the English text says clinical liver events were not tested. MRI fat quantity is also distinct from clinical-event effects and was not directly measured in this 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": "Clinical-event definitions, adjudication, long-term follow-up, group-specific time at risk, denominators, effects, CIs and direct MRI data are needed. No conversion into zero events or treatment efficacy is made.",
      "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": "Clinical-event definitions, adjudication, long-term follow-up, group-specific time at risk, denominators, effects, CIs and direct MRI data are needed. No conversion into zero events or treatment efficacy is made."
    },
    {
      "item_id": "N08",
      "question_type": "Evidence condition",
      "question": "Is the MASLD population the same as the separate NAFLD seed trial?",
      "needed": "Distinguishing the overweight/obese MASLD population from another seed trial",
      "role": "Required",
      "role_reason": "This condition connects Distinguishing the overweight/obese MASLD population from another seed trial 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 the overweight/obese MASLD population from another seed trial 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 populations, diagnoses, baseline imaging, liver disease, medication, interventions, durations and direct MRI evidence are needed. No generalization to every liver disease or formulation is made. This records needed materials; no new research was executed.",
      "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 main trial involved 80 adults with overweight or obesity and MASLD. The 2016 supporting safety citation concerns NAFLD seed intervention and anthropometry. Differences in diagnosis, disease stage, baseline imaging, medication and formulation are not merged into evidence for the same MRI efficacy question.",
      "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": "Report-specific populations, diagnoses, baseline imaging, liver disease, medication, interventions, durations and direct MRI evidence are needed. No generalization to every liver disease or formulation is made.",
      "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 populations, diagnoses, baseline imaging, liver disease, medication, interventions, durations and direct MRI evidence are needed. No generalization to every liver disease or formulation is made."
    },
    {
      "item_id": "N09",
      "question_type": "Evidence condition",
      "question": "Can common diet advice and comparator conditions substitute for MRI effects?",
      "needed": "The psyllium versus ground-wheat comparison and common lifestyle advice",
      "role": "Required",
      "role_reason": "This condition connects The psyllium versus ground-wheat comparison and 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 The psyllium versus ground-wheat comparison and 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: Actual diet, activity, weight, medication, adherence, comparator, exposure and direct MRI measurement data are needed. No new diet, liver-disease-management or intake advice is created. This records needed materials; no new research was executed.",
      "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 10g/day interventions, ground-wheat comparator, weight-loss diet and physical-activity advice in both groups are original study conditions. Common advice or weight changes are not assumed to establish MRI liver-fat improvement, an isolated effect or a comparison with no treatment.",
      "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 diet, activity, weight, medication, adherence, comparator, exposure and direct MRI measurement data are needed. No new diet, liver-disease-management or intake 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": "Actual diet, activity, weight, medication, adherence, comparator, exposure and direct MRI measurement data are needed. No new diet, liver-disease-management or intake advice is created."
    },
    {
      "item_id": "N10",
      "question_type": "Evidence condition",
      "question": "Are 80 randomized and 78 completed MRI measurement denominators?",
      "needed": "Distinguishing randomized/completed counts from an unmeasured endpoint denominator",
      "role": "Required",
      "role_reason": "This condition connects Distinguishing randomized/completed counts from an unmeasured endpoint denominator 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 randomized/completed counts from an unmeasured endpoint denominator 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-specific randomization, valid scans, missingness, analysis flow, effects and CIs from direct MRI research are needed. No new valid MRI denominator, dropout count or dropout rate is calculated. This records needed materials; no new research was executed.",
      "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": "80 randomized and 78 completed describe participation in the main trial, not numbers or denominators measured by MRI. Time points, tests and report counts are not added as independent trials or participants.",
      "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": "Group-specific randomization, valid scans, missingness, analysis flow, effects and CIs from direct MRI research are needed. No new valid MRI denominator, dropout count or dropout rate is 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": "Group-specific randomization, valid scans, missingness, analysis flow, effects and CIs from direct MRI research are needed. No new valid MRI denominator, dropout count or dropout rate is calculated."
    },
    {
      "item_id": "N11",
      "question_type": "Evidence condition",
      "question": "Does ten-week study exposure show sustained MRI effects?",
      "needed": "Duration, actual exposure and post-trial follow-up",
      "role": "Required",
      "role_reason": "This condition connects Duration, actual exposure and post-trial follow-up 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 Duration, actual exposure and post-trial follow-up 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 MRI baseline, follow-up and post-trial data, actual exposure, denominators, comparator and duration are needed. No product-intake, maintenance or treatment-replacement instructions are created. This records needed materials; no new research was executed.",
      "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": "Ten weeks, psyllium10g/day and ground wheat10g/day identify the original efficacy trial. With MRI unmeasured, no ten-week MRI effect, persistence, subsequent fat quantity or long-term safety is 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": "Direct MRI baseline, follow-up and post-trial data, actual exposure, denominators, comparator and duration are needed. No product-intake, maintenance or treatment-replacement instructions are 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": "Direct MRI baseline, follow-up and post-trial data, actual exposure, denominators, comparator and duration are needed. No product-intake, maintenance or treatment-replacement instructions are created."
    },
    {
      "item_id": "N12",
      "question_type": "Evidence condition",
      "question": "Did registration or the prespecified endpoint hierarchy include MRI?",
      "needed": "Distinguishing unverified registration/prespecified endpoints from unmeasured MRI",
      "role": "Required",
      "role_reason": "This condition connects Distinguishing unverified registration/prespecified endpoints from unmeasured MRI 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 unverified registration/prespecified endpoints from unmeasured MRI 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 registration and amendment history, protocols, SAPs, actual endpoints, time points and direct MRI design data are needed. External registration and planning materials remain unread. This records needed materials; no new research was executed.",
      "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 leaves effect size, prespecified primary-endpoint hierarchy and registration unverified; MRI was not a measured endpoint. Registration identifiers or plans are not invented to verify MRI as a prespecified or later endpoint.",
      "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 registration and amendment history, protocols, SAPs, actual endpoints, time points and direct MRI design data are needed. External registration and planning materials remain unread.",
      "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 registration and amendment history, protocols, SAPs, actual endpoints, time points and direct MRI design data are needed. External registration and planning materials remain unread."
    },
    {
      "item_id": "N13",
      "question_type": "Evidence condition",
      "question": "Can P values from other tests fill MRI effects or CIs?",
      "needed": "Direct estimates, within/between-group comparisons and unmeasured outcomes",
      "role": "Required",
      "role_reason": "This condition connects Direct estimates, within/between-group comparisons and unmeasured outcomes 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 Direct estimates, within/between-group comparisons and unmeasured outcomes 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 MRI group values, baseline, changes, adjusted estimates, 95%CIs, units, denominators and clinical importance are needed. No new calculations, hypothetical examples or effect sizes are created. This records needed materials; no new research was executed.",
      "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": "MRI values, direct effects and CIs remain a gap because MRI was not measured. Covariate-adjusted ALT/FibroScan P values and the parent verdict's interpretation do not provide quantitative MRI evidence.",
      "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": "Direct MRI group values, baseline, changes, adjusted estimates, 95%CIs, units, denominators and clinical importance are needed. No new calculations, hypothetical examples or effect sizes are 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": "Direct MRI group values, baseline, changes, adjusted estimates, 95%CIs, units, denominators and clinical importance are needed. No new calculations, hypothetical examples or effect sizes are created."
    },
    {
      "item_id": "N14",
      "question_type": "Evidence condition",
      "question": "What direct evidence would address the MRI gap?",
      "needed": "MRI measurements addressing the same question",
      "role": "Required",
      "role_reason": "This condition connects MRI measurements addressing the same question 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 MRI measurements addressing the same question 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: MRI liver-fat methods, baseline, follow-up, denominators, effects, CIs, actual exposure and harms for the same formulation, common advice, comparator and selected MASLD population are needed. Only research needs are recorded; no new research, calculation or regrading is performed. This records needed materials; no new research was executed.",
      "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 contains selected ten-week liver-test signals and unmeasured MRI. Other surrogates or the separate seed safety citation do not fill this gap; needed direct MRI materials are identified.",
      "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": "MRI liver-fat methods, baseline, follow-up, denominators, effects, CIs, actual exposure and harms for the same formulation, common advice, comparator and selected MASLD population are needed. Only research needs are recorded; no new research, calculation or regrading is 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": "MRI liver-fat methods, baseline, follow-up, denominators, effects, CIs, actual exposure and harms for the same formulation, common advice, comparator and selected MASLD population are needed. Only research needs are recorded; no new research, calculation or regrading is performed."
    },
    {
      "item_id": "N15",
      "question_type": "Evidence condition",
      "question": "Are the same reports, participants or time points counted as independent evidence?",
      "needed": "Links between parent/subclaims and reports/studies",
      "role": "Required",
      "role_reason": "This condition connects Links between parent/subclaims and reports/studies 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 Links between parent/subclaims and reports/studies 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: Links between efficacy/safety reports, cohorts, actual interventions, analysis populations and time points are needed. Material-item counts are not unique-trial or participant counts or quality scores. This records needed materials; no new research was executed.",
      "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 the ALT/FibroScan and MRI sheets share the Akbarzadeh2026 efficacy-trial context and Akbarian2016 supporting safety citation. Tests, conditions and time points from the same participants are not added as new independent trials or people. 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": "Links between efficacy/safety reports, cohorts, actual interventions, analysis populations and time points are needed. Material-item counts are not unique-trial or participant counts 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": "Links between efficacy/safety reports, cohorts, actual interventions, analysis populations and time points are needed. Material-item counts are not unique-trial or participant counts or quality scores."
    },
    {
      "item_id": "N16",
      "question_type": "Evidence condition",
      "question": "Which materials were actually read?",
      "needed": "Distinguishing the complete stored parent summary from external material",
      "role": "Required",
      "role_reason": "This condition connects Distinguishing the complete stored parent summary from 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 Distinguishing the complete stored parent summary from 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: Acquisition and reading records for actual full texts, supplements, plans and registration materials are needed. External source-link access and operation were not tested. This records needed materials; no new research was executed.",
      "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 stored parent-verdict summary was read for production and an exact whole-byte copy preserved. External abstracts, full texts, registration, protocols and SAPs remain unread. URLs or PMCIDs are not treated as verification of reading, access or condition fulfillment.",
      "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": "Acquisition and reading records for actual full texts, supplements, plans and registration materials are needed. External source-link access and operation were not tested.",
      "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": "Acquisition and reading records for actual full texts, supplements, plans and registration materials are needed. External source-link access and operation were not tested."
    },
    {
      "item_id": "N17",
      "question_type": "Evidence condition",
      "question": "Where are citation and registration identifiers recorded?",
      "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 bibliographic, study and registration identifiers, content and dates are needed. Full-text or registration URLs are not newly inferred from a PMCID. This records needed materials; no new research was executed.",
      "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. Neither citation/evidence record contains a separate registration identifier.",
      "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 bibliographic, study and registration identifiers, content and dates are needed. Full-text or registration URLs are not newly inferred from a PMCID.",
      "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 bibliographic, study and registration identifiers, content and dates are needed. Full-text or registration URLs are not newly inferred from a PMCID."
    },
    {
      "item_id": "N18",
      "question_type": "Evidence condition",
      "question": "Are historical bilingual and cross-check records distinguished from this review?",
      "needed": "Original bilingual wording, subclaim records and historical verification",
      "role": "Required",
      "role_reason": "This condition connects Original bilingual wording, subclaim records 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 wording, subclaim records 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: Existing review of original text, translation, corrections and claim boundaries is needed. Historical verification is not presented as completed current clinical review, new calculations or independence certification. This records needed materials; no new research was executed.",
      "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": "Bilingual text, subclaims, notes and historical Codex PubMed/PMC/scoring checks and verification statements in citation summaries are preserved. This production uses stored summaries; external material is unread and existing content, model and claim-boundary reviews remain 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": "Existing review of original text, translation, corrections and claim boundaries is needed. Historical verification is not presented as completed current clinical review, new calculations or 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": "Existing review of original text, translation, corrections and claim boundaries is needed. Historical verification is not presented as completed current clinical review, new calculations or independence certification."
    },
    {
      "item_id": "N19",
      "question_type": "Evidence condition",
      "question": "Are the subclaim record and parent C50/axes distinguished?",
      "needed": "Subclaim grade/note and absent score/status/axes",
      "role": "Required",
      "role_reason": "This condition connects 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 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: Existing review of the selected subclaim and original parent values is needed. No new score, axes, efficacy grade or verdict change is created. This records needed materials; no new research was executed.",
      "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 absent score, status and axes are retained. Parent C50, Caution, B/S/R1/I2/EX/B2 and unrecorded precision are parent context. They do not fill the selected MRI liver-fat score or axes or certify independence.",
      "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": "Existing review of the selected subclaim and original parent values is needed. No new score, axes, efficacy grade or verdict change 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": "Existing review of the selected subclaim and original parent values is needed. No new score, axes, efficacy grade or verdict change is created."
    },
    {
      "item_id": "N20",
      "question_type": "Evidence condition",
      "question": "Are the original evidence date and empty corrections distinguished from production?",
      "needed": "Original evidence date and empty correction/deliberation values",
      "role": "Required",
      "role_reason": "This condition connects Original evidence date and empty correction/deliberation values 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 evidence date and empty correction/deliberation values 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/correction materials and the complete pre-change original and event history are needed. Absent dates or correction values are not invented. This records needed materials; no new research was executed.",
      "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 evidence date2026-09-07, the empty correction array and empty deliberation string are retained. This is not a production or review date or certification that no external corrections exist.",
      "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/correction materials and the complete pre-change original and event history are needed. Absent 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": "Follow-up/correction materials and the complete pre-change original and event history are needed. Absent dates or correction values are not invented."
    },
    {
      "item_id": "N21",
      "question_type": "Evidence condition",
      "question": "Are funding, support, employee authors and analysis roles distinguished?",
      "needed": "Company-related items and report-specific verification scope",
      "role": "Required",
      "role_reason": "This condition connects Company-related items and report-specific verification 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 Company-related items and report-specific verification 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: Report-specific funding, COI, product/ingredient support, author affiliations and analysis/publication roles are needed. Parent I2 is not used as new independence certification. This records needed materials; no new research was executed.",
      "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 main funding record reports academic Isfahan University research and no conflicts. It does not mean product support, company-employee authors or company analysis/reporting involvement are all verified. Funding details for the 2016 supporting citation are separately unrecorded.",
      "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": "Report-specific funding, COI, product/ingredient support, author affiliations and analysis/publication roles are needed. Parent I2 is not used as 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": "Report-specific funding, COI, product/ingredient support, author affiliations and analysis/publication roles are needed. Parent I2 is not used as new independence certification."
    },
    {
      "item_id": "N22",
      "question_type": "Evidence condition",
      "question": "Are allocation, measurement, missingness and selective-reporting details verified?",
      "needed": "Boundaries of block randomization, covariate adjustment and completer analysis",
      "role": "Required",
      "role_reason": "This condition connects Boundaries of block randomization, covariate adjustment and completer analysis 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 Boundaries of block randomization, covariate adjustment and completer analysis 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, protocols, SAPs, registration/amendment history, test tables, denominators and models are needed. Design names or objective tests alone do not establish formal RoB/GRADE or completed review. This records needed materials; no new research was executed.",
      "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 main trial used block randomization and records covariate adjustment and limitations of completer-focused analysis. Allocation concealment, blinding, test devices/validity, missingness, covariate prespecification 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, protocols, SAPs, registration/amendment history, test tables, denominators and models are needed. Design names or objective tests alone do not establish formal RoB/GRADE 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, protocols, SAPs, registration/amendment history, test tables, denominators and models are needed. Design names or objective tests alone do not establish formal RoB/GRADE or completed review."
    },
    {
      "item_id": "N23",
      "question_type": "Evidence condition",
      "question": "Does common lifestyle advice establish actual concurrent exposure?",
      "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 exposure, weight, diet, activity, baseline/follow-up medication, exposure, adherence and denominators are needed. No diet, intake or liver-disease-management instructions are created. This records needed materials; no new research was executed.",
      "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 exposure, weight, diet, activity, baseline/follow-up medication, exposure, adherence and denominators are needed. No diet, intake or liver-disease-management instructions are 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": "Actual concurrent exposure, weight, diet, activity, baseline/follow-up medication, exposure, adherence and denominators are needed. No diet, intake or liver-disease-management instructions are created."
    },
    {
      "item_id": "N24",
      "question_type": "Harm-information gaps supplementing the efficacy table",
      "question": "Which formulation or group had withdrawals in the supporting safety citation?",
      "needed": "Links between the 2016 seed intervention, withdrawals and harms",
      "role": "Supplementary",
      "role_reason": "This condition connects Links between the 2016 seed intervention, withdrawals and harms 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 Links between the 2016 seed intervention, withdrawals and harms 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, ingredients, group-specific events, withdrawals, reasons, durations, harm collection and exposure denominators are needed. A different safety citation is not converted into independent efficacy replication or the original trial's harm rate. This records needed materials; no new research was executed.",
      "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 reports some withdrawals for constipation, nausea or abdominal pain in a separate NAFLD seed intervention. Exact groups, products, counts, exposure denominators and durations are unverified. 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, ingredients, group-specific events, withdrawals, reasons, durations, harm collection and exposure denominators are needed. A different safety citation is not converted 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, ingredients, group-specific events, withdrawals, reasons, durations, harm collection and exposure denominators are needed. A different safety citation is not converted into independent efficacy replication or the original trial's harm rate."
    },
    {
      "item_id": "N25",
      "question_type": "Harm-information gaps supplementing the efficacy table",
      "question": "Are caution statements, observed harms and long-term safety the same?",
      "needed": "Potential harms, collection methods, denominators and specific risk groups",
      "role": "Supplementary",
      "role_reason": "This condition connects Potential harms, collection methods, denominators and specific 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 Potential harms, collection methods, denominators and specific 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 exposure, denominators, withdrawals, attrition and long-term risk-group data are needed. Caution is not converted into safety, no harm or a new established incidence rate. This records needed materials; no new research was executed.",
      "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": "Potential gas, bloating, abdominal pain, constipation or nausea and swallowing, narrowing and obstruction boundaries are existing safety statements. Harm collection, group-specific events, exposure denominators, CIs, long-term and rare harms remain separately unverified. Original adequate-fluid wording is preserved without creating new fluid quantities, intake methods 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 exposure, denominators, withdrawals, attrition and long-term risk-group data are needed. Caution is not converted into safety, no harm or a new 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 exposure, denominators, withdrawals, attrition and long-term risk-group data are needed. Caution is not converted into safety, no harm or a new established incidence rate."
    },
    {
      "item_id": "N26",
      "question_type": "Evidence condition",
      "question": "Which new materials would prompt an update to this table?",
      "needed": "Separate records for original materials, conditions, observations and verdict changes",
      "role": "Required",
      "role_reason": "This condition connects Separate records for original materials, conditions, observations and verdict changes 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 records for original materials, conditions, observations and verdict changes 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 complete pre-change original, original materials, condition versions, separate application and change-decision records are needed. No new clinical research, calculation, regrading, independence certification, intake, diet, liver-disease-management or treatment-replacement advice is created. This records needed materials; no new research was executed.",
      "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 table transfers the stored MRI liver-fat summary. Related observations can be updated after review of original tables, actual test measures/units, direct imaging, histology, clinical endpoints, 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": "The complete pre-change original, original materials, condition versions, separate application and change-decision records are needed. No new clinical research, calculation, regrading, independence certification, intake, diet, 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": "The complete pre-change original, original materials, condition versions, separate application and change-decision records are needed. No new clinical research, calculation, regrading, independence certification, intake, diet, liver-disease-management or treatment-replacement advice is created."
    }
  ],
  "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",
      "result_level": "Corresponding efficacy summary in the evidence record; directness for MRI/other endpoints is distinguished by condition rows and report roles.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "Stored summary",
          "public_status": "Local preserved copy of the complete parent summary",
          "access_status": "Stored summary read",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-09-07",
          "qualification": "Only original PubMed links, PMCIDs and absent/unverified registration information are preserved. No new reading, access, prespecification or verification is certified. Full-text or registration URLs are not inferred."
        },
        {
          "material_type": "External abstract",
          "public_status": "Original citation links or required-material slots; external public/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "Only original PubMed links, PMCIDs and absent/unverified registration information are preserved. No new reading, access, prespecification or verification is certified. Full-text or registration URLs are not inferred."
        },
        {
          "material_type": "External full text",
          "public_status": "Original citation links or required-material slots; external public/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "Only original PubMed links, PMCIDs and absent/unverified registration information are preserved. No new reading, access, prespecification or verification is certified. Full-text or registration URLs are not inferred."
        },
        {
          "material_type": "Original registration",
          "public_status": "Original citation links or required-material slots; external public/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "Only original PubMed links, PMCIDs and absent/unverified registration information are preserved. No new reading, access, prespecification or verification is certified. Full-text or registration URLs are not inferred."
        },
        {
          "material_type": "Original protocol",
          "public_status": "Original citation links or required-material slots; external public/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "Only original PubMed links, PMCIDs and absent/unverified registration information are preserved. No new reading, access, prespecification or verification is certified. Full-text or registration URLs are not inferred."
        }
      ],
      "links": [
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/42621560/"
        }
      ]
    },
    {
      "report_id": "R02",
      "title": "Akbarian SA, Asgary S, Feizi A, Iraj B, Askari G. Comparative Study on the Effect of Plantago psyllium and Ocimum basilicum Seeds on Anthropometric Measures in Nonalcoholic Fatty Liver Patients. Int J Prev Med. 2016;7:114. PMID: 27761216. PMCID: PMC5070040. DOI: 10.4103/2008-7802.191865.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/27761216/",
      "report_type": "Supporting safety citation from a separate seed-intervention and anthropometric study",
      "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": "F02",
      "independent_replication": "Content review remains incomplete. Report identifiers or different formulations do not certify unique-trial counts or independent efficacy replication.",
      "observed_result": "Some participants withdrew because of constipation, nausea or abdominal pain in a separate NAFLD seed-intervention trial.",
      "result_level": "Supporting safety citation; exact groups, formulations, counts, effects and harm denominators are unverified.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "Stored summary",
          "public_status": "Local preserved copy of the complete parent summary",
          "access_status": "Stored summary read",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-09-07",
          "qualification": "Only original PubMed links, PMCIDs and absent/unverified registration information are preserved. No new reading, access, prespecification or verification is certified. Full-text or registration URLs are not inferred."
        },
        {
          "material_type": "External abstract",
          "public_status": "Original citation links or required-material slots; external public/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "Only original PubMed links, PMCIDs and absent/unverified registration information are preserved. No new reading, access, prespecification or verification is certified. Full-text or registration URLs are not inferred."
        },
        {
          "material_type": "External full text",
          "public_status": "Original citation links or required-material slots; external public/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
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  "language": "en",
  "translation_date": "2026-10-16"
}