# Psyllium × Ten-week ALT and FibroScan findings: signals, effect size and measurement gaps Verdict 2985 · Evidence Check Stored-material review date: Not recorded Original evidence cut-off: 2026-09-07 Review-criteria version: 1.0 Public page/material preparation date: 2026-10-15 Clinical papers were not read directly; existing review summaries were checked. No new clinical-literature search was performed. Unverified does not mean that research is absent or that there is no effect. ## Assessment scope - Population: 80 adults with overweight or obesity and MASLD were randomized; 78 completed. Group/test denominators and detailed eligibility are unverified. - Ingredient, formulation and route: 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. - Measured outcome: Actual ten-week ALT and FibroScan measures, distinguished from AST, MRI, histologic and clinical outcomes. - Duration: A ten-week efficacy trial. MRI was not directly measured; post-trial follow-up and direct long-term clinical evidence are unverified. - Questions outside this scope: 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 ## Checklist items ### N01 · What is the selected ten-week test question? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The selected original wording concerns improved ALT and FibroScan measures over ten weeks, with original grade C. Its note records some positive between-group P values but unclear effect size and prespecified hierarchy. Absent subclaim scores, status and axes are distinguished from parent C50. - Why unverified: 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. - Reason for missing information: Exact ALT/FibroScan endpoints, population, comparator, time points and denominators, and review of the question boundary. Parent scores or axes are not inserted into subclaim values. - Required materials and conditions: Original ten-week ALT and FibroScan improvement - Materials to obtain first: Exact ALT/FibroScan endpoints, population, comparator, time points and denominators, and review of the question boundary. Parent scores or axes are not inserted into subclaim values. - Further research: Material needed: Exact ALT/FibroScan endpoints, population, comparator, time points and denominators, and review of the question boundary. Parent scores or axes are not inserted into subclaim values. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Original ten-week ALT and FibroScan improvement must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Original ten-week ALT and FibroScan improvement with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N02 · What was the original ALT result? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The original reader answer and research description record covariate-adjusted ALT favoring psyllium, P=.006. Exact group values, changes, adjusted effects, units and 95% CIs are unverified. - Why unverified: 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. - Reason for missing information: Original ALT tables, units, assay, baseline/follow-up/change values, covariates, model, group denominators, effects and CIs. No effect sizes or normalization rates are derived from P values. - Required materials and conditions: Ten-week covariate-adjusted between-group ALT test - Materials to obtain first: Original ALT tables, units, assay, baseline/follow-up/change values, covariates, model, group denominators, effects and CIs. No effect sizes or normalization rates are derived from P values. - Further research: Material needed: Original ALT tables, units, assay, baseline/follow-up/change values, covariates, model, group denominators, effects and CIs. No effect sizes or normalization rates are derived from P values. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Ten-week covariate-adjusted between-group ALT test must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Ten-week covariate-adjusted between-group ALT test with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N03 · What was the original FibroScan measure? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The stored summary describes a favorable FibroScan fibrosis score or fibrosis-related measure, P=.001. Exact measure names, units, equipment, algorithms, test validity and baseline/follow-up/change values cannot be established from the stored summary. - Why unverified: 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. - Reason for missing information: The actual FibroScan measure and score definition, units, measurement conditions, validity criteria, group tables, denominators, between-group effects and CIs. No particular measurement name or value is invented. - Required materials and conditions: FibroScan fibrosis score P=.001 - Materials to obtain first: The actual FibroScan measure and score definition, units, measurement conditions, validity criteria, group tables, denominators, between-group effects and CIs. No particular measurement name or value is invented. - Further research: Material needed: The actual FibroScan measure and score definition, units, measurement conditions, validity criteria, group tables, denominators, between-group effects and CIs. No particular measurement name or value is invented. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for FibroScan fibrosis score P=.001 must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects FibroScan fibrosis score P=.001 with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N04 · Are FibroScan and MRI/MRS liver-fat measurements the same? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: Original product information states that FibroScan is not the same measurement as MRI liver fat; the advertising interpretation limits the signal to enzymes and elastography-related measures. Other tests do not fill the unmeasured MRI outcome. - Why unverified: 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. - Reason for missing information: Actual FibroScan measures and separately measured or defined MRI/MRS, other imaging or histology, with their denominators and estimates. A device name alone does not establish liver-fat quantity or histologic improvement. - Required materials and conditions: Distinguishing elastography-related measures from MRI and other tests - Materials to obtain first: Actual FibroScan measures and separately measured or defined MRI/MRS, other imaging or histology, with their denominators and estimates. A device name alone does not establish liver-fat quantity or histologic improvement. - Further research: Material needed: Actual FibroScan measures and separately measured or defined MRI/MRS, other imaging or histology, with their denominators and estimates. A device name alone does not establish liver-fat quantity or histologic improvement. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Distinguishing elastography-related measures from MRI and other tests must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Distinguishing elastography-related measures from MRI and other tests with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N05 · Is the null AST result retained? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: Original AST P=.98 is recorded as null. ALT P=.006 and FibroScan P=.001 are not transferred into AST efficacy or success across every liver-function test. Null AST is not proof of zero effect or equivalence. - Why unverified: 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. - Reason for missing information: AST baseline/follow-up/change values, group denominators, adjustment models, effects, CIs and prespecified hierarchy. - Required materials and conditions: Separate ALT and AST tests - Materials to obtain first: AST baseline/follow-up/change values, group denominators, adjustment models, effects, CIs and prespecified hierarchy. - Further research: Material needed: AST baseline/follow-up/change values, group denominators, adjustment models, effects, CIs and prespecified hierarchy. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Separate ALT and AST tests must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Separate ALT and AST tests with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N06 · Are within-group improvement and adjusted between-group comparison the same? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The original research description records favorable covariate-adjusted ALT and FibroScan findings. Exact covariates, baseline values, within-group changes and adjusted between-group estimates are unavailable, so P values alone do not reconstruct either effect. - Why unverified: 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. - Reason for missing information: Original ANCOVA or analysis model, covariates, prespecification, baseline/follow-up/change values, direct effects, CIs and denominators. No new within-group or between-group values are calculated. - Required materials and conditions: Target effect, covariate adjustment and change estimates - Materials to obtain first: Original ANCOVA or analysis model, covariates, prespecification, baseline/follow-up/change values, direct effects, CIs and denominators. No new within-group or between-group values are calculated. - Further research: Material needed: Original ANCOVA or analysis model, covariates, prespecification, baseline/follow-up/change values, direct effects, CIs and denominators. No new within-group or between-group values are calculated. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Target effect, covariate adjustment and change estimates must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Target effect, covariate adjustment and change estimates with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N07 · What were the actual comparator and common advice? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The original intervention was psyllium 10g/day versus ground wheat 10g/day; both groups received weight-loss-diet and physical-activity advice. This add-on contrast is not changed into no treatment, psyllium alone or the same effect without a diet. - Why unverified: 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. - Reason for missing information: Control products and composition, diet/activity advice in both arms, actual intake, activity, weight changes and co-treatment records. Identical advice and identical actual behavior are distinguished. - Required materials and conditions: Psyllium versus ground wheat with common lifestyle advice - Materials to obtain first: Control products and composition, diet/activity advice in both arms, actual intake, activity, weight changes and co-treatment records. Identical advice and identical actual behavior are distinguished. - Further research: Material needed: Control products and composition, diet/activity advice in both arms, actual intake, activity, weight changes and co-treatment records. Identical advice and identical actual behavior are distinguished. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Psyllium versus ground wheat with common lifestyle advice must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Psyllium versus ground wheat with common lifestyle advice with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N08 · Who was actually studied? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The original population comprised 80 adults with overweight or obesity and MASLD. Detailed diagnosis, liver-disease stage, baseline ALT and weight, medication, comorbidity, sex and age remain separately unverified. Findings are not generalized to other liver diseases, normal weight or advanced disease. - Why unverified: 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. - Reason for missing information: Diagnosis, eligibility, baseline liver disease, imaging, metabolic factors, medication, group baselines, subgroups and test denominators. - Required materials and conditions: Overweight/obesity, MASLD and eligibility - Materials to obtain first: Diagnosis, eligibility, baseline liver disease, imaging, metabolic factors, medication, group baselines, subgroups and test denominators. - Further research: Material needed: Diagnosis, eligibility, baseline liver disease, imaging, metabolic factors, medication, group baselines, subgroups and test denominators. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Overweight/obesity, MASLD and eligibility must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Overweight/obesity, MASLD and eligibility with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N09 · Do 80 randomized and 78 completers provide every test denominator? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The original record states 80 randomized, 78 completed and ten weeks. Group allocation/completion, valid ALT/FibroScan/AST denominators, withdrawal reasons and timing remain separately unverified. No completion differences or rates are newly calculated. - Why unverified: 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. - Reason for missing information: Group flow, test- and time-specific denominators, ITT/completer populations, missing-data handling and exposure/withdrawal tables. Overall n is not copied into each group or test. - Required materials and conditions: Allocation, completion, valid tests and dropout - Materials to obtain first: Group flow, test- and time-specific denominators, ITT/completer populations, missing-data handling and exposure/withdrawal tables. Overall n is not copied into each group or test. - Further research: Material needed: Group flow, test- and time-specific denominators, ITT/completer populations, missing-data handling and exposure/withdrawal tables. Overall n is not copied into each group or test. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Allocation, completion, valid tests and dropout must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Allocation, completion, valid tests and dropout with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N10 · Are ten-week research exposure and actual adherence verified? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: Original psyllium 10g/day, ten weeks and control 10g/day are retained only to identify the study. Actual product quantification, manufacturing, intake, concurrent exposures, adherence and total exposure are separately unverified. No cumulative quantities or intake instructions are created. - Why unverified: 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. - Reason for missing information: Original products, formulations, composition, actual exposure, adherence, dropout and changes in diet/activity. No psyllium, product or diet instructions are provided. - Required materials and conditions: Oral 10g/day, duration, products and exposure - Materials to obtain first: Original products, formulations, composition, actual exposure, adherence, dropout and changes in diet/activity. No psyllium, product or diet instructions are provided. - Further research: Material needed: Original products, formulations, composition, actual exposure, adherence, dropout and changes in diet/activity. No psyllium, product or diet instructions are provided. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Oral 10g/day, duration, products and exposure must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Oral 10g/day, duration, products and exposure with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N11 · Is the prespecified primary-endpoint hierarchy verified? Verification status: Unverified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The original reader answer, grading rationale and flags record unverified prespecified primary hierarchy and registration. Three test endpoints or positive P values do not make all of them prespecified primary successes. - Why unverified: 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. - Reason for missing information: Initial and amended registration, protocol/SAP, endpoints, time points, multiplicity and analysis plans. Missing registration identifiers or URLs are not invented. - Required materials and conditions: ALT/AST/FibroScan hierarchy, registration and SAP - Materials to obtain first: Initial and amended registration, protocol/SAP, endpoints, time points, multiplicity and analysis plans. Missing registration identifiers or URLs are not invented. - Further research: Material needed: Initial and amended registration, protocol/SAP, endpoints, time points, multiplicity and analysis plans. Missing registration identifiers or URLs are not invented. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for ALT/AST/FibroScan hierarchy, registration and SAP must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects ALT/AST/FibroScan hierarchy, registration and SAP with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N12 · Are exact effect sizes, CIs and clinical importance available? Verification status: Unverified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: Original P=.006, .001 and .98 are present, but exact between-group effect sizes, confidence intervals and clinical importance are unverified. Small significant P values do not establish large quantitative effects, precision or disease improvement. - Why unverified: 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. - Reason for missing information: Original models, estimates, CIs, variance, denominators, prespecified importance thresholds and test units. No hypothetical quantitative examples or new effect/CI calculations are produced. - Required materials and conditions: P values, estimates, intervals and surrogate-test importance - Materials to obtain first: Original models, estimates, CIs, variance, denominators, prespecified importance thresholds and test units. No hypothetical quantitative examples or new effect/CI calculations are produced. - Further research: Material needed: Original models, estimates, CIs, variance, denominators, prespecified importance thresholds and test units. No hypothetical quantitative examples or new effect/CI calculations are produced. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for P values, estimates, intervals and surrogate-test importance must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects P values, estimates, intervals and surrogate-test importance with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N13 · Does a FibroScan measure establish histologic fibrosis improvement? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The original fibrosis-score signal is not changed into histologic fibrosis reversal or reduced MRI/histologic liver fat. The original advertising interpretation cautions against adding MRI or histologic liver-fat results that were not measured. - Why unverified: 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. - Reason for missing information: Actual score definitions and tables, separate direct histology/disease-stage evidence, denominators, timing and CIs. Unrecorded histologic outcomes are not assumed. - Required materials and conditions: Separate directness for test scores, histology and disease stage - Materials to obtain first: Actual score definitions and tables, separate direct histology/disease-stage evidence, denominators, timing and CIs. Unrecorded histologic outcomes are not assumed. - Further research: Material needed: Actual score definitions and tables, separate direct histology/disease-stage evidence, denominators, timing and CIs. Unrecorded histologic outcomes are not assumed. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Separate directness for test scores, histology and disease stage must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Separate directness for test scores, histology and disease stage with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N14 · Are ALT and FibroScan clinical liver-disease outcomes? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The original Korean counterview says it is unknown whether the measures translate into cirrhosis or hospitalization; the English counterview says clinical liver events were not tested. Surrogate signals are not converted into disease improvement or event-prevention effects. - Why unverified: 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. - Reason for missing information: Direct clinical-event types, definitions, adjudication, group events, time at risk, long-term denominators and CIs. Unverified information is not changed into zero events or zero effect. - Required materials and conditions: Clinical outcomes such as cirrhosis/hospitalization versus surrogates - Materials to obtain first: Direct clinical-event types, definitions, adjudication, group events, time at risk, long-term denominators and CIs. Unverified information is not changed into zero events or zero effect. - Further research: Material needed: Direct clinical-event types, definitions, adjudication, group events, time at risk, long-term denominators and CIs. Unverified information is not changed into zero events or zero effect. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Clinical outcomes such as cirrhosis/hospitalization versus surrogates must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Clinical outcomes such as cirrhosis/hospitalization versus surrogates with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N15 · Is the separate seed trial an efficacy replication? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The 2016 citation provides safety support from a Plantago psyllium/Ocimum basilicum seed-intervention and anthropometric trial. It has no separate current efficacy-evidence row and is not counted as replication of the same formulation and ten-week ALT/FibroScan outcomes. - Why unverified: 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. - Reason for missing information: That report's original formulation, duration, population, group effects, harms, denominators and study/cohort relationships. Detailed unverified/unread status is retained. - Required materials and conditions: Akbarian2016 safety support and a different intervention - Materials to obtain first: That report's original formulation, duration, population, group effects, harms, denominators and study/cohort relationships. Detailed unverified/unread status is retained. - Further research: Material needed: That report's original formulation, duration, population, group effects, harms, denominators and study/cohort relationships. Detailed unverified/unread status is retained. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Akbarian2016 safety support and a different intervention must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Akbarian2016 safety support and a different intervention with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R02 ### N16 · Are test effects after stopping or over other durations available? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The current record concerns a small ten-week surrogate trial. Persistence after stopping and effects in other products, durations, populations or long-term clinical outcomes cannot be established from the stored summary. - Why unverified: 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. - Reason for missing information: Follow-up, actual exposure, endpoint-specific denominators/CIs and matching comparator/population data. No maintenance-intake, liver-disease-management or treatment-replacement advice is created. - Required materials and conditions: Ten weeks, persistence and generalization - Materials to obtain first: Follow-up, actual exposure, endpoint-specific denominators/CIs and matching comparator/population data. No maintenance-intake, liver-disease-management or treatment-replacement advice is created. - Further research: Material needed: Follow-up, actual exposure, endpoint-specific denominators/CIs and matching comparator/population data. No maintenance-intake, liver-disease-management or treatment-replacement advice is created. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Ten weeks, persistence and generalization must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Ten weeks, persistence and generalization with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N17 · Are the same citation, population or time points counted as new independent evidence? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: Parent2985 and both existing subclaims share the Akbarzadeh2026 efficacy-trial context and Akbarian2016 supporting safety citation. Two tables or tests, conditions and time points from the same participants are not added as independent trials or participants. Different citations are also distinguished from unique-trial or independence certification; unique-trial and total unique-participant counts remain unverified. - Why unverified: 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. - Reason for missing information: Mapping efficacy/safety reports, cohorts, actual interventions, analysis populations and time points. Material-slot counts are not unique trials, participants or quality scores. - Required materials and conditions: Parent/subclaim and report/trial relationships - Materials to obtain first: Mapping efficacy/safety reports, cohorts, actual interventions, analysis populations and time points. Material-slot counts are not unique trials, participants or quality scores. - Further research: Material needed: Mapping efficacy/safety reports, cohorts, actual interventions, analysis populations and time points. Material-slot counts are not unique trials, participants or quality scores. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Parent/subclaim and report/trial relationships must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Parent/subclaim and report/trial relationships with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02 ### N18 · What was actually read? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The complete parent stored summary was read for production and preserved as a complete byte copy. External abstracts, full texts, registration, protocols and SAPs are unread. URLs or PMCIDs alone do not upgrade reading, access or verification status. - Why unverified: 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. - Reason for missing information: Actual acquisition/reading records for full texts, supplements, plans and registration. No separate external-link, screen, web or API checks were performed. - Required materials and conditions: The complete parent stored summary and external material - Materials to obtain first: Actual acquisition/reading records for full texts, supplements, plans and registration. No separate external-link, screen, web or API checks were performed. - Further research: Material needed: Actual acquisition/reading records for full texts, supplements, plans and registration. No separate external-link, screen, web or API checks were performed. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for The complete parent stored summary and external material must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects The complete parent stored summary and external material with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02 ### N19 · Where are the original citation and registration identifiers? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The 2026 efficacy citation has PMID42621560, PMCID PMC13489564 and DOI10.4103/ijpvm.ijpvm_254_24; the 2016 supporting citation has PMID27761216, PMCID PMC5070040 and DOI10.4103/2008-7802.191865. No separate registration identifier occurs in the two citation/evidence records. - Why unverified: 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. - Reason for missing information: Exact original citations, study/registration identifiers, content and dates. Full-text or registration URLs are not inferred from PMCIDs. - Required materials and conditions: PMID, PMCID and DOI for each citation - Materials to obtain first: Exact original citations, study/registration identifiers, content and dates. Full-text or registration URLs are not inferred from PMCIDs. - Further research: Material needed: Exact original citations, study/registration identifiers, content and dates. Full-text or registration URLs are not inferred from PMCIDs. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02 ### N20 · Are bilingual and historical checks distinguished from this review? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: Original bilingual text, subclaims, notes and historical Codex PubMed/PMC/scoring checks and citation one-line verification statements are preserved. This work concerns production; external material is unread and content/model/question-boundary review remains incomplete. - Why unverified: 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. - Reason for missing information: Original-text, translation, correction and boundary review. Historical checks are not labeled current FULL/QA, new clinical calculation or independent certification. - Required materials and conditions: Original bilingual text, subclaims and historical verification - Materials to obtain first: Original-text, translation, correction and boundary review. Historical checks are not labeled current FULL/QA, new clinical calculation or independent certification. - Further research: Material needed: Original-text, translation, correction and boundary review. Historical checks are not labeled current FULL/QA, new clinical calculation or independent certification. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Original bilingual text, subclaims and historical verification must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Original bilingual text, subclaims and historical verification with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02 ### N21 · Are subclaim values distinguished from parent C50 and axes? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The selected original grade/note and absence of score/status/axes are retained. Parent C50, Caution, B/S/R1/I2/EX/B2 and unrecorded precision describe parent context. They do not fill selected ten-week ALT/FibroScan scores, axes or independence certification. - Why unverified: 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. - Reason for missing information: Review of selected and parent original values. No new scores, axes, efficacy grades or verdict changes. - Required materials and conditions: Original subclaim grade/note and absent score/status/axes - Materials to obtain first: Review of selected and parent original values. No new scores, axes, efficacy grades or verdict changes. - Further research: Material needed: Review of selected and parent original values. No new scores, axes, efficacy grades or verdict changes. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Original subclaim grade/note and absent score/status/axes must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Original subclaim grade/note and absent score/status/axes with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02 ### N22 · Are the cut-off, empty corrections and production date distinguished? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The original cut-off2026-09-07, empty corrections array and empty deliberation string are retained. They are not production/review dates or certification that no external correction exists. - Why unverified: 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. - Reason for missing information: Subsequent/corrected material, complete pre-change originals and case history. Missing dates or correction values are not invented. - Required materials and conditions: Original cut-off and empty correction/deliberation records - Materials to obtain first: Subsequent/corrected material, complete pre-change originals and case history. Missing dates or correction values are not invented. - Further research: Material needed: Subsequent/corrected material, complete pre-change originals and case history. Missing dates or correction values are not invented. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Original cut-off and empty correction/deliberation records must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Original cut-off and empty correction/deliberation records with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02 ### N23 · Are funding, support, employee authors and analysis roles distinguished? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: Core funding information records academic Isfahan University research and no conflicts reported. This does not establish that product support, company employee authors or company analysis/reporting involvement were all verified. Detailed funding for the 2016 supporting citation is not separately present in this stored summary. - Why unverified: 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. - Reason for missing information: Original funding/COI, product/material support, author affiliations and analysis/publication roles for each report. Parent I2 is not upgraded into new independence certification. - Required materials and conditions: Four company-related areas and report-specific scope - Materials to obtain first: Original funding/COI, product/material support, author affiliations and analysis/publication roles for each report. Parent I2 is not upgraded into new independence certification. - Further research: Material needed: Original funding/COI, product/material support, author affiliations and analysis/publication roles for each report. Parent I2 is not upgraded into new independence certification. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Four company-related areas and report-specific scope must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Four company-related areas and report-specific scope with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02 ### N24 · Are randomization, measurement, missingness and reporting details available? Verification status: Unverified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The original core design is block randomization, with limitations involving covariate adjustment and completer-focused analysis. Allocation concealment, masking, test equipment/validity, missingness, prespecification of covariates and selective-reporting details remain separately unverified. - Why unverified: 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. - Reason for missing information: Original methods, protocol/SAP, registration/amendments, test tables, denominators and models. Design labels or objective tests do not establish official RoB/GRADE completion or completed review. - Required materials and conditions: Block allocation, covariates and completer boundaries - Materials to obtain first: Original methods, protocol/SAP, registration/amendments, test tables, denominators and models. Design labels or objective tests do not establish official RoB/GRADE completion or completed review. - Further research: Material needed: Original methods, protocol/SAP, registration/amendments, test tables, denominators and models. Design labels or objective tests do not establish official RoB/GRADE completion or completed review. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Block allocation, covariates and completer boundaries must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Block allocation, covariates and completer boundaries with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N25 · Are identical lifestyle advice and actual concurrent exposure the same? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: 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. - Why unverified: 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. - Reason for missing information: Actual concurrent exposures, weight, diet, activity, baseline/follow-up medication, exposure, adherence and denominators. No diet, intake or liver-disease-management instructions are provided. - Required materials and conditions: Weight-loss diet, physical activity, adherence and co-management - Materials to obtain first: Actual concurrent exposures, weight, diet, activity, baseline/follow-up medication, exposure, adherence and denominators. No diet, intake or liver-disease-management instructions are provided. - Further research: Material needed: Actual concurrent exposures, weight, diet, activity, baseline/follow-up medication, exposure, adherence and denominators. No diet, intake or liver-disease-management instructions are provided. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N26 · Which formulation and group had withdrawals in the supporting safety citation? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: The 2016 citation records some withdrawals for constipation, nausea or abdominal pain in a separate NAFLD seed intervention. Exact groups, products, counts, exposure denominators and duration cannot be established from the stored citation. All withdrawals are not assigned to the current psyllium10g/day trial. - Why unverified: 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. - Reason for missing information: That report's formulations/materials, group events, withdrawals, reasons, durations, harm collection and exposure denominators. Other safety citations are not transferred into independent efficacy replication or the original trial's harm rate. - Required materials and conditions: Withdrawals and harms in the 2016 seed intervention - Materials to obtain first: That report's formulations/materials, group events, withdrawals, reasons, durations, harm collection and exposure denominators. Other safety citations are not transferred into independent efficacy replication or the original trial's harm rate. - Further research: Material needed: That report's formulations/materials, group events, withdrawals, reasons, durations, harm collection and exposure denominators. Other safety citations are not transferred into independent efficacy replication or the original trial's harm rate. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Withdrawals and harms in the 2016 seed intervention must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Withdrawals and harms in the 2016 seed intervention with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R02 ### N27 · Are caution statements, observed harms and long-term safety the same? Verification status: Unverified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: Original safety wording describes possible gas, bloating, abdominal pain, constipation or nausea and swallowing/narrowing/obstruction concerns. Harm collection, group events, exposure denominators, CIs and long-term/rare harms are separately unverified. Original adequate-fluid wording is preserved without creating new fluid quantities, intake instructions or treatment advice. - Why unverified: 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. - Reason for missing information: Report-specific harm definitions, active collection, group exposures/denominators, discontinuation, dropout and long-term risk-group evidence. Caution is not replaced with safe/no harms or a newly established incidence rate. - Required materials and conditions: Possible harms, collection, denominators and particular risk groups - Materials to obtain first: Report-specific harm definitions, active collection, group exposures/denominators, discontinuation, dropout and long-term risk-group evidence. Caution is not replaced with safe/no harms or a newly established incidence rate. - Further research: Material needed: Report-specific harm definitions, active collection, group exposures/denominators, discontinuation, dropout and long-term risk-group evidence. Caution is not replaced with safe/no harms or a newly established incidence rate. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Possible harms, collection, denominators and particular risk groups must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Possible harms, collection, denominators and particular risk groups with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02 ### N28 · What material would trigger a sheet update? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols and SAPs unread - Current findings: This is a production table of stored ten-week ALT/FibroScan material. Relevant observations can be updated after content review of original tables, actual test names/units, direct imaging/histologic/clinical outcomes, between-group effects, denominators, concurrent exposures and harms. - Why unverified: 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. - Reason for missing information: Complete pre-change preservation, original material/condition versions, separate application and content-review records. The source records no QA/tests, web/API or link/screen checks, new calculations, regrading, independence certification, product intake, diet, liver-disease-management or treatment-replacement instructions. - Required materials and conditions: Original material, conditions, observations and verdict-change events - Materials to obtain first: Complete pre-change preservation, original material/condition versions, separate application and content-review records. The source records no QA/tests, web/API or link/screen checks, new calculations, regrading, independence certification, product intake, diet, liver-disease-management or treatment-replacement instructions. - Further research: Material needed: Complete pre-change preservation, original material/condition versions, separate application and content-review records. The source records no QA/tests, web/API or link/screen checks, new calculations, regrading, independence certification, product intake, diet, liver-disease-management or treatment-replacement instructions. Only material requests and research needs are recorded; no new search or clinical research is executed here. - Conditions for verification: Material for Original material, conditions, observations and verdict-change events must be linked to the selected subclaim, parent context, original report, direct endpoints, time points, comparator and denominators, with unread external material distinguished. - Why this condition is needed: This condition connects Original material, conditions, observations and verdict-change events with the selected question, actual population/intervention/comparator, tests/imaging/histology/clinical outcomes, time points, within- and between-group comparisons, denominators and harms. - Application exceptions: 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. - Remaining 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. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02 ## Evidence and sources ### R01 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. [PubMed](https://pubmed.ncbi.nlm.nih.gov/42621560/) Materials actually read: Preserved summary read; external abstracts/full texts/registrations/plans remain unread Findings recorded in the summary: ALT P=.006, FibroScan score P=.001; AST P=.98 Record level: Corresponding efficacy summary in the evidence record; directness for MRI/other endpoints is distinguished by condition rows and report roles. Independent replication: The Akbarzadeh2026 report concerns ten-week add-on psyllium ALT/FibroScan signals, null AST and gaps in effect size and endpoint hierarchy; MRI was not directly measured. The Akbarian2016 citation provides supporting harm/withdrawal information from a separate NAFLD seed-intervention/anthropometric study; it is not replication of current ALT/FibroScan/MRI efficacy. Parent2985 and both existing subclaims share these citations. Tables or tests, conditions and time points from the same participants are not added as new independent trials or people. Different citations do not certify unique trials or independence; unique-trial and total unique-participant counts remain unverified. Links are provisional by citation and actual cohort/independent-study relationships remain unreviewed. | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Stored summary | Local preserved copy of the complete parent summary | Stored summary read | Summary read | 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. | | External abstract | Original citation links or required-material slots; external public/access status unverified | Unread; access not attempted | Not read | 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. | | External full text | Original citation links or required-material slots; external public/access status unverified | Unread; access not attempted | Not read | 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. | | Original registration | Original citation links or required-material slots; external public/access status unverified | Unread; access not attempted | Not read | 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. | | Original protocol | Original citation links or required-material slots; external public/access status unverified | Unread; access not attempted | Not read | 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. | ### R02 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. [PubMed](https://pubmed.ncbi.nlm.nih.gov/27761216/) Materials actually read: Preserved summary read; external abstracts/full texts/registrations/plans remain unread Findings recorded in the summary: Some participants withdrew because of constipation, nausea or abdominal pain in a separate NAFLD seed-intervention trial. Record level: Supporting safety citation; exact groups, formulations, counts, effects and harm denominators are unverified. Independent replication: The Akbarzadeh2026 report concerns ten-week add-on psyllium ALT/FibroScan signals, null AST and gaps in effect size and endpoint hierarchy; MRI was not directly measured. The Akbarian2016 citation provides supporting harm/withdrawal information from a separate NAFLD seed-intervention/anthropometric study; it is not replication of current ALT/FibroScan/MRI efficacy. Parent2985 and both existing subclaims share these citations. Tables or tests, conditions and time points from the same participants are not added as new independent trials or people. Different citations do not certify unique trials or independence; unique-trial and total unique-participant counts remain unverified. Links are provisional by citation and actual cohort/independent-study relationships remain unreviewed. | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Stored summary | Local preserved copy of the complete parent summary | Stored summary read | Summary read | 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. | | External abstract | Original citation links or required-material slots; external public/access status unverified | Unread; access not attempted | Not read | 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. | | External full text | Original citation links or required-material slots; external public/access status unverified | Unread; access not attempted | Not read | 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. | | Original registration | Original citation links or required-material slots; external public/access status unverified | Unread; access not attempted | Not read | 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. | | Original protocol | Original citation links or required-material slots; external public/access status unverified | Unread; access not attempted | Not read | 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. | ## Review criteria and methods These are Chamgap's own application conditions, informed by the relevant sections of official methodological guidance. They do not constitute official assessment-tool certification or a new efficacy score. - M03 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03) · §3.1, §3.2.1–3.2.3, MECIR C5/C7/C13 · Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions. · Link preserved methodological application records; no current clinical-content reassessment or external-link verification was performed. - M04 [Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04) · §4.5, §4.6.1–4.6.3, MECIR C42 · Distinguish studies from reports and link them; do not omit a study solely because results are unreported. · Link preserved methodological application records; no current clinical-content reassessment or external-link verification was performed. - M08 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08) · §8.1–8.2.3, Table 8.2.a · Define the outcome and effect of interest, then examine randomization, deviations, missing data, measurement and selective reporting. · Link preserved methodological application records; no current clinical-content reassessment or external-link verification was performed. - M15 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15) · §15.2.4, §15.3.1–15.3.3 · Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision. · Link preserved methodological application records; no current clinical-content reassessment or external-link verification was performed. - M19 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19) · §19.1.2, §19.2.1–19.2.4 · Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates. · Link preserved methodological application records; no current clinical-content reassessment or external-link verification was performed. ## What the statuses mean - Partly verified: Some information exists in the preserved review summary; detailed original materials remain unverified. This does not certify a passed review or clinical efficacy. - Unverified: Detailed materials for the selected condition could not be established within the stored scope; this does not mean zero effect, zero studies or safety - Review incomplete: Review of existing content incomplete - Met: Use only within the relevant conditions after existing content review; no automatic designation in this preparation - Not reported: Distinguish only within materials actually read; do not turn unread external materials into unreported findings - Inaccessible: Not applied during this preparation because actual access was not tested - Not applicable: Use with a reason for non-applicability based on an explicit question boundary - Conflicting data: Judge after actual material comparison; review was not performed during this preparation - Insufficient evidence for the conditions: Do not use as a clinical grade encompassing currently unread materials ## Change history 2026-10-15 · Public page/materials 1.0. Public reader pages and material were prepared from the existing 28 items. No new clinical searches, verification-state changes or scoring were performed.