{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T22:58:23Z","timestamp":1791845903881,"version":"4.3.4"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,6,17]],"date-time":"2019-06-17T00:00:00Z","timestamp":1560729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIHR Collaboration for Leadership in Applied Health Research and Care Northwest London"},{"name":"NIHR Collaboration for Leadership in Applied Health Research and Care for South London and Cicely Saunders International"},{"name":"NIHR Career Development Fellowship","award":["CDF-2017-10-009"],"award-info":[{"award-number":["CDF-2017-10-009"]}]},{"name":"NIHR Doctoral Research Fellowships"},{"name":"NIHR Doctoral Research Fellowship"},{"name":"European Respiratory Society Short Term Research Fellowship"},{"name":"NIHR Clinical Trials Fellowship"},{"name":"Medical Research Council (UK) New Investigator Research Grant"},{"name":"National Institute for Health Research (NIHR) Clinician Scientist Award"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cachexia is an important extra\u2010pulmonary manifestation of chronic obstructive pulmonary disease (COPD) presenting as unintentional weight loss and altered body composition. Previous studies have focused on the relative importance of body composition compared with body mass rather than the relative importance of dynamic compared with static measures. We aimed to determine the prevalence of cachexia and pre\u2010cachexia phenotypes in COPD and examine the associations between cachexia and its component features with all\u2010cause mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We enrolled 1755 consecutive outpatients with stable COPD from two London centres between 2012 and 2017, stratified according to European Respiratory Society Task Force defined cachexia [unintentional weight loss &gt;5% and low fat\u2010free mass index (FFMI)], pre\u2010cachexia (weight loss &gt;5% but preserved FFMI), or no cachexia. The primary outcome was all\u2010cause mortality. We calculated hazard ratios (HRs) using Cox proportional hazards regression for cachexia classifications (cachexia, pre\u2010cachexia, and no cachexia) and component features (weight loss and FFMI) and mortality, adjusting for age, sex, body mass index, and disease\u2010specific prognostic markers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of cachexia was 4.6% [95% confidence interval (CI): 3.6\u20135.6] and pre\u2010cachexia 1.6% (95% CI: 1.0\u20132.2). Prevalence was similar across sexes but increased with worsening Global Initiative for Chronic Obstructive Pulmonary Disease spirometric stage and Medical Research Council dyspnoea score (all <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). There were 313 (17.8%) deaths over a median (interquartile range) follow\u2010up duration 1089 (547\u20131704) days. Both cachexia [HR 1.98 (95% CI: 1.31\u20132.99), <jats:italic>P<\/jats:italic>\u00a0=\u00a00.002] and pre\u2010cachexia [HR 2.79 (95% CI: 1.48\u20135.29), <jats:italic>P<\/jats:italic>\u00a0=\u00a00.001] were associated with increased mortality. In multivariable analysis, the unintentional weight loss feature of cachexia was independently associated with mortality [HR 2.16 (95% CI: 1.31\u20133.08), <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001], whereas low FFMI was not [HR 0.88 (95% CI: 0.64\u20131.20), <jats:italic>P<\/jats:italic>\u00a0=\u00a00.402]. Sensitivity analyses using body mass index\u2010specific, age\u2010specific, and gender\u2010specific low FFMI values found consistent findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite the low prevalence of cachexia and pre\u2010cachexia, both confer increased mortality risk in COPD, driven by the unintentional weight loss component. Our data suggest that low FFMI without concurrent weight loss may not confer the poor prognosis as previously reported for this group. Weight loss should be regularly monitored in practice and may represent an important target in COPD management. We propose the incorporation of weight monitoring into national and international COPD guidance.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcsm.12463","type":"journal-article","created":{"date-parts":[[2019,6,17]],"date-time":"2019-06-17T18:36:34Z","timestamp":1560796594000},"page":"1330-1338","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":74,"title":["The prognostic significance of weight loss in chronic obstructive pulmonary disease\u2010related cachexia: a prospective cohort study"],"prefix":"10.1002","volume":"10","author":[{"given":"Hoi Yee","family":"Kwan","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine Kowloon Hospital  HKSAR China"},{"name":"Harefield Pulmonary Rehabilitation and Muscle Research Laboratory Royal Brompton and Harefield NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0189-0952","authenticated-orcid":false,"given":"Matthew","family":"Maddocks","sequence":"additional","affiliation":[{"name":"Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire M.","family":"Nolan","sequence":"additional","affiliation":[{"name":"Harefield Pulmonary Rehabilitation and Muscle Research Laboratory Royal Brompton and Harefield NHS Foundation Trust  London UK"},{"name":"National Heart and Lung Institute Imperial College  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E.","family":"Jones","sequence":"additional","affiliation":[{"name":"Harefield Pulmonary Rehabilitation and Muscle Research Laboratory Royal Brompton and Harefield NHS Foundation Trust  London UK"},{"name":"National Heart and Lung Institute Imperial College  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhani","family":"Patel","sequence":"additional","affiliation":[{"name":"Harefield Pulmonary Rehabilitation and Muscle Research Laboratory Royal Brompton and Harefield NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth E.","family":"Barker","sequence":"additional","affiliation":[{"name":"Harefield Pulmonary Rehabilitation and Muscle Research Laboratory Royal Brompton and Harefield NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha S.C.","family":"Kon","sequence":"additional","affiliation":[{"name":"Harefield Pulmonary Rehabilitation and Muscle Research Laboratory Royal Brompton and Harefield NHS Foundation Trust  London UK"},{"name":"The Hillingdon Hospitals NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael I.","family":"Polkey","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute Imperial College  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Cullinan","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute Imperial College  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William D.\u2010C.","family":"Man","sequence":"additional","affiliation":[{"name":"Harefield Pulmonary Rehabilitation and Muscle Research Laboratory Royal Brompton and Harefield NHS Foundation Trust  London UK"},{"name":"National Heart and Lung Institute Imperial College  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,6,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32203-7"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/139.6.1435"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/82.1.53"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2006.062026"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200505-969OC"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2014-206440"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-018-1013-y"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2008.06.013"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2016.09.004"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2009.12.004"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00070914"},{"key":"e_1_2_10_13_1","first-page":"556","article-title":"Weight changes in the terminal stages of chronic obstructive pulmonary disease. 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