{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T10:48:35Z","timestamp":1785754115075,"version":"3.56.0"},"reference-count":42,"publisher":"Elsevier BV","issue":"2","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004385","name":"Universiteit Gent","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004385","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["The American Journal of Clinical Nutrition"],"published-print":{"date-parts":[[2026,8]]},"DOI":"10.1016\/j.ajcnut.2026.101402","type":"journal-article","created":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T15:00:31Z","timestamp":1781967631000},"page":"101402","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nutritional anemia is associated with increased risk of severe COPD exacerbations: a prospective cohort study"],"prefix":"10.1016","volume":"124","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4014-3255","authenticated-orcid":false,"given":"Valerie","family":"Dehondt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Kint","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lowie EGW","family":"Vanfleteren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3494-4363","authenticated-orcid":false,"given":"Lies","family":"Lahousse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"11","key":"10.1016\/j.ajcnut.2026.101402_bib1","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1016\/S2213-2600(23)00261-8","article-title":"COPD and multimorbidity: recognising and addressing a syndemic occurrence","volume":"11","author":"Fabbri","year":"2023","journal-title":"Lancet Respir. Med."},{"issue":"130","key":"10.1016\/j.ajcnut.2026.101402_bib2","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1183\/09059180.00008612","volume":"22","author":"Cavaill\u00e8s","year":"2013","journal-title":"Eur. Respir. Rev."},{"issue":"5","key":"10.1016\/j.ajcnut.2026.101402_bib3","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1042\/CS20140344","article-title":"Anaemia in chronic obstructive pulmonary disease: an insight into its prevalence and pathophysiology","volume":"128","author":"Boutou","year":"2015","journal-title":"Clin. Sci. (Lond)."},{"issue":"1","key":"10.1016\/j.ajcnut.2026.101402_bib4","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1186\/s12890-021-01585-5","article-title":"Secondary polycythemia in chronic obstructive pulmonary disease: prevalence and risk factors","volume":"21","author":"Zhang","year":"2021","journal-title":"BMC Pulm. Med."},{"issue":"2","key":"10.1016\/j.ajcnut.2026.101402_bib5","doi-asserted-by":"crossref","first-page":"142","DOI":"10.4103\/0970-2113.152626","article-title":"Anemia in chronic obstructive pulmonary disease: prevalence, pathogenesis, and potential impact","volume":"32","author":"Sarkar","year":"2015","journal-title":"Lung India"},{"issue":"2","key":"10.1016\/j.ajcnut.2026.101402_bib6","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1183\/09031936.06.00143704","article-title":"The potential impact of anaemia of chronic disease in COPD","volume":"27","author":"Similowski","year":"2006","journal-title":"Eur. Respir. J."},{"issue":"1","key":"10.1016\/j.ajcnut.2026.101402_bib7","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1182\/blood-2018-06-856500","article-title":"Anemia of inflammation","volume":"133","author":"Weiss","year":"2019","journal-title":"Blood"},{"issue":"14","key":"10.1016\/j.ajcnut.2026.101402_bib8","doi-asserted-by":"crossref","first-page":"2232","DOI":"10.7150\/ijms.46163","article-title":"The significance of iron deficiency and anemia in a real-life COPD cohort","volume":"17","author":"Pizzini","year":"2020","journal-title":"Int. J. Med. Sci."},{"issue":"3","key":"10.1016\/j.ajcnut.2026.101402_bib9","first-page":"27","article-title":"Prevalence of anemia and its impact on mortality in patients with acute exacerbation of chronic obstructive pulmonary disease in a developing country setting","volume":"64","author":"Rahimi-Rad","year":"2015","journal-title":"Pneumologia"},{"issue":"1","key":"10.1016\/j.ajcnut.2026.101402_bib10","doi-asserted-by":"crossref","first-page":"100","DOI":"10.3109\/15412555.2015.1043519","article-title":"Anemia in chronic obstructive pulmonary disease and the potential role of iron deficiency","volume":"13","author":"Vasquez","year":"2016","journal-title":"COPD"},{"issue":"1","key":"10.1016\/j.ajcnut.2026.101402_bib11","article-title":"Anemia and polycythemia in patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease: prevalence, patient characteristics, and risk of readmission and mortality, Eur","volume":"12","author":"Nielsen","year":"2025","journal-title":"Clin. Respir. J."},{"key":"10.1016\/j.ajcnut.2026.101402_bib12","series-title":"Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2026 Report","author":"Agusti","year":"2026"},{"key":"10.1016\/j.ajcnut.2026.101402_bib13","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1183\/23120541.01276-2024","article-title":"Predictors of mortality and hospitalised exacerbations in obstructive airway diseases","volume":"11","author":"Vauterin","year":"2025","journal-title":"ERJ Open Res"},{"key":"10.1016\/j.ajcnut.2026.101402_bib14","series-title":"The Sectoral Committee of Social Security and Health, Section Health ('Informatieveiligheidscomit\u00e9')","year":"2024"},{"key":"10.1016\/j.ajcnut.2026.101402_bib15","series-title":"InterMutualistic Agency (IMA\/AIM)","year":"2024"},{"key":"10.1016\/j.ajcnut.2026.101402_bib16","series-title":"The Minimal Hospital Dataset","year":"2024"},{"issue":"3","key":"10.1016\/j.ajcnut.2026.101402_bib17","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/j.chest.2025.03.018","article-title":"Association of timely spirometry with lower all-cause mortality: a nationwide obstructive cohort study","volume":"168","author":"Dehondt","year":"2025","journal-title":"Chest"},{"key":"10.1016\/j.ajcnut.2026.101402_bib18","doi-asserted-by":"crossref","first-page":"241","DOI":"10.2147\/CLEP.S93643","article-title":"Positive predictive value of diagnosis coding for hemolytic anemias in the Danish National Patient Register","volume":"8","author":"Hansen","year":"2016","journal-title":"Clin. Epidemiol."},{"key":"10.1016\/j.ajcnut.2026.101402_bib19","first-page":"327","article-title":"Positive predictive value of the International Classification of Diseases, 10th edition diagnosis codes for anemia caused by bleeding in the Danish National Registry of Patients","volume":"4","author":"Zalfani","year":"2012","journal-title":"Clin. Epidemiol."},{"key":"10.1016\/j.ajcnut.2026.101402_bib20","doi-asserted-by":"crossref","first-page":"946","DOI":"10.3389\/fimmu.2020.00946","article-title":"The changing landscape of autoimmune hemolytic anemia","volume":"11","author":"Barcellini","year":"2020","journal-title":"Front Immunol"},{"issue":"1","key":"10.1016\/j.ajcnut.2026.101402_bib21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000452104","article-title":"Anaemia of chronic disease: an in-depth review, Med","volume":"26","author":"Madu","year":"2017","journal-title":"Princ. Pract."},{"issue":"7","key":"10.1016\/j.ajcnut.2026.101402_bib22","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1097\/MLR.0000000000000729","article-title":"Development of a claims-based frailty indicator anchored to a well-established frailty phenotype, Med","volume":"55","author":"Segal","year":"2017","journal-title":"Care"},{"issue":"1","key":"10.1016\/j.ajcnut.2026.101402_bib23","article-title":"Anemia as a significant predictor of adverse outcomes in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease: analysis of national (Nationwide) inpatient sample database","volume":"15","author":"Sonani","year":"2023","journal-title":"Cureus"},{"key":"10.1016\/j.ajcnut.2026.101402_bib24","article-title":"Hemoglobin and clinical outcomes of in-hospital patients with severe acute exacerbation of chronic obstructive pulmonary disease: a multicenter cohort study","volume":"12","author":"Wu","year":"2025","journal-title":"Front. Med. (Lausanne)."},{"key":"10.1016\/j.ajcnut.2026.101402_bib25","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.2147\/COPD.S159249","article-title":"Hemoglobin and mortality in patients with COPD: a nationwide population-based cohort study","volume":"13","author":"Park","year":"2018","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"issue":"4","key":"10.1016\/j.ajcnut.2026.101402_bib26","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1185\/03007995.2012.675318","article-title":"Anemia in chronic obstructive pulmonary disease: a readmission prognosis factor","volume":"28","author":"Barba","year":"2012","journal-title":"Curr. Med. Res. Opin."},{"issue":"3","key":"10.1016\/j.ajcnut.2026.101402_bib27","doi-asserted-by":"crossref","DOI":"10.1183\/23120541.00068-2021","article-title":"Haemoglobin as a biomarker for clinical outcomes in chronic obstructive pulmonary disease","volume":"7","author":"Balasubramanian","year":"2021","journal-title":"ERJ Open Res"},{"key":"10.1016\/j.ajcnut.2026.101402_bib28","doi-asserted-by":"crossref","DOI":"10.1016\/j.rmed.2025.108046","article-title":"Exploring the pathophysiology of anemia in COPD: insights from chest CT and longitudinal clinical data","volume":"240","author":"Takizawa","year":"2025","journal-title":"Respir. Med."},{"key":"10.1016\/j.ajcnut.2026.101402_bib29","article-title":"Cardiac power output associated with hospitalization and mortality in coronary artery disease patients at stage B heart failure","volume":"55","author":"Hsieh","year":"2024","journal-title":"Int. J. Cardiol. Heart Vasc"},{"issue":"1","key":"10.1016\/j.ajcnut.2026.101402_bib30","first-page":"38","article-title":"Left ventricular hypertrophy is independently associated with all-cause mortality","volume":"12","author":"Movahed","year":"2022","journal-title":"Am. J. Cardiovasc. Dis."},{"key":"10.1016\/j.ajcnut.2026.101402_bib31","doi-asserted-by":"crossref","DOI":"10.1177\/17534666221113647","article-title":"Association of COPD exacerbations and acute cardiovascular events: a systematic review and meta-analysis","volume":"16","author":"M\u00fcllerov\u00e1","year":"2022","journal-title":"Ther. Adv. Respir. Dis."},{"issue":"1","key":"10.1016\/j.ajcnut.2026.101402_bib32","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1471-2466-14-24","article-title":"Anemia and iron deficiency in COPD patients: prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron","volume":"14","author":"Silverberg","year":"2014","journal-title":"BMC Pulm. Med."},{"issue":"12","key":"10.1016\/j.ajcnut.2026.101402_bib33","doi-asserted-by":"crossref","first-page":"4154","DOI":"10.3390\/jcm14124154","article-title":"Non-anemic iron deficiency predicts COPD exacerbations and hospitalizations: results from a prospective cohort","volume":"14","author":"Amado","year":"2025","journal-title":"J. Clin. Med."},{"issue":"5","key":"10.1016\/j.ajcnut.2026.101402_bib34","doi-asserted-by":"crossref","first-page":"965","DOI":"10.3390\/antiox11050965","article-title":"Oxidative stress in chronic obstructive pulmonary disease","volume":"11","author":"Barnes","year":"2022","journal-title":"Antioxidants (Basel)"},{"key":"10.1016\/j.ajcnut.2026.101402_bib35","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.2147\/COPD.S488701","article-title":"Comorbidities and cause of death in COPD patients compared to Non-COPD controls: an 8-year observational retrospective healthcare claims database cohort study","volume":"20","author":"Vogelmeier","year":"2025","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"issue":"4","key":"10.1016\/j.ajcnut.2026.101402_bib36","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/j.resinv.2022.03.006","article-title":"Anemia in chronic obstructive pulmonary disease: a systematic review","volume":"60","author":"Alisamir","year":"2022","journal-title":"Respir. Investig."},{"issue":"9","key":"10.1016\/j.ajcnut.2026.101402_bib37","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.3390\/biomedicines9091191","article-title":"Iron replacement and redox balance in non-anemic and mildly anemic iron deficiency COPD patients: insights from a clinical trial","volume":"9","author":"P\u00e9rez-Peir\u00f3","year":"2021","journal-title":"Biomedicines"},{"issue":"5","key":"10.1016\/j.ajcnut.2026.101402_bib38","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1513\/AnnalsATS.201401-017OC","article-title":"Associations between physical activity and 30-day readmission risk in chronic obstructive pulmonary disease","volume":"11","author":"Nguyen","year":"2014","journal-title":"Ann. Am. Thorac. Soc."},{"issue":"2","key":"10.1016\/j.ajcnut.2026.101402_bib39","first-page":"2254","article-title":"The impact of anemia on the mortality of COPD patients hospitalized for acute exacerbation resulting in respiratory failure","volume":"93","author":"Cireli","year":"2022","journal-title":"Monaldi Arch, Chest Dis"},{"issue":"1","key":"10.1016\/j.ajcnut.2026.101402_bib40","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.ejim.2013.07.011","article-title":"Anemia of chronic disease: a unique defect of iron recycling for many different chronic diseases","volume":"25","author":"Poggiali","year":"2014","journal-title":"Eur. J. Intern. Med."},{"issue":"10","key":"10.1016\/j.ajcnut.2026.101402_bib41","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.3390\/antiox10101569","article-title":"Iron-regulated reactive oxygen species production and programmed cell death in chronic obstructive pulmonary disease","volume":"10","author":"Mizumura","year":"2021","journal-title":"Antioxidants (Basel)"},{"issue":"1","key":"10.1016\/j.ajcnut.2026.101402_bib42","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12931-022-01929-7","article-title":"Iron in airway macrophages and infective exacerbations of chronic obstructive pulmonary disease","volume":"23","author":"Ho","year":"2022","journal-title":"Respir. Res."}],"container-title":["The American Journal of Clinical Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S000291652600211X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S000291652600211X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T10:31:22Z","timestamp":1785753082000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S000291652600211X"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":42,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["S000291652600211X"],"URL":"https:\/\/doi.org\/10.1016\/j.ajcnut.2026.101402","relation":{},"ISSN":["0002-9165"],"issn-type":[{"value":"0002-9165","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Nutritional anemia is associated with increased risk of severe COPD exacerbations: a prospective cohort study","name":"articletitle","label":"Article Title"},{"value":"The American Journal of Clinical Nutrition","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ajcnut.2026.101402","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Author(s). Published by Elsevier Inc. on behalf of American Society for Nutrition.","name":"copyright","label":"Copyright"}],"article-number":"101402"}}