{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T22:11:02Z","timestamp":1794003062188,"version":"4.8.0"},"reference-count":53,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    To determine the relationship between mucus plugging and CT-derived parameters of sarcopenia in routine chest CT-scans. Patients with advanced Chronic Obstructive Lung Disease (COPD GOLD 3 or 4) were investigated. Mucus plug score (MPS) and cross-sectional muscle area (CSA) of pectoralis and erector spinae muscle of each patient was assessed by two radiologists. Statistics included non-parametric group comparison, multivariate analysis, and inter- and intrarater agreement. Median age of 123 patients (47 female) was 66\u00a0years. In 63 patients (15 females) no mucus plugging was found. 31 patients (15 females) had 1\u20132 mucus plugs and 29 patients (17 females) had a mucus plug of\u2009\u2265\u20093. PM\n                    <jats:sub>CSA<\/jats:sub>\n                    and ESM\n                    <jats:sub>CSA<\/jats:sub>\n                    were not independently associated with MPS; however, the association between PM\n                    <jats:sub>CSA<\/jats:sub>\n                    and MPS was modified by body weight, with a significant negative correlation between body weight and PM\n                    <jats:sub>CSA<\/jats:sub>\n                    in patients with higher MPS (\u2265\u20093). Inter- and intrarater agreement was very good (ICC 0.899 or higher). Imaging based evaluation of MPS and CSA is reliable on routine chest CT-scans. Patients with more advanced COPD exhibited a higher MPS and larger PM\n                    <jats:sub>CSA<\/jats:sub>\n                    relative to body weight, possibly due to the greater muscular effort required for breathing.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-49060-7","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T04:33:11Z","timestamp":1777350791000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Investigating sarcopenia and mucus plugging by chest computed tomography in patients with severe chronic obstructive pulmonary disease"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0957-6474","authenticated-orcid":false,"given":"Antonia","family":"Petersen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5969-2089","authenticated-orcid":false,"given":"Ralf-Harto","family":"H\u00fcbner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4057-2199","authenticated-orcid":false,"given":"Marcus A.","family":"Mall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2059-4275","authenticated-orcid":false,"given":"Ingo G.","family":"Steffen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9507-076X","authenticated-orcid":false,"given":"Oliver","family":"Weinheimer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9787-5633","authenticated-orcid":false,"given":"Martin","family":"Witzenrath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0188-7541","authenticated-orcid":false,"given":"Jacopo","family":"Saccomanno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7155-6044","authenticated-orcid":false,"given":"Thomas","family":"Elgeti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"49060_CR1","doi-asserted-by":"publisher","first-page":"2227","DOI":"10.1016\/S0140-6736(22)00470-6","volume":"399","author":"SA Christenson","year":"2022","unstructured":"Christenson, S. A., Smith, B. M., Bafadhel, M. & Putcha, N. Chronic obstructive pulmonary disease. Lancet 399, 2227\u20132242. https:\/\/doi.org\/10.1016\/S0140-6736(22)00470-6 (2022).","journal-title":"Lancet"},{"issue":"Suppl 2","key":"49060_CR2","doi-asserted-by":"publisher","first-page":"S177","DOI":"10.1513\/AnnalsATS.201509-641KV","volume":"13","author":"MA Mall","year":"2016","unstructured":"Mall, M. A. Unplugging mucus in Cystic Fibrosis and chronic obstructive pulmonary disease. Ann. Am. Thorac. Soc. 13(Suppl 2), S177-185. https:\/\/doi.org\/10.1513\/AnnalsATS.201509-641KV (2016).","journal-title":"Ann. Am. Thorac. Soc."},{"key":"49060_CR3","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-019-1017-y","author":"A Higham","year":"2019","unstructured":"Higham, A., Quinn, A. M., Can\u00e7ado, J. E. D. & Singh, D. The pathology of small airways disease in COPD: Historical aspects and future directions. Respir. Res. https:\/\/doi.org\/10.1186\/s12931-019-1017-y (2019).","journal-title":"Respir. Res."},{"key":"49060_CR4","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1164\/rccm.200612-1772OC","volume":"176","author":"JC Hogg","year":"2007","unstructured":"Hogg, J. C. et al. Survival after lung volume reduction in chronic obstructive pulmonary disease: Insights from small airway pathology. Am. J. Respir. Crit. Care Med. 176, 454\u2013459. https:\/\/doi.org\/10.1164\/rccm.200612-1772OC (2007).","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"49060_CR5","doi-asserted-by":"publisher","first-page":"1832","DOI":"10.1001\/jama.2023.2065","volume":"329","author":"AA Diaz","year":"2023","unstructured":"Diaz, A. A. et al. Airway-occluding mucus plugs and mortality in patients with chronic obstructive pulmonary disease. JAMA 329, 1832\u20131839. https:\/\/doi.org\/10.1001\/jama.2023.2065 (2023).","journal-title":"JAMA"},{"key":"49060_CR6","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1159\/000540781","volume":"104","author":"P Konietzke","year":"2025","unstructured":"Konietzke, P. et al. GOLD-grade specific disease characterization and phenotyping of COPD using quantitative computed tomography in the nationwide COSYCONET multicenter trial in Germany. Respiration 104, 133\u2013150. https:\/\/doi.org\/10.1159\/000540781 (2025).","journal-title":"Respiration"},{"key":"49060_CR7","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1016\/S0140-6736(22)01273-9","volume":"400","author":"D Stolz","year":"2022","unstructured":"Stolz, D. et al. Towards the elimination of chronic obstructive pulmonary disease: A Lancet Commission. Lancet 400, 921\u2013972. https:\/\/doi.org\/10.1016\/S0140-6736(22)01273-9 (2022).","journal-title":"Lancet"},{"key":"49060_CR8","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1093\/ageing\/afy169","volume":"48","author":"AJ Cruz-Jentoft","year":"2019","unstructured":"Cruz-Jentoft, A. J. et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing 48, 16\u201331. https:\/\/doi.org\/10.1093\/ageing\/afy169 (2019).","journal-title":"Age Ageing"},{"key":"49060_CR9","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1055\/a-2057-0205","volume":"195","author":"V Vasilevska Nikodinovska","year":"2023","unstructured":"Vasilevska Nikodinovska, V. & Ivanoski, S. Sarcopenia, more than just muscle atrophy: Imaging methods for the assessment of muscle quantity and quality. Rofo 195, 777\u2013789. https:\/\/doi.org\/10.1055\/a-2057-0205 (2023).","journal-title":"Rofo"},{"key":"49060_CR10","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1213\/ane.0000000000007035","volume":"140","author":"M Umbrello","year":"2025","unstructured":"Umbrello, M. et al. Association between the ultrasound evaluation of muscle mass and adverse outcomes in critically ill patients: A prospective cohort study. Anesth. Analg. 140, 427\u2013436. https:\/\/doi.org\/10.1213\/ane.0000000000007035 (2025).","journal-title":"Anesth. Analg."},{"key":"49060_CR11","doi-asserted-by":"publisher","first-page":"e108","DOI":"10.1016\/s2666-7568(23)00241-6","volume":"5","author":"JL S\u00e1nchez-S\u00e1nchez","year":"2024","unstructured":"S\u00e1nchez-S\u00e1nchez, J. L. et al. Association of physical behaviours with sarcopenia in older adults: A systematic review and meta-analysis of observational studies. Lancet Healthy Longev. 5, e108\u2013e119. https:\/\/doi.org\/10.1016\/s2666-7568(23)00241-6 (2024).","journal-title":"Lancet Healthy Longev."},{"key":"49060_CR12","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1002\/jcsm.12600","volume":"11","author":"W Sepulveda-Loyola","year":"2020","unstructured":"Sepulveda-Loyola, W. et al. Diagnosis, prevalence, and clinical impact of sarcopenia in COPD: A systematic review and meta-analysis. J. Cachexia Sarcopenia Muscle 11, 1164\u20131176. https:\/\/doi.org\/10.1002\/jcsm.12600 (2020).","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"49060_CR13","doi-asserted-by":"publisher","DOI":"10.1177\/17534666241304626","volume":"18","author":"W Li","year":"2024","unstructured":"Li, W. et al. Association between muscular atrophy and mortality risk in patients with COPD: A systematic review. Ther. Adv. Respir. Dis. 18, 17534666241304626. https:\/\/doi.org\/10.1177\/17534666241304626 (2024).","journal-title":"Ther. Adv. Respir. Dis."},{"key":"49060_CR14","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1513\/AnnalsATS.201307-229OC","volume":"11","author":"ML McDonald","year":"2014","unstructured":"McDonald, M. L. et al. Quantitative computed tomography measures of pectoralis muscle area and disease severity in chronic obstructive pulmonary disease. A cross-sectional study. Ann. Am. Thorac. Soc. 11, 326\u2013334. https:\/\/doi.org\/10.1513\/AnnalsATS.201307-229OC (2014).","journal-title":"Ann. Am. Thorac. Soc."},{"key":"49060_CR15","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1513\/AnnalsATS.201507-446OC","volume":"13","author":"K Tanimura","year":"2016","unstructured":"Tanimura, K. et al. Quantitative assessment of Erector Spinae muscles in patients with chronic obstructive pulmonary disease. Novel chest computed tomography-derived index for prognosis. Ann. Am. Thorac. Soc. 13, 334\u2013341. https:\/\/doi.org\/10.1513\/AnnalsATS.201507-446OC (2016).","journal-title":"Ann. Am. Thorac. Soc."},{"key":"49060_CR16","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1148\/radiol.2021203959","volume":"299","author":"F Pishgar","year":"2021","unstructured":"Pishgar, F. et al. Quantitative analysis of adipose depots by using chest CT and associations with all-cause mortality in chronic obstructive pulmonary disease: Longitudinal analysis from MESArthritis Ancillary Study. Radiology 299, 703\u2013711. https:\/\/doi.org\/10.1148\/radiol.2021203959 (2021).","journal-title":"Radiology"},{"key":"49060_CR17","doi-asserted-by":"publisher","DOI":"10.1177\/14799731221133387","volume":"19","author":"JM Nicholson","year":"2022","unstructured":"Nicholson, J. M. et al. Computed tomography-based body composition measures in COPD and their association with clinical outcomes: A systematic review. Chron. Respir. Dis. 19, 14799731221133387. https:\/\/doi.org\/10.1177\/14799731221133387 (2022).","journal-title":"Chron. Respir. Dis."},{"key":"49060_CR18","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1007\/s00330-024-10953-8","volume":"35","author":"S Soh","year":"2025","unstructured":"Soh, S. et al. Prognostic value of CT body composition analysis for 1-year mortality after transcatheter aortic valve replacement. Eur. Radiol. 35, 244\u2013254. https:\/\/doi.org\/10.1007\/s00330-024-10953-8 (2025).","journal-title":"Eur. Radiol."},{"key":"49060_CR19","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-02754-w","volume":"15","author":"L Li","year":"2025","unstructured":"Li, L. et al. Chest CT-determined sarcopenia is associated with poorer functional outcomes in osteoarthritis patients undergoing total knee arthroplasty: A retrospective cohort study. Sci. Rep. 15, 18272. https:\/\/doi.org\/10.1038\/s41598-025-02754-w (2025).","journal-title":"Sci. Rep."},{"key":"49060_CR20","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-06167-7","volume":"15","author":"B Salam","year":"2025","unstructured":"Salam, B. et al. Associations between cardiac adipose tissue and abdominal visceral fat and muscle based on computed tomography area and density. Sci. Rep. 15, 20192. https:\/\/doi.org\/10.1038\/s41598-025-06167-7 (2025).","journal-title":"Sci. Rep."},{"key":"49060_CR21","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-83897-0","volume":"14","author":"A Hata","year":"2024","unstructured":"Hata, A. et al. Automated chest CT three-dimensional quantification of body composition: Adipose tissue and paravertebral muscle. Sci. Rep. 14, 32117. https:\/\/doi.org\/10.1038\/s41598-024-83897-0 (2024).","journal-title":"Sci. Rep."},{"key":"49060_CR22","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-97907-2","volume":"15","author":"Y Kawaguchi","year":"2025","unstructured":"Kawaguchi, Y. et al. Activin A is deeply involved in the progression of sarcopenia and leads to poor prognosis in lung cancer patients. Sci. Rep. 15, 13641. https:\/\/doi.org\/10.1038\/s41598-025-97907-2 (2025).","journal-title":"Sci. Rep."},{"key":"49060_CR23","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-62825-2","volume":"14","author":"L Ying","year":"2024","unstructured":"Ying, L., Xu, L., Yang, J. & Zhang, Q. Prognostic significance of CT-determined sarcopenia in older patients with advanced squamous cell lung cancer treated with Programmed Death-1 inhibitors. Sci. Rep. 14, 12025. https:\/\/doi.org\/10.1038\/s41598-024-62825-2 (2024).","journal-title":"Sci. Rep."},{"key":"49060_CR24","doi-asserted-by":"publisher","first-page":"490","DOI":"10.15326\/jcopdf.2025.0617","volume":"12","author":"J Saccomanno","year":"2025","unstructured":"Saccomanno, J. et al. Association of mucus plugging and body mass index in patients with advanced COPD GOLD 3\/4 with emphysema. Chronic. Obstr. Pulm. Dis. 12, 490\u2013499. https:\/\/doi.org\/10.15326\/jcopdf.2025.0617 (2025).","journal-title":"Chronic. Obstr. Pulm. Dis."},{"key":"49060_CR25","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00410-2024","author":"J Saccomanno","year":"2025","unstructured":"Saccomanno, J. et al. Clinical improvements after endoscopic lung volume reduction with valves in patients with advanced emphysema and a 6-min walk test \u2264140\u2005m at baseline. ERJ. Open. Res. https:\/\/doi.org\/10.1183\/23120541.00410-2024 (2025).","journal-title":"ERJ. Open. Res."},{"key":"49060_CR26","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1159\/000524996","volume":"101","author":"P Lenga","year":"2022","unstructured":"Lenga, P. et al. Endoscopic lung volume reduction with one-way valves in patients with severe chronic obstructive pulmonary disease with hypercapnia. Respiration 101, 823\u2013832. https:\/\/doi.org\/10.1159\/000524996 (2022).","journal-title":"Respiration"},{"key":"49060_CR27","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00190-2023","author":"T Sgarbossa","year":"2023","unstructured":"Sgarbossa, T. et al. Assessment of efficacy and safety of endoscopic lung volume reduction with one-way valves in patients with a very low FEV(1). ERJ. Open. Res. https:\/\/doi.org\/10.1183\/23120541.00190-2023 (2023).","journal-title":"ERJ. Open. Res."},{"key":"49060_CR28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208","volume":"95","author":"PA Harris","year":"2019","unstructured":"Harris, P. A. et al. The REDCap consortium: Building an international community of software platform partners. J. Biomed. Inform. 95, 103208. https:\/\/doi.org\/10.1016\/j.jbi.2019.103208 (2019).","journal-title":"J. Biomed. Inform."},{"key":"49060_CR29","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1172\/JCI95693","volume":"128","author":"EM Dunican","year":"2018","unstructured":"Dunican, E. M. et al. Mucus plugs in patients with asthma linked to eosinophilia and airflow obstruction. J. Clin. Invest. 128, 997\u20131009. https:\/\/doi.org\/10.1172\/JCI95693 (2018).","journal-title":"J. Clin. Invest."},{"key":"49060_CR30","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-29825-5","volume":"8","author":"BA Derstine","year":"2018","unstructured":"Derstine, B. A. et al. Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population. Sci. Rep. 8, 11369. https:\/\/doi.org\/10.1038\/s41598-018-29825-5 (2018).","journal-title":"Sci. Rep."},{"key":"49060_CR31","doi-asserted-by":"publisher","DOI":"10.1007\/s40520-023-02665-8","volume":"36","author":"Y Tabara","year":"2024","unstructured":"Tabara, Y., Okada, Y., Ochi, M., Ohyagi, Y. & Igase, M. One-leg standing time is a simple measure for loss of skeletal muscle mass and fat deposition in muscle: The J-SHIPP study. Aging Clin. Exp. Res. 36, 7. https:\/\/doi.org\/10.1007\/s40520-023-02665-8 (2024).","journal-title":"Aging Clin. Exp. Res."},{"key":"49060_CR32","doi-asserted-by":"publisher","first-page":"72","DOI":"10.6133\/apjcn.201903_28(1).0011","volume":"28","author":"NI Tanaka","year":"2019","unstructured":"Tanaka, N. I. et al. Effects of 1-year weight loss intervention on abdominal skeletal muscle mass in Japanese overweight men and women. Asia Pac. J. Clin. Nutr. 28, 72\u201378. https:\/\/doi.org\/10.6133\/apjcn.201903_28(1).0011 (2019).","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"49060_CR33","doi-asserted-by":"publisher","first-page":"W255","DOI":"10.2214\/ajr.15.14635","volume":"205","author":"RD Boutin","year":"2015","unstructured":"Boutin, R. D., Yao, L., Canter, R. J. & Lenchik, L. Sarcopenia: Current concepts and imaging implications. AJR Am. J. Roentgenol. 205, W255-266. https:\/\/doi.org\/10.2214\/ajr.15.14635 (2015).","journal-title":"AJR Am. J. Roentgenol."},{"key":"49060_CR34","doi-asserted-by":"publisher","first-page":"3205","DOI":"10.1007\/s00261-021-03294-3","volume":"47","author":"V Chianca","year":"2022","unstructured":"Chianca, V. et al. Sarcopenia: Imaging assessment and clinical application. Abdom. Radiol. (NY) 47, 3205\u20133216. https:\/\/doi.org\/10.1007\/s00261-021-03294-3 (2022).","journal-title":"Abdom. Radiol. (NY)"},{"key":"49060_CR35","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1007\/s11547-022-01450-3","volume":"127","author":"AS Tagliafico","year":"2022","unstructured":"Tagliafico, A. S., Bignotti, B., Torri, L. & Rossi, F. Sarcopenia: How to measure, when and why. Radiol. Med. 127, 228\u2013237. https:\/\/doi.org\/10.1007\/s11547-022-01450-3 (2022).","journal-title":"Radiol. Med."},{"key":"49060_CR36","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1080\/15412555.2021.1897560","volume":"18","author":"AH Attaway","year":"2021","unstructured":"Attaway, A. H. et al. Quantitative computed tomography assessment of pectoralis and erector spinae muscle area and disease severity in chronic obstructive pulmonary disease referred for lung volume reduction. COPD J. Chronic Obstr. Pulm. Dis. 18, 191\u2013200. https:\/\/doi.org\/10.1080\/15412555.2021.1897560 (2021).","journal-title":"COPD J. Chronic Obstr. Pulm. Dis."},{"key":"49060_CR37","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1093\/ajcn\/84.5.1193","volume":"84","author":"G Mazzali","year":"2006","unstructured":"Mazzali, G. et al. Interrelations between fat distribution, muscle lipid content, adipocytokines, and insulin resistance: Effect of moderate weight loss in older women. Am. J. Clin. Nutr. 84, 1193\u20131199. https:\/\/doi.org\/10.1093\/ajcn\/84.5.1193 (2006).","journal-title":"Am. J. Clin. Nutr."},{"key":"49060_CR38","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1159\/000520037","volume":"211","author":"E Steidle-Kloc","year":"2022","unstructured":"Steidle-Kloc, E., Dannhauer, T., Wirth, W. & Eckstein, F. Responsiveness of subcutaneous fat, intermuscular fat, and muscle anatomical cross-sectional area of the thigh to longitudinal body weight loss and gain: Data from the Osteoarthritis Initiative (OAI). Cells Tissues Organs 211, 555\u2013564. https:\/\/doi.org\/10.1159\/000520037 (2022).","journal-title":"Cells Tissues Organs"},{"key":"49060_CR39","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1111\/resp.14537","volume":"28","author":"A Yamazaki","year":"2023","unstructured":"Yamazaki, A. et al. Predictors of longitudinal changes in body weight, muscle and fat in patients with and ever-smokers at risk of COPD. Respirology 28, 851\u2013859. https:\/\/doi.org\/10.1111\/resp.14537 (2023).","journal-title":"Respirology"},{"key":"49060_CR40","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1136\/thoraxjnl-2020-215085","volume":"76","author":"N Tanabe","year":"2021","unstructured":"Tanabe, N. et al. Associations of CT evaluations of antigravity muscles, emphysema and airway disease with longitudinal outcomes in patients with COPD. Thorax 76, 295\u2013297. https:\/\/doi.org\/10.1136\/thoraxjnl-2020-215085 (2021).","journal-title":"Thorax"},{"key":"49060_CR41","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1093\/aje\/kwv153","volume":"183","author":"I Reinders","year":"2016","unstructured":"Reinders, I. et al. Muscle quality and myosteatosis: Novel associations with mortality risk: The Age, Gene\/Environment Susceptibility (AGES)-Reykjavik Study. Am. J. Epidemiol. 183, 53\u201360. https:\/\/doi.org\/10.1093\/aje\/kwv153 (2016).","journal-title":"Am. J. Epidemiol."},{"key":"49060_CR42","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1017\/S0029665115000129","volume":"74","author":"SB Heymsfield","year":"2015","unstructured":"Heymsfield, S. B., Gonzalez, M. C., Lu, J., Jia, G. & Zheng, J. Skeletal muscle mass and quality: Evolution of modern measurement concepts in the context of sarcopenia. Proc. Nutr. Soc. 74, 355\u2013366. https:\/\/doi.org\/10.1017\/S0029665115000129 (2015).","journal-title":"Proc. Nutr. Soc."},{"key":"49060_CR43","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2022.110956","volume":"132","author":"MB Lanza","year":"2022","unstructured":"Lanza, M. B. et al. Muscle volume vs. anatomical cross-sectional area: Different muscle assessment does not affect the muscle size-strength relationship. J. Biomech. 132, 110956. https:\/\/doi.org\/10.1016\/j.jbiomech.2022.110956 (2022).","journal-title":"J. Biomech."},{"key":"49060_CR44","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1016\/j.resinv.2020.05.010","volume":"58","author":"Y Higashimoto","year":"2020","unstructured":"Higashimoto, Y. et al. Effect of pulmonary rehabilitation programs including lower limb endurance training on dyspnea in stable COPD: A systematic review and meta-analysis. Respir. Investig. 58, 355\u2013366. https:\/\/doi.org\/10.1016\/j.resinv.2020.05.010 (2020).","journal-title":"Respir. Investig."},{"key":"49060_CR45","doi-asserted-by":"publisher","first-page":"451","DOI":"10.2147\/copd.S124750","volume":"12","author":"M Martin","year":"2017","unstructured":"Martin, M. et al. Ectopic fat accumulation in patients with COPD: An ECLIPSE substudy. Int. J. Chron. Obstruct. Pulmon. Dis. 12, 451\u2013460. https:\/\/doi.org\/10.2147\/copd.S124750 (2017).","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"49060_CR46","doi-asserted-by":"publisher","first-page":"395","DOI":"10.2147\/CIA.S56662","volume":"9","author":"AS Ryan","year":"2014","unstructured":"Ryan, A. S. & Harduarsingh-Permaul, A. S. Effects of weight loss and exercise on trunk muscle composition in older women. Clin. Interv. Aging 9, 395\u2013402. https:\/\/doi.org\/10.2147\/CIA.S56662 (2014).","journal-title":"Clin. Interv. Aging"},{"key":"49060_CR47","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1093\/gerona\/glp007","volume":"64","author":"P Chomentowski","year":"2009","unstructured":"Chomentowski, P. et al. Moderate exercise attenuates the loss of skeletal muscle mass that occurs with intentional caloric restriction-induced weight loss in older, overweight to obese adults. J. Gerontol. A Biol. Sci. Med. Sci. 64, 575\u2013580. https:\/\/doi.org\/10.1093\/gerona\/glp007 (2009).","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"49060_CR48","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1111\/resp.12746","volume":"21","author":"VM McDonald","year":"2016","unstructured":"McDonald, V. M. et al. Should we treat obesity in COPD? The effects of diet and resistance exercise training. Respirology 21, 875\u2013882. https:\/\/doi.org\/10.1111\/resp.12746 (2016).","journal-title":"Respirology"},{"key":"49060_CR49","doi-asserted-by":"publisher","first-page":"1570","DOI":"10.1002\/jcsm.12604","volume":"11","author":"A Mishra","year":"2020","unstructured":"Mishra, A. et al. Sarcopenia and low muscle radiodensity associate with impaired FEV(1) in allogeneic haematopoietic stem cell transplant recipients. J. Cachexia Sarcopenia Muscle 11, 1570\u20131579. https:\/\/doi.org\/10.1002\/jcsm.12604 (2020).","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"49060_CR50","doi-asserted-by":"publisher","first-page":"2145","DOI":"10.1002\/jcsm.12821","volume":"12","author":"HK Park","year":"2021","unstructured":"Park, H. K., Lee, S. H., Lee, S. Y., Kim, S. S. & Park, H. W. Relationships between lung function decline and skeletal muscle and fat mass changes: A longitudinal study in healthy individuals. J. Cachexia Sarcopenia Muscle 12, 2145\u20132153. https:\/\/doi.org\/10.1002\/jcsm.12821 (2021).","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"49060_CR51","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000012281","volume":"97","author":"CH Park","year":"2018","unstructured":"Park, C. H., Yi, Y., Do, J. G., Lee, Y. T. & Yoon, K. J. Relationship between skeletal muscle mass and lung function in Korean adults without clinically apparent lung disease. Medicine (Baltimore) 97, e12281. https:\/\/doi.org\/10.1097\/md.0000000000012281 (2018).","journal-title":"Medicine (Baltimore)"},{"key":"49060_CR52","doi-asserted-by":"publisher","DOI":"10.1038\/s41533-021-00236-w","volume":"31","author":"S Kakavas","year":"2021","unstructured":"Kakavas, S. et al. Pulmonary function testing in COPD: Looking beyond the curtain of FEV1. NPJ Prim. Care Respir. Med. 31, 23. https:\/\/doi.org\/10.1038\/s41533-021-00236-w (2021).","journal-title":"NPJ Prim. Care Respir. Med."},{"key":"49060_CR53","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1002\/cncr.34545","volume":"129","author":"B Nandakumar","year":"2023","unstructured":"Nandakumar, B. et al. Sarcopenia identified by computed tomography imaging using a deep learning-based segmentation approach impacts survival in patients with newly diagnosed multiple myeloma. Cancer 129, 385\u2013392. https:\/\/doi.org\/10.1002\/cncr.34545 (2023).","journal-title":"Cancer"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-49060-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-49060-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-49060-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:00:50Z","timestamp":1777449650000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-49060-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["49060"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-49060-7","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]},"assertion":[{"value":"25 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors of this manuscript declare relationships with the following companies: M.A.M. reports grants or contracts from the German Research Foundation (DFG), German Federal Ministry for Education and Research (BMBF), Boehringer Ingelheim, Enterprise Therapeutics, and Vertex Pharmaceuticals with payments made to the institution; fees for consultancy or participation in advisory board meetings from Boehringer Ingelheim, Enterprise Therapeutics, Kither Biotech, Pari, Splisense and Vertex Pharmaceuticals; payment or honoraria for lectures from Vertex Pharmaceuticals; and travel reimbursement received for participation in advisory board meetings for Boehringer Ingelheim and Vertex Pharmaceuticals. M.W. received funding for research from the German Research Foundation\u2014SFB 1449 (project ID 431232613), sub-project B02, from the German Federal Ministry of Education and Research in the framework of e:Med SYMPATH (01ZX2206A, 01ZX1906A), NUM-NAPKON (01KX2121, 01KX2021), CAP-TSD (031L0286B), PROGRESS (82DZLJ19C1, 82DZLJ19B1), from the Federal Joint Committee (G-BA)\u2014T-CABS (01NVF23109), from the Federal Ministry of Health (BMG)\u2014PAIS Care (ZMII2-2524FSB105), from the Ministry of Defence\u2014NoVAP (E\/U2ED\/PD014\/OF550), and from Aptarion, Pantherna and Biotest for research outside the current study, and for lectures and advisory from Aptarion, Astra Zeneca, Boehringer, Biotest, Chiesi, CSL Behring, Gilead, Insmed, Pantherna, Pfizer. R.-H.H. received honoraria for lectures from AstraZeneca, Berlin Chemie, Boehringer Ingelheim, Chiesi and Olympus, Pulmonx. J.S. received honoraria for lectures from PulmonX, Boehringer Ingelheim, Astra Zeneca and travel support from Medtronic.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"13762"}}