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We examined associations of the PGSBMI with automated quantification and visual interpretation of computed tomographic emphysema and airway wall thickness (AWT) in COPD-enriched and community-based cohorts. We summarized the results using meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and main results<\/jats:title>\n                    <jats:p>In the meta-analyses combining results of all cohorts (n\u2009=\u200916\u2009349), a standard-deviation increase of the PGSBMI was associated with less emphysema as quantified by log-transformed percent of low attenuation areas\u2009\u2264950 Hounsfield units (\u03b2\u2009=\u2009\u22120.062, P\u2009&amp;lt; .0001) and 15th percentile value of lung density histogram (\u03b2\u2009=\u20092.27, P\u2009&amp;lt; .0001), and increased AWT as quantified by the square root of wall area of a 10-mm lumen perimeter airway (\u03b2\u2009=\u20090.016, P\u2009=\u2009.0006) and mean segmental bronchial wall area percent (\u03b2\u2009=\u20090.26, P\u2009=\u2009.0013). For imaging characteristics assessed by visual interpretation, a higher PGSBMI was associated with reduced emphysema in both COPD-enriched cohorts (odds ratio [OR] for a higher severity grade\u2009=\u20090.89, P\u2009=\u2009.0080) and in the community-based Framingham Heart Study (OR for the presence of emphysema\u2009=\u20090.82, P\u2009=\u2009.0034), and a higher risk of airway wall thickening in the COPDGene study (OR\u2009=\u20091.17, P\u2009=\u2009.0023).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In individuals with and without COPD, a higher BMI polygenic risk is associated with both quantitative and visual decreased emphysema and increased AWT, suggesting genetic determinants of BMI affect both emphysema and airway wall thickening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/annalsats\/aaoag007","type":"journal-article","created":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T14:21:01Z","timestamp":1771683661000},"page":"720-727","source":"Crossref","is-referenced-by-count":2,"title":["Body Mass Index-related genetic factors and COPD imaging phenotypes"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8803-2861","authenticated-orcid":false,"given":"Jingzhou","family":"Zhang","sequence":"first","affiliation":[{"name":"The Pulmonary Center, Boston University Chobanian and Avedisian School of Medicine , Boston, MA,","place":["United States"]},{"name":"Section of Pulmonary, Allergy, Sleep and Critical Care Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine , Boston, MA,","place":["United States"]},{"name":"Channing Division of Network Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School , Boston, MA,","place":["United 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