{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:57:41Z","timestamp":1791374261222,"version":"4.3.1"},"reference-count":40,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T00:00:00Z","timestamp":1743724800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82370358"],"award-info":[{"award-number":["82370358"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82400495"],"award-info":[{"award-number":["82400495"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82470361"],"award-info":[{"award-number":["82470361"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021171","name":"Basic and Applied Basic Research Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2022A1515111181"],"award-info":[{"award-number":["2022A1515111181"]}],"id":[{"id":"10.13039\/501100021171","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021171","name":"Basic and Applied Basic Research Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2024A1515012356"],"award-info":[{"award-number":["2024A1515012356"]}],"id":[{"id":"10.13039\/501100021171","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021171","name":"Basic and Applied Basic Research Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2024A1515013234"],"award-info":[{"award-number":["2024A1515013234"]}],"id":[{"id":"10.13039\/501100021171","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To confirm the \u2018obesity paradox\u2019 in hospitalized populations and examine the heterogeneous effects of obesity on all\u2010cause mortality risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We included 5967 hospitalized patients from the Real\u2010world Data of Cardiometabolic Protection (RED\u2010CARPET) study (ChiCTR2000039901) in China. After 1:1\u2009k\u2010nearest neighbours matching, a causal forest model classified the population into four subgroups. Cox models were used to assess the association between obesity and all\u2010cause mortality, with external validation in the Atherosclerosis Risk in Communities (ARIC) cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a median follow\u2010up of 63.8\u2009months, 919 (15.4%) deaths occurred. A U\u2010shaped association between body mass index (BMI) and all\u2010cause mortality was observed, illustrating the \u2018obesity paradox\u2019, with the highest mortality rate (18.5%) observed in the normal weight group. Furthermore, 911 participants with obesity and 911 participants with normal weight, matched for homogeneity, were categorized into four subgroups using the causal forest model. In subgroup 3 (with good renal function, well\u2010controlled blood glucose and favourable nutritional status), patients with obesity had a higher risk of all\u2010cause mortality compared to those with normal weight (HR, 2.12; 95% CI, 1.06\u20134.22;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033). No significant association was observed in the other subgroups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Similar results were verified in the ARIC study cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The association between obesity and all\u2010cause mortality is heterogeneous, as individuals with good renal function, well\u2010controlled blood glucose and favourable nutritional status may experience a higher mortality risk. These findings emphasize the need for personalized management strategies in clinical practice to address the varying effects of obesity across different health conditions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.16391","type":"journal-article","created":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T10:07:16Z","timestamp":1743847636000},"page":"3695-3704","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Heterogeneous effects of obesity on all\u2010cause mortality: A causal forest analysis of hospitalized patients in\n                    <scp>China<\/scp>"],"prefix":"10.1111","volume":"27","author":[{"given":"Menghui","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital Sun Yat\u2010sen University  Guangzhou China"},{"name":"NHC Key Laboratory of Assisted Circulation Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zemeihong","family":"Xu","sequence":"additional","affiliation":[{"name":"Zhongshan School of Medicine Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixiang","family":"He","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital Sun Yat\u2010sen University  Guangzhou China"},{"name":"NHC Key Laboratory of Assisted Circulation Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingfeng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital Sun Yat\u2010sen University  Guangzhou China"},{"name":"NHC Key Laboratory of Assisted Circulation Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojie","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital Sun Yat\u2010sen University  Guangzhou China"},{"name":"NHC Key Laboratory of Assisted Circulation Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital Sun Yat\u2010sen University  Guangzhou China"},{"name":"NHC Key Laboratory of Assisted Circulation Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaozhao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital Sun Yat\u2010sen University  Guangzhou China"},{"name":"NHC Key Laboratory of Assisted Circulation Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinghao","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital Sun Yat\u2010sen University  Guangzhou China"},{"name":"NHC Key Laboratory of Assisted Circulation Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenyu","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital Sun Yat\u2010sen University  Guangzhou China"},{"name":"NHC Key Laboratory of Assisted Circulation Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Zhuang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital Sun Yat\u2010sen University  Guangzhou China"},{"name":"NHC Key Laboratory of Assisted Circulation Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7631-1866","authenticated-orcid":false,"given":"Xinxue","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital Sun Yat\u2010sen University  Guangzhou China"},{"name":"NHC Key Laboratory of Assisted Circulation Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.065485"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-023-00847-5"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30054-X"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1614362"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30175-1"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2014.165"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2018.07.003"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2015.02.024"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-014-9961-9"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.029617"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2018.10.011"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.05.035"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/advances\/nmab040"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.01.022"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1210\/endrev\/bnaa004"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1510489113"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2004.05.012"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.113905"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.15238"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/547809"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(18)30051-2"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.86.2.713"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina59010070"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003863"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-127-8_Part_2-199710151-00064"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6959"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a115184"},{"key":"e_1_2_11_29_1","unstructured":"CEA.The Science Strengths and Limitations of Body Mass Index.2023https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK594362\/"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature05485"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa055643"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.162.16.1867"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(13)70062-7"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41366-023-01288-3"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature05487"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1089\/154099903321576565"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101451"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.0219"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.067264"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwad099"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1038\/ng.686"}],"container-title":["Diabetes, Obesity and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/pdf\/10.1111\/dom.16391","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T05:39:14Z","timestamp":1761889154000},"score":1,"resource":{"primary":{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/10.1111\/dom.16391"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,4]]},"references-count":40,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1111\/dom.16391"],"URL":"https:\/\/doi.org\/10.1111\/dom.16391","archive":["Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.1111\/DOM.16391\/v2\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16391\/v1\/review3","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16391\/v1\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16391\/v2\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16391\/v1\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16391\/v2\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16391\/v1\/decision1","asserted-by":"object"}]},"ISSN":["1462-8902","1463-1326"],"issn-type":[{"value":"1462-8902","type":"print"},{"value":"1463-1326","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,4]]},"assertion":[{"value":"2025-02-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}