{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:22:55Z","timestamp":1791498175017,"version":"4.3.4"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82070588"],"award-info":[{"award-number":["82070588"]}],"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":["82370577"],"award-info":[{"award-number":["82370577"]}],"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":["82470843"],"award-info":[{"award-number":["82470843"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2023YFA1800801"],"award-info":[{"award-number":["2023YFA1800801"]}],"id":[{"id":"10.13039\/501100012166","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":[[2026,2]]},"abstract":"Abstract<\/jats:title>\n \n Aims<\/jats:title>\n \n To compare the prognostic implications of the newly proposed clinical obesity classification against traditional body mass index (\n BMI)<\/jats:styled-content>\n \u2010defined obesity in a population\u2010based cohort.\n <\/jats:p>\n <\/jats:sec>\n \n Materials and Methods<\/jats:title>\n \n Using\n UK<\/jats:styled-content>\n Biobank, we compared the impact of newly defined obesity, including clinical obesity (obesity status with obesity\u2010related comorbidities) and pre\u2010clinical obesity (obesity status with preserved organ function), with traditional\n BMI<\/jats:styled-content>\n \u2010defined obesity on death, cardiovascular disease (\n CVD<\/jats:styled-content>\n ), chronic kidney disease (\n CKD<\/jats:styled-content>\n ), and liver\u2010related events (\n LREs<\/jats:styled-content>\n ). To further delineate heterogeneity within the clinical obesity group, we performed stratified analyses based on comorbidity burden (number of comorbidities), severity of adiposity, and presence of diabetes or hypertension.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 502\u2009129 participants were enrolled. About 375\u2009585 (74.8%) had non\u2010obesity, 126\u2009544 (25.2%) had\n BMI<\/jats:styled-content>\n \u2010defined obesity (including 93\u2009410 [73.8%] with clinical obesity and 13\u2009875 [11.0%] with pre\u2010clinical obesity). During a median follow\u2010up of 15.8\u2009years, clinical obesity was associated with significantly higher risks of death (\n HR<\/jats:styled-content>\n \u2009=\u20091.097, 95%\n CI<\/jats:styled-content>\n : 1.071\u20131.125,\n p<\/jats:italic>\n \u2009<\u20090.001),\n LRE<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n \u2009=\u20091.103, 95%\n CI<\/jats:styled-content>\n : 1.040\u20131.169,\n p<\/jats:italic>\n \u2009<\u20090.001),\n CVD<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n \u2009=\u20091.118, 95%\n CI<\/jats:styled-content>\n : 1.091\u20131.146,\n p<\/jats:italic>\n \u2009<\u20090.001), and\n CKD<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n \u2009=\u20091.111, 95%\n CI<\/jats:styled-content>\n : 1.081\u20131.141,\n p<\/jats:italic>\n \u2009<\u20090.001) compared to\n BMI<\/jats:styled-content>\n \u2010based obesity. Conversely, pre\u2010clinical obesity showed significantly lower risks across these outcomes. High\u2010risk clinical obesity subgroups with multiple comorbidities or severe adiposity showed particularly increased risks.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The clinical obesity classification helps to define a high\u2010risk phenotype with substantially increased risks of mortality and major comorbidities, while pre\u2010clinical obesity defines a distinct subgroup with more favourable outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/dom.70271","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T08:30:33Z","timestamp":1762763433000},"page":"994-1003","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Newly defined clinical obesity versus\n body mass index<\/scp>\n \u2010defined obesity: Differential risks of overall death and adverse events in a population\u2010based cohort"],"prefix":"10.1111","volume":"28","author":[{"given":"Li\u2010You","family":"Lian","sequence":"first","affiliation":[{"name":"MAFLD Research Center, Department of Hepatology the First Affiliated Hospital of Wenzhou Medical University Wenzhou China"},{"name":"Institute of Hepatology Wenzhou Medical University Wenzhou China"},{"name":"Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University) Nanjing China"},{"name":"Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital Southeast University"},{"name":"State Key Laboratory of Digital Medical Engineering Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8534-0818","authenticated-orcid":false,"given":"Xiao\u2010Dong","family":"Zhou","sequence":"additional","affiliation":[{"name":"MAFLD Research Center, Department of Hepatology the First Affiliated Hospital of Wenzhou Medical University Wenzhou China"},{"name":"Institute of Hepatology Wenzhou Medical University Wenzhou China"},{"name":"Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4325-3900","authenticated-orcid":false,"given":"Giovanni","family":"Targher","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Verona Verona Italy"},{"name":"Metabolic Diseases Research Unit, IRCCS Sacro Cuore\u2014Don Calabria Hospital Negrar di Valpolicella Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6322-7753","authenticated-orcid":false,"given":"Christopher D.","family":"Byrne","sequence":"additional","affiliation":[{"name":"Southampton National Institute for Health and Care Research, Biomedical Research Centre University Hospital Southampton, and University of Southampton, Southampton General Hospital Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Center of Portal Hypertension, Department of Radiology Zhongda Hospital, Medical School, Southeast University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolong","family":"Qi","sequence":"additional","affiliation":[{"name":"Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University) Nanjing China"},{"name":"Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital Southeast University"},{"name":"State Key Laboratory of Digital Medical Engineering Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition Zhongda Hospital, School of Medicine, Southeast University Nanjing Jiangsu Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4984-2631","authenticated-orcid":false,"given":"Ming\u2010Hua","family":"Zheng","sequence":"additional","affiliation":[{"name":"MAFLD Research Center, Department of Hepatology the First Affiliated Hospital of Wenzhou Medical University Wenzhou China"},{"name":"Institute of Hepatology Wenzhou Medical University Wenzhou China"},{"name":"Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen\u2010Yue","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology the First Affiliated Hospital of Wenzhou Medical University Wenzhou China"},{"name":"Wenzhou Key Laboratory of Diabetes Research Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"WHO.Obesity and overweight.2024https:\/\/wwwwhoint\/en\/news-room\/fact-sheets\/detail\/obesity-and-overweight"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2024.155999"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1042\/cs20160221"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13679\u2010017\u20100256\u20109"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102848"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2024.11.016"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1614362"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/hep.0000000000000913"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2025.10.003"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41569\u2010025\u201001199\u2010y"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2213\u20108587(18)30288\u20102"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/circresaha.120.316101"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2025.08.017"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2013.10.003"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2024.102989"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(18)32225\u20106"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1210\/endrev\/bnaa004"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010159\u201011\u2010201312030\u201000008"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2213\u20108587(24)00316\u20104"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1467\u2010789x.2001.00031.x"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13679\u2010024\u201000580\u20101"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.5603\/KP.a2017.0149"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature05488"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00033.2011"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2023.110842"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13691"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2018.11.009"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010immunol\u2010031210\u2010101322"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2015.163"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591\u2010023\u201002248\u20100"}],"container-title":["Diabetes, Obesity and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/pdf\/10.1111\/dom.70271","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/full-xml\/10.1111\/dom.70271","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/pdf\/10.1111\/dom.70271","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T20:47:10Z","timestamp":1769719630000},"score":1,"resource":{"primary":{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/10.1111\/dom.70271"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,10]]},"references-count":30,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1111\/dom.70271"],"URL":"https:\/\/doi.org\/10.1111\/dom.70271","archive":["Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.1111\/DOM.70271\/v3\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.70271\/v2\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.70271\/v1\/review3","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.70271\/v1\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.70271\/v1\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.70271\/v2\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.70271\/v1\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.70271\/v3\/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":[[2025,11,10]]},"assertion":[{"value":"2025-09-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}