{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:14:41Z","timestamp":1788412481067,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100002635","name":"Inha University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002635","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":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Body mass index (BMI) inadequately captures heterogeneity in cardiovascular (CV) risk. We hypothesised that a \u2018Slow Burn\u2019 phenotype, defined as lower\u2010than\u2010expected energy intake relative to BMI, age, and sex, identifies individuals at elevated CV risk across the BMI spectrum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed 160\u2009905 White\/European participants from the UK Biobank. Relative caloric intake status was derived using residuals from a linear model predicting energy intake from BMI, age, and sex and categorised as low (LI; the \u2018Slow Burn\u2019 phenotype, &lt;\u200930th percentile), normal (NI, 30th\u201370th), or high (HI, &gt;\u200970th). Nine phenotypes were defined by combining intake groups with BMI categories: normal weight (NW), overweight (OW), and obese (OB). The primary outcome was 3\u2010point major adverse cardiovascular events (3P\u2010MACE: myocardial infarction [MI], stroke, and CV mortality).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with the NI group, the LI phenotype was associated with a higher risk of 3P\u2010MACE (adjusted hazard ratio [aHR] 1.07, 95% CI 1.01\u20131.14) and MI (aHR 1.15, 95% CI 1.06\u20131.25), while the HI group showed no increased risk. In BMI\u2010stratified analyses, the NW\u2010LI (Normal\u2010Weight Slow Burn) phenotype demonstrated an increased 3P\u2010MACE risk (aHR 1.17; 95% CI 1.04\u20131.33) versus the NW\u2010NI reference. Mediation analysis revealed that low muscle strength accounted for 5.2% (95% CI 1.6%\u201317.7%) of the excess risk in the normal\u2010weight stratum, whereas MASLD showed no evidence of mediation. Longitudinally, NW\u2010LI participants were more prone to future weight gain than their NI counterparts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Relative caloric intake identifies a high\u2010risk \u2018Slow Burn\u2019 phenotype, characterised by increased cardiovascular risk despite lower\u2010than\u2010expected caloric intake. These findings highlight the limitations of BMI\u2010based risk assessment and support risk\u2010stratification strategies that incorporate energy balance and functional status.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71192","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T01:33:24Z","timestamp":1785980004000},"page":"9644-9654","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The \u2018Slow Burn\u2019 Phenotype: How Relative Caloric Intake Reveals Hidden Cardiovascular Risk Beyond\n                    <scp>BMI<\/scp>"],"prefix":"10.1111","volume":"28","author":[{"given":"Yongin","family":"Cho","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism Inha University School of Medicine  Incheon Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1255-1323","authenticated-orcid":false,"given":"Jong Hyun","family":"Jhee","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital Yonsei University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong Ho","family":"Jhee","sequence":"additional","affiliation":[{"name":"Inria, Inserm Universit\u00e9 Paris Cit\u00e9, UMR 1346  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5757-6233","authenticated-orcid":false,"given":"Hye\u2010Sun","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Internal Medicine, Gangnam Severance Hospital Yonsei University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwac187"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2018.07.003"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2020.35.2.416"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2022.11.013"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-024-01008-5"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(24)00316-4"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.064071"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-2832"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m688"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.115.116046"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60404-8"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001779"},{"key":"e_1_2_10_14_1","unstructured":"C. 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