{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:19:09Z","timestamp":1787548749375,"version":"build-2736575974"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic obstructive pulmonary disease (COPD) is a systemic disorder characterized by significant body composition alterations, including muscle loss (sarcopenia) and abnormal fat distribution. These changes contribute to a high metabolic burden, with increased resting energy expenditure and systemic inflammation accelerating disease progression. Traditional assessments like body mass index (BMI) fail to capture these complex interactions. This study aimed to evaluate a multidimensional \u201cmuscle-fat-metabolism\u201d framework for stratifying COPD risk and severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this multi-center, cross-sectional study, 377 participants (213 stable COPD patients, 164 healthy controls) underwent bioelectrical impedance analysis (BIA) to assess body composition parameters, including fat-free mass index (FFMI), appendicular skeletal muscle mass index (ASMI), visceral fat area (VFA), and basal metabolic rate (BMR) and other indicators. Spirometry was used to confirm COPD diagnosis and grade severity according to GOLD criteria. Statistical analyses included between-group comparisons, correlation analyses, and multivariate logistic regression to develop predictive models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>COPD patients exhibited significantly lower skeletal muscle mass (FFMI, ASMI) and higher systemic fat levels (FM, BFP) compared with controls. Logistic regression analysis suggested that FFMI and ASMI may be protective against COPD risk and severity, whereas FM and BFP may be risk factors for it. Appendicular and truncal fat decreased progressively with advancing GOLD stage. The integrated muscle-fat-metabolism model achieved excellent predictive performance for severe COPD. Body composition and metabolic markers substantially improved risk stratification in patients with COPD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An integrative assessment of muscle, fat, metabolic, inflammatory, and functional indicators provided a more effective tool for stratifying COPD risk and severity than conventional metrics. This framework facilitates early identification of high-risk phenotypes like sarcopenic obesity and supports the development of personalized management strategies for COPD patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1835742","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T04:24:46Z","timestamp":1787545486000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A multidimensional muscle-fat-metabolism model for severity stratification in COPD: a multi-center cross-sectional study"],"prefix":"10.3389","volume":"13","author":[{"given":"Qianlian","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Shanghai Tenth People\u2019s Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]},{"name":"Department of Clinical Laboratory, Shanghai Tenth People\u2019s Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjie","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Shanghai Tongji Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hengxing","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueyuan","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Shanghai Tenth People\u2019s Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunlu","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Shanghai Tenth People\u2019s Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Shanghai Tenth People\u2019s Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Shanghai Tenth People\u2019s Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]},{"name":"State Key Laboratory of Pollution Control and Resource Reuse, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limin","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Second People\u2019s Hospital of Lianyungang & The Oncology Hospital of Lianyungang","place":["Lianyungang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuanshuan","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Shanghai Tenth People\u2019s Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunfeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Liqun Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"79","DOI":"10.2147\/COPD.S394907","article-title":"Body composition and COPD: a new perspective.","volume":"18","author":"Wang","year":"2023","journal-title":"Int J Chron Obstruct Pulmon Dis."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e069679","DOI":"10.1136\/bmj-2021-069679","article-title":"Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019.","volume":"378","author":"Safiri","year":"2022","journal-title":"BMJ."},{"key":"B3","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1038\/s41591-025-04077-9","article-title":"Global, regional, and national burden of chronic respiratory diseases and impact of the COVID-19 pandemic, 1990-2023: a Global Burden of Disease study.","volume":"32","author":"Oh","year":"2026","journal-title":"Nat Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/S2213-2600(21)00511-7","article-title":"Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis.","volume":"10","author":"Adeloye","year":"2022","journal-title":"Lancet Respir Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"9762","DOI":"10.26355\/eurrev_202310_34150","article-title":"Sarcopenia and its clinical correlation in elderly chronic obstructive pulmonary disease: a prospective cohort study.","volume":"27","author":"Wu","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci."},{"key":"B6","doi-asserted-by":"publisher","first-page":"465","DOI":"10.3390\/metabo10110465","article-title":"Metabolic syndrome and abnormal peri-organ or intra-organ fat (APIFat) deposition in chronic obstructive pulmonary disease: an overview.","volume":"10","author":"Katsiki","year":"2020","journal-title":"Metabolites."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2493","DOI":"10.3390\/nu13082493","article-title":"The utility of body composition assessment in nutrition and clinical practice: an overview of current methodology.","volume":"13","author":"Holmes","year":"2021","journal-title":"Nutrients"},{"key":"B8","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/S2213-2600(12)70060-7","article-title":"Chronic obstructive pulmonary disease and comorbidities.","volume":"1","author":"Decramer","year":"2013","journal-title":"Lancet Respir Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"33","DOI":"10.14336\/AD.2022.0603","article-title":"Skeletal muscle mitochondrial dysfunction in chronic obstructive pulmonary disease: underlying mechanisms and physical therapy perspectives.","volume":"14","author":"Wang","year":"2023","journal-title":"Aging Dis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1002\/jcsm.12600","article-title":"Diagnosis, prevalence, and clinical impact of sarcopenia in COPD: a systematic review and meta-analysis.","volume":"11","author":"Sep\u00falveda-Loyola","year":"2020","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"B11","doi-asserted-by":"publisher","first-page":"E457","DOI":"10.1503\/cmaj.140025","article-title":"Body size and physical activity in relation to incidence of chronic obstructive pulmonary disease.","volume":"186","author":"Behrens","year":"2014","journal-title":"CMAJ."},{"key":"B12","doi-asserted-by":"publisher","first-page":"423","DOI":"10.2147\/COPD.S22885","article-title":"Excessive visceral fat accumulation in advanced chronic obstructive pulmonary disease.","volume":"6","author":"Furutate","year":"2011","journal-title":"Int J Chron Obstruct Pulmon Dis."},{"key":"B13","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1186\/s12877-025-06310-z","article-title":"Predictive efficacy of waist-related indices for sarcopenic obesity incidence in Chinese older adults: a nationwide cohort study.","volume":"25","author":"Zhang","year":"2025","journal-title":"BMC Geriatr."},{"key":"B14","doi-asserted-by":"publisher","first-page":"170","DOI":"10.3760\/cma.j.cn112147-20210109-00031","article-title":"[Guidelines for the diagnosis and management of chronic obstructive pulmonary disease (revised version 2021)].","volume":"44","year":"2021","journal-title":"Zhonghua Jie He He Hu Xi Za Zhi."},{"key":"B15","first-page":"1","article-title":"Obesity: preventing and managing the global epidemic. Report of a WHO consultation.","volume":"894","year":"2000","journal-title":"World Health Organ Tech Rep Ser."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1504","DOI":"10.1183\/09031936.00070914","article-title":"Nutritional assessment and therapy in COPD: a European respiratory society statement.","volume":"44","author":"Schols","year":"2014","journal-title":"Eur Respir J."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e97556","DOI":"10.7759\/cureus.97556","article-title":"Research progress of sarcopenia index in chronic obstructive pulmonary disease: a review.","volume":"17","author":"Li","year":"2025","journal-title":"Cureus."},{"key":"B18","doi-asserted-by":"publisher","first-page":"2180","DOI":"10.1016\/j.clnu.2018.09.014","article-title":"Malnutrition according to ESPEN consensus predicts hospitalizations and long-term mortality in rehabilitation patients with stable chronic obstructive pulmonary disease.","volume":"38","author":"Marco","year":"2019","journal-title":"Clin Nutr."},{"key":"B19","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.cger.2016.08.002","article-title":"Pathogenesis and management of sarcopenia.","volume":"33","author":"Dhillon","year":"2017","journal-title":"Clin Geriatr Med."},{"key":"B20","doi-asserted-by":"crossref","DOI":"10.1093\/med\/9780198837114.001.0001","volume-title":"Oxford Handbook of Respiratory Medicine 4e.","author":"Chapman","year":"2021"},{"key":"B21","doi-asserted-by":"publisher","first-page":"S1377","DOI":"10.21037\/jtd.2018.05.81","article-title":"Can muscle protein metabolism be specifically targeted by nutritional support and exercise training in chronic obstructive pulmonary disease?","volume":"10","author":"Lakhdar","year":"2018","journal-title":"J Thorac Dis."},{"key":"B22","doi-asserted-by":"publisher","first-page":"34","DOI":"10.47176\/mjiri.35.34","article-title":"Muscle mass and function are related to respiratory function in chronic obstructive pulmonary disease.","volume":"35","author":"Ahmadi","year":"2021","journal-title":"Med J Islam Repub Iran."},{"key":"B23","doi-asserted-by":"publisher","first-page":"E418","DOI":"10.3978\/j.issn.2072-1439.2015.08.04","article-title":"Muscle dysfunction in chronic obstructive pulmonary disease: update on causes and biological findings.","volume":"7","author":"Gea","year":"2015","journal-title":"J Thorac Dis."},{"key":"B24","doi-asserted-by":"publisher","first-page":"S1415","DOI":"10.21037\/jtd.2018.04.168","article-title":"Muscle atrophy in chronic obstructive pulmonary disease: molecular basis and potential therapeutic targets.","volume":"10","author":"Barreiro","year":"2018","journal-title":"J Thorac Dis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"173","DOI":"10.4274\/MMJ.galenos.2022.06787","article-title":"How to utilize CAT and mMRC scores to assess symptom status of patients with COPD in clinical practice?","volume":"37","author":"Ertan Yazar","year":"2022","journal-title":"Medeni Med J."},{"key":"B26","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1186\/s12931-023-02521-3","article-title":"Incident low muscle mass is associated with greater lung disease and lower circulating leptin in a tobacco-exposed longitudinal cohort.","volume":"24","author":"Zou","year":"2023","journal-title":"Respir Res."},{"key":"B27","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1183\/09031936.00197314","article-title":"Antagonistic implications of sarcopenia and abdominal obesity on physical performance in COPD.","volume":"46","author":"van de Bool","year":"2015","journal-title":"Eur Respir J."},{"key":"B28","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.gaitpost.2015.09.004","article-title":"Balance recovery is compromised and trunk muscle activity is increased in chronic obstructive pulmonary disease.","volume":"43","author":"Smith","year":"2016","journal-title":"Gait Posture."},{"key":"B29","doi-asserted-by":"publisher","first-page":"104","DOI":"10.3389\/fphys.2014.00104","article-title":"Structural alterations of skeletal muscle in copd.","volume":"5","author":"Mathur","year":"2014","journal-title":"Front Physiol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"R1142","DOI":"10.1152\/ajpregu.00835.2010","article-title":"Evidence that a higher ATP cost of muscular contraction contributes to the lower mechanical efficiency associated with COPD: preliminary findings.","volume":"300","author":"Layec","year":"2011","journal-title":"Am J Physiol Regul Integr Comp Physiol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/1475-2891-11-37","article-title":"Resting energy expenditure and carbohydrate oxidation are higher in elderly patients with COPD: a case control study.","volume":"11","author":"Ramires","year":"2012","journal-title":"Nutr J."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e0150586","DOI":"10.1371\/journal.pone.0150586","article-title":"Inflammatory markers and the risk of chronic obstructive pulmonary disease: a systematic review and meta-analysis.","volume":"11","author":"Su","year":"2016","journal-title":"PLoS One."},{"key":"B33","doi-asserted-by":"publisher","first-page":"5086","DOI":"10.21037\/jtd.2018.08.67","article-title":"Body mass index of patients with chronic obstructive pulmonary disease is associated with pulmonary function and exacerbations: a retrospective real world research.","volume":"10","author":"Wu","year":"2018","journal-title":"J Thorac Dis."},{"key":"B34","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.clnesp.2019.02.009","article-title":"Insufficient intake of energy and protein is related to physical functional capacity among COPD patients referred to municipality based pulmonary rehabilitation.","volume":"30","author":"Holst","year":"2019","journal-title":"Clin Nutr ESPEN."},{"key":"B35","doi-asserted-by":"publisher","first-page":"7349","DOI":"10.3390\/ijms23137349","article-title":"Adipose tissue inflammation and pulmonary dysfunction in obesity.","volume":"23","author":"Palma","year":"2022","journal-title":"Int J Mol Sci."},{"key":"B36","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1080\/17476348.2018.1506331","article-title":"The effect of obesity on lung function.","volume":"12","author":"Dixon","year":"2018","journal-title":"Expert Rev Respir Med."},{"key":"B37","doi-asserted-by":"crossref","DOI":"10.35339\/msz.2019.82.01.06","article-title":"Metabolic Role of Visceral Adipose Tissue and Main Methods of its Diagnosis at the Present Stage.","author":"Fadieienko","year":"2020"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e0231072","DOI":"10.1371\/journal.pone.0231072","article-title":"Metabolic profiles among COPD and controls in the CanCOLD population-based cohort.","volume":"15","author":"Viglino","year":"2020","journal-title":"PLoS One."},{"key":"B39","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1164\/ajrccm.155.2.9032193","article-title":"Total free living energy expenditure in patients with severe chronic obstructive pulmonary disease.","volume":"155","author":"Baarends","year":"1997","journal-title":"Am J Respir Crit Care Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1404615","DOI":"10.3389\/fimmu.2024.1404615","article-title":"Inflammation mechanism and research progress of COPD.","volume":"15","author":"Xu","year":"2024","journal-title":"Front Immunol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"597675","DOI":"10.3389\/fphys.2020.597675","article-title":"Inflammation and skeletal muscle wasting during cachexia.","volume":"11","author":"Webster","year":"2020","journal-title":"Front Physiol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.rmed.2017.11.006","article-title":"Malnutrition and sarcopenia assessment in patients with chronic obstructive pulmonary disease according to international diagnostic criteria, and evaluation of raw BIA variables.","volume":"134","author":"de Blasio","year":"2018","journal-title":"Respir Med."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1038\/s41598-022-05192-0","article-title":"The impact of hydration status and fluid distribution on pulmonary function in COPD patients.","volume":"12","author":"Orea-Tejeda","year":"2022","journal-title":"Sci Rep."},{"key":"B44","doi-asserted-by":"publisher","first-page":"230","DOI":"10.3390\/arm92030023","article-title":"Extracellular water ratio and phase angle as predictors of exacerbation in chronic obstructive pulmonary disease.","volume":"92","author":"Xie","year":"2024","journal-title":"Adv Respir Med."}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1835742\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T04:24:49Z","timestamp":1787545489000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1835742\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":44,"alternative-id":["10.3389\/fnut.2026.1835742"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1835742","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"article-number":"1835742"}}