CoChat
Sign Up
Cited by 2,326Cardiovascular Function and Risk FactorsCardiovascular Disease and AdiposityDiabetes, Cardiovascular Risks, and Lipoproteins

Obesity and Cardiovascular Disease

Open access
Lavie, Carl J., Milani, Richard V., Ventura, Hector O.·2009·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2008.12.068
Open this paper in CoChat — free accountOpen PDF

Abstract

Obesity has reached global epidemic proportions in both adults and children and is associated with numerous comorbidities, including hypertension (HTN), type II diabetes mellitus, dyslipidemia, obstructive sleep apnea and sleep-disordered breathing, certain cancers, and major cardiovascular (CV) diseases. Because of its maladaptive effects on various CV risk factors and its adverse effects on CV structure and function, obesity has a major impact on CV diseases, such as heart failure (HF), coronary heart disease (CHD), sudden cardiac death, and atrial fibrillation, and is associated with reduced overall survival. Despite this adverse association, numerous studies have documented an obesity paradox in which overweight and obese people with established CV disease, including HTN, HF, CHD, and peripheral arterial disease, have a better prognosis compared with nonoverweight/nonobese patients. This review summarizes the adverse effects of obesity on CV disease risk factors and its role in the pathogenesis of various CV diseases, reviews the obesity paradox and potential explanations for these puzzling data, and concludes with a discussion regarding the current state of weight reduction in the prevention and treatment of CV diseases.

Integrity signals

Registry

Crossref · 10.1016/j.jacc.2008.12.068

Cites

94 of 94 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 71 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    In that 530-patient study, the weight-loss group had a trend toward lower mortality.

    “In a study of 530 patients, we noted marked improvements in CHD risk factors among overweight and obese CHD patients who lost weight, including CRP, lipids, and glucose, and this group had a trend of lower mortality (48).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Lavie, 2009, The obesity paradox, weight loss, and coronary disease, Am J Med source

      Not checked in the free run.

  • Findingcitation

    Among 45 obese patients who lost at least 5% of weight (average 10%) after cardiac rehabilitation, exercise capacity and plasma lipids improved more than in 81 obese patients who did not lose weight.

    “In a small subgroup of 45 obese patients with 5% or more weight loss (average 10%) after cardiac rehabilitation, we noted more significant improvements in exercise capacity and plasma lipids than in 81 obese patients who did not lose weight (76).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [76] Lavie, 1997, Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients, Am J Cardiol source

      Not checked in the free run.

  • Findingcitation

    In a 530-patient study, overweight and obese coronary heart disease patients who lost weight showed marked improvements in CRP, lipids, and glucose.

    “In a study of 530 patients, we noted marked improvements in CHD risk factors among overweight and obese CHD patients who lost weight, including CRP, lipids, and glucose, and this group had a trend of lower mortality (48).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Lavie, 2009, The obesity paradox, weight loss, and coronary disease, Am J Med source

      Not checked in the free run.

  • Premisecitation

    In 5,881 Framingham Heart Study participants followed for 14 years, each 1 kg/m2 increase in BMI was associated with a 5% higher risk of heart failure in men and a 7% higher risk in women.

    “In a study of 5,881 Framingham Heart Study participants, Kenchaiah et al. (30) showed that during a 14-year follow-up, for every 1 kg/m 2 increment in BMI, the risk of HF increased 5% in men and 7% in women.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Kenchaiah, 2002, Obesity and the risk of heart failure, N Engl J Med source

      Not checked in the free run.

  • Interpretationcitation

    Left atrial enlargement may increase the risk of atrial fibrillation and its morbid complications.

    “These abnormalities not only increase the risk of HF, but LA enlargement may increase the risk of AF and its morbid complications discussed later (20).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Wang, 2004, Obesity and the risk of new-onset atrial fibrillation, JAMA source

      Not checked in the free run.

  • May combine two claims. 26
  • Classified as probably not a substantial claim. 2
  • The quote only partly states this claim. 2

  • May combine two claims.

    Findingcitation

    After cardiac rehabilitation, obese coronary heart disease patients showed marked CRP reductions, while lean patients had only slight, nonsignificant CRP declines.

    “Recently, we noted marked reductions after cardiac rehabilitation in CRP levels in obese CHD patients, whereas lean patients had only slight and nonsignificant declines in CRP (77).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] Lavie, 2008, Impact of cardiac rehabilitation on coronary risk factors, inflammation, and the metabolic syndrome in obese coronary patients, J Cardiometab Syndr source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Some long-term studies show that weight loss in overweight and obesity is associated with increased mortality, and many cardiovascular studies show better prognosis with higher BMI, leading to the suggestion that purposeful weight loss may not be beneficial and may even be detrimental in patients with cardiovascular diseases.

    “Considering that some long-term studies have shown that weight loss in overweight and obesity is associated with increased mortality coupled with many CV studies showing a better prognosis with a higher BMI, it has been suggested that purposeful weight loss may not be beneficial and may even be detrimental in patients with CV diseases (31,66 -68).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [31] Horwich, 2001, The relationship between obesity and mortality in patients with heart failure, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [66] Fonarow, 2002, Obesity, weight reduction and survival in heart failure: reply, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [67] Allison, 1999, Weight loss increases and fat loss decreases all-cause mortality rates: results from two independent cohort studies, Int J Obes Relat Metab Disord source

      Not checked in the free run.

    • cites [68] Sierra-Johnson, 2008, Prognostic importance of weight loss in patients with coronary heart disease regardless of initial body mass index, Eur Cardiovasc Prev Rehabil source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The adipocyte acts as an endocrine organ and plays a substantial role in the pathogenesis and complications of obesity.

    “The adipocyte acts as an endocrine organ, and plays a substantial role in the pathogenesis and complications of obesity (1,10).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Poirier, 2006, Circulation source

      Not checked in the free run.

    • cites [10] Martin, 2008, Leptin resistance, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § STATE-OF-THE-ART PAPER Obesity and Cardiovascular Disease Risk Factor, Paradox, and Impact of Weight Loss

    Obesity is associated with more morbidity than smoking, alcoholism, and poverty, and if current trends continue it may soon overtake cigarette abuse as the leading cause of preventable death in the United States.

    “Recent evidence indicates that obesity is associated with more morbidity than smoking, alcoholism, and poverty, and if current trends continue, obesity may soon overtake cigarette abuse as the leading cause of preventable death in the U.S. (6 -8).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [6] Lavie, 2003, Obesity and cardiovascular disease: the Hippocrates paradox?, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [7] Manson, 2003, Obesity in the United States: a fresh look at its high toll, JAMA source

      Not checked in the free run.

    • cites [8] Sturm, 2001, Does obesity contribute as much to morbidity as poverty or smoking?, Public Health source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Obstructive sleep apnea may contribute to the pathogenesis of hypertension and increased inflammation and CRP.

    “In fact, OSA may contribute to the pathogenesis of HTN and increased inflammation and CRP (61).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] Shamsuzzaman, 2002, Elevated C-reactive protein in patients with obstructive sleep apnea, Circulation source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § STATE-OF-THE-ART PAPER Obesity and Cardiovascular Disease Risk Factor, Paradox, and Impact of Weight Loss

    In the United States, adult obesity prevalence increased by nearly 50% during the 1980s and 1990s, and nearly 70% of adults are now overweight or obese compared with fewer than 25% 40 years ago.

    “with the prevalence among adults increasing by nearly 50% during the 1980s and 1990s (5); now, nearly 70% of adults are classified as overweight or obese compared with fewer than 25% 40 years ago (5)(6)(7).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [5] Flegal, 2002, Prevalence and trends in obesity among US adults, 1999–2000, JAMA source

      Not checked in the free run.

    • cites [6] Lavie, 2003, Obesity and cardiovascular disease: the Hippocrates paradox?, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [7] Manson, 2003, Obesity in the United States: a fresh look at its high toll, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Obesity is a classic cause of alveolar hypoventilation and obstructive sleep apnea syndrome.

    “Obesity is a classic cause of alveolar hypoventilation and the obstructive sleep apnea (OSA) syndrome (60).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [60] Trollo, 1996, Obstructive sleep apnea, N Engl J Med source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In over 30,000 patients with preserved left ventricular systolic function referred for echocardiography, BMI was inversely related to all-cause mortality; underweight patients had the highest mortality, while overweight, mildly obese, and obese patients with BMI at least 35 had lower mortality than those with ideal BMI.

    “We have also documented the inverse relationship between BMI and all-cause mortality in over 30,000 patients with preserved LV systolic function referred for echocardiography (18).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Lavie, 2007, Disparate effects of left ventricular geometry and obesity on mortality in patients with preserved left ventricular ejection fraction, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning
    § STATE-OF-THE-ART PAPER Obesity and Cardiovascular Disease Risk Factor, Paradox, and Impact of Weight Loss

    Obesity adversely affects cardiovascular structure and function and thereby has a major impact on heart failure, coronary heart disease, sudden cardiac death, and atrial fibrillation, and it is associated with reduced overall survival.

    “Because of its maladaptive effects on various CV risk factors and its adverse effects on CV structure and function, obesity has a major impact on CV diseases, such as heart failure (HF), coronary heart disease (CHD), sudden cardiac death, and atrial fibrillation, and is associated with reduced overall survival.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In coronary heart disease patients with BMI at least 35 kg/m2, there was excess cardiovascular mortality risk without any increase in total mortality.

    “However, in patients with a BMI Ն35 kg/m 2 , there was an excess risk for CV mortality without any increase in total mortality.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [47] Romero-Corral, 2006, Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § STATE-OF-THE-ART PAPER Obesity and Cardiovascular Disease Risk Factor, Paradox, and Impact of Weight Loss

    Obesity has become a global epidemic in adults and children and is linked to many comorbidities, including hypertension, type II diabetes, dyslipidemia, obstructive sleep apnea, certain cancers, and major cardiovascular diseases.

    “Obesity has reached global epidemic proportions in both adults and children and is associated with numerous comorbidities, including hypertension (HTN), type II diabetes mellitus, dyslipidemia, obstructive sleep apnea and sleep-disordered breathing, certain cancers, and major cardiovascular (CV) diseases.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Lavie, 2003, Obesity and cardiovascular disease: the Hippocrates paradox?, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Obese patients typically have higher cardiac output but lower total peripheral resistance at any given arterial pressure.

    “Typically, obese patients have a higher cardiac output but a lower level of total peripheral resistance at any given level of arterial pressure (14,15).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [14] Alpert, 2001, Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome, Am J Med Sci source

      Not checked in the free run.

    • cites [15] Messerli, 1982, Borderline hypertension and obesity: two prehypertensive states with elevated cardiac output, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In five population-based studies enrolling 78,602 patients, obese patients had nearly a 50% increased risk of developing atrial fibrillation that escalated with increasing BMI.

    “In the subgroup of 5 population-based studies enrolling 78,602 patients, obese patients had a nearly 50% increased risk of developing AF that escalated with increasing BMI.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] Wanahita, 2008, Atrial fibrillation and obesity—results of a meta-analysis, Am Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In 108,927 decompensated heart failure patients, higher BMI was associated with lower in-hospital mortality, and each 5-unit increase in BMI was associated with 10% lower mortality risk.

    “Likewise, in an analysis of BMI and in-hospital mortality for 108,927 decompensated HF patients, higher BMI was associated with lower mortality (35).”
    • Also stated in: § Clinical Consequences of Obesity · plain
      “In fact, for every 5-unit increase in BMI, the risk of mortality was 10% lower (p Ͻ 0.001).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Fonarow, 2007, An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the acute decompensated heart failure national registry, Am Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § STATE-OF-THE-ART PAPER Obesity and Cardiovascular Disease Risk Factor, Paradox, and Impact of Weight Loss

    A study of nearly 360,000 participants from nine European countries found that general obesity and abdominal adiposity are associated with mortality risk, supporting the use of waist circumference or waist-to-hip ratio in addition to BMI for mortality risk assessment.

    “A recent study of nearly 360,000 participants from 9 European countries showed that both general obesity and abdominal adiposity are associated with risk of death and support the importance of WC or WHR in addition to BMI for assessing mortality risk (4).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Pischon, 2008, General and abdominal adiposity and risk of death in Europe, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Starvation, very-low-calorie diets, liquid protein diets, and obesity surgeries are associated with QTc prolongation and increased risk of malignant dysrhythmias, and various pharmacologic agents have limited efficacy or considerable toxicity.

    “Certainly, starvation, very-low-calorie diets, liquid protein diets, and obesity surgeries have been associated with prolongation of the QTc interval and increased risk of malignant dysrhythmias (1), and various pharmacologic agents have either limited efficacy or considerable toxicity (70 -72).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [1] Poirier, 2006, Circulation source

      Not checked in the free run.

    • cites [70] Connolly, 1997, Valvular heart disease associated with fenfluramine-phentermine, N Engl J Med source

      Not checked in the free run.

    • cites [71] Albenhaim, 1996, Appetite-suppressant drugs and the risk of primary pulmonary hypertension, N Engl J Med source

      Not checked in the free run.

    • cites [72] Zannad, 2002, Effects of sibutramine on ventricular dimensions and heart valves in obese patients during weight reduction, Am Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Obesity increases total blood volume and cardiac output, and cardiac workload is greater in obesity.

    “Obesity increases total blood volume and cardiac output, and cardiac workload is greater in obesity.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] Alpert, 2001, Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome, Am J Med Sci source

      Not checked in the free run.

  • The quote only partly states this claim.

    Premisecitation

    In 2,392 peripheral arterial disease patients who had undergone major vascular surgery, there was a powerful obesity paradox with progressive mortality reductions in normal BMI, overweight, and obese groups compared with underweight patients.

    “This study also showed a powerful obesity paradox, with progressive reductions in mortality in normal BMI, overweight, and obese groups compared with underweight patients.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] Galal, 2009, The obesity paradox in patients with peripheral arterial disease: the influence of chronic obstructive pulmonary disease, Chest source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    For each 1-unit increase in BMI, the risk of ischemic stroke increases by 4% and the risk of hemorrhagic stroke increases by 6%.

    “In fact, for each 1-U increase in BMI, there was an increase of 4% in the risk of ischemic stroke and 6% for hemorrhagic stroke (1,53).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Poirier, 2006, Circulation source

      Not checked in the free run.

    • cites [53] Kurth, 2002, Body mass index and the risk of stroke in men, Arch Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a multivariate model, leptin was an independent predictor of cardiovascular events, whereas CRP was not.

    “In a multivariate model, leptin was an independent predictor of CV events, whereas CRP was not.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Increased concentrations of both CRP and leptin are associated with increased risk of major cardiovascular events, but leptin appears to be a more robust predictor.

    “Recently, increased concentrations of both CRP and leptin were associated with an increased risk of major CV events, but leptin seems to be a more robust predictor (13).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Romero-Corral, 2008, Relationships between leptin and C-reactive protein with cardiovascular disease in the adult general population, Nat Clin Pract Cardiovasc Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent small study suggests that bariatric surgery is safe and effective for patients with severe systolic heart failure.

    “a recent small study suggests that bariatric surgery is safe and effective in patients with severe systolic HF (87).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [87] Ramani, 2008, Safety and efficacy of bariatric surgery in morbidly obese patients with severe systolic heart failure, Clin Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In heart failure, despite the obesity paradox, trials suggest that weight loss can improve left ventricular mass and systolic and diastolic ventricular function.

    “In HF, despite the obesity paradox, trials have suggested that weight loss can induce improvements in LV mass as well as in systolic and diastolic ventricular function (14).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] Alpert, 2001, Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome, Am J Med Sci source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Thirty-day mortality after gastric bypass has been reported to be higher than expected and closely linked to surgeon inexperience.

    “Although 30-day mortality after gastric bypass has recently been reported to be higher than expected, closely linked to surgeon inexperience (80)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [80] Flum, 2004, Impact of gastric bypass operation on survival: a population-based analysis, J Am Coll Surg source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Weight loss was also associated with marked improvements in left ventricular chamber size, left ventricular end-systolic wall stress, and systolic and diastolic left ventricular function.

    “Weight loss also was associated with marked improvements in LV chamber size, LV end-systolic wall stress, and systolic and diastolic LV function.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Alpert, 1997, Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The cited studies justify intentional weight loss in overweight and obese patients with coronary heart disease, even though the obesity paradox exists.

    “These studies support purposeful weight reduction in overweight and obese CHD patients, despite the obesity paradox.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Bariatric surgery is associated with short- and long-term improvements in major morbidity and all-cause mortality, particularly from cancers, diabetes, and cardiovascular diseases.

    “more studies are now showing that these surgical procedures are associated with short-and long-term improvements in major morbidity and all-cause mortality, particularly related with cancers, DM, and CV diseases”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [81] Adams, 2007, Long-term mortality after gastric bypass surgery, N Engl J Med source

      Not checked in the free run.

    • cites [82] Sjöström, 2007, Effects of bariatric surgery on mortality in Swedish obese subjects, N Engl J Med source

      Not checked in the free run.

    • cites [83] Christou, 2004, Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients, Ann Surg source

      Not checked in the free run.

27 of 27

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

2 of the 96 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Lavie, C. J., Milani, R. V., & Ventura, H. O.
Affiliations
  • Ochsner Health System (US)
  • Ochsner Medical Center (US)
Corresponding author
Lavie, Carl J.
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2009-05
Volume
53
Issue
21
Pages
1925-1932
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2008.12.068
OpenAlex
W1598667444
Cited by
2,326
References
96
Citations by year
2026: 87 · 2025: 110 · 2024: 129 · 2023: 107 · 2022: 130 · 2021: 159 · 2020: 162 · 2019: 135 · 2018: 143 · 2017: 141 · 2016: 157 · 2015: 139 · 2014: 152 · 2013: 153 · 2012: 135
FWCI
20.43
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
obesity, cardiovascular disease, obesity paradox, heart failure, coronary artery disease, sudden cardiac death, atrial fibrillation, hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, cardiovascular risk factors, weight loss, obesity pathogenesis
MeSH terms
Cardiovascular Diseases, Humans, Obesity, Risk Factors, United States, Weight Loss, Prevalence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-04.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-04.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review