Mechanisms of insulin resistance in obesity. Front Med. 2013;7:14-24. [PMID: 23471659 DOI: 10.1007/s11684-013-0262-6]

Lipid-based nano-carriers for the delivery of anti-obesity natural compounds: advances in targeted delivery and precision therapeutics

Obesity is a major global health challenge, contributing to metabolic disorders such as type 2 diabetes, cardiovascular diseases, and hypertension. The increasing prevalence of obesity, driven by sedentary lifestyles, poor dietary habits, and genetic predisposition, underscores the urgent need for effective therapeutic strategies. Conventional pharmacological treatments, including appetite suppressants and metabolic modulators, often fail to provide sustainable weight loss due to side effects, poor adherence, and limited long-term efficacy. As a result, natural bioactive compounds have gained attention for their anti-obesity potential. However, their clinical application is hindered by poor bioavailability, rapid metabolism, and inefficient delivery. Lipid-based nano-carriers, including liposomes, solid lipid nanoparticles, and nanostructured lipid carriers, offer a promising solution by enhancing the solubility, stability, and targeted delivery of these compounds. These advanced delivery systems improve bioactive retention, enable controlled release, and enhance therapeutic action on adipose tissue and metabolic pathways. Additionally, functionalized and stimulus-responsive nanocarriers present innovative approaches for precision obesity treatment. Despite these advancements, challenges remain in large-scale production, regulatory approval, and long-term safety. Overcoming these barriers is critical to ensuring the successful clinical translation of nano-formulated therapies. This review explores the potential of lipid-based nano-carriers in optimizing the therapeutic efficacy of natural anti-obesity compounds and highlights their role in advancing next-generation obesity management strategies.

Mechanisms through which laparoscopic sleeve gastrectomy mitigates atherosclerosis risk: a focus on visceral adipose tissue

Bariatric surgery is currently considered the key treatment method for patients with obesity and related complications. Among the various surgeries, laparoscopic sleeve gastrectomy (LSG) is the most widely used. Obesity is a multifactor chronic disease characterized by the accumulation of visceral adipose tissue (VAT), leading to susceptibility to cardiac metabolic diseases. Many mechanisms, including abnormal lipid metabolism, insulin resistance, inflammation, endothelial dysfunction, adipocytokine imbalance and inflammasome activation, have been identified as the basis for the relationship between obesity and atherosclerosis. Bariatric surgery, such as LSG, reduces the risk of atherosclerosis in people living with obesity by reducing energy intake, disrupting energy balance and reducing the secretion of intestinal hormones to intervene in these risk factors. This review explores the current understanding of how LSG affects VAT and its impact on the risk of atherosclerosis.

Association among obesity, insulin resistance, and depressive symptoms: a mediation analysis

BACKGROUND

The mechanistic role of insulin resistance(IR) between obesity and Depressive Symptoms has long been debated.

OBJECTIVE

This study aims to explore the relationship between BMI and Depressive Symptoms to investigate the mediating role of IR in this association.

METHODS

We rigorously selected data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Multivariate logistic regression analysis, Restricted cubic splines (RCS) and Subgroup analysis were employed to assess the correlation between obesity and Depressive Symptoms. Mediation analysis was conducted to examine the role of IR in the relationship between Overweight/obesity and Depressive Symptoms.

RESULTS

After strict exclusion, the final analysis included 12,744 participants. Multivariate logistic regression analysis indicated a significant association between obesity and Depressive Symptoms. Subgroup analysis revealed an interaction from lack of exercise and vigorous activity levels to the association between obesity and Depressive Symptoms in the physical activity group (P for interaction < 0.05); A significant interaction was found between BMI and smoking status (P for interaction < 0.05). BMI was found to have an S-shaped association with Depressive Symptoms, becoming positively correlated after reaching a turning point (BMI > 23.22 kg/m², p < 0.001). IR partially mediated the potential impact of overweight/obesity on Depressive Symptoms (IR: 54.13%, p = 0.018).

CONCLUSION

Our study confirms a significant association between obesity and Depressive Symptoms. IR partially mediates the association between overweight/obesity and Depressive Symptoms. Furthermore, appropriate physical exercise and smoking may reduce the risk of depressive symptoms.

Hidden in the Fat: Unpacking the Metabolic Tango Between Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Syndrome

Metabolic syndrome (MetS) and metabolic dysfunction-associated steatotic liver disease (MASLD) are closely related, with rapidly increasing prevalence globally, driving significant public health concerns. Both conditions share common pathophysiological mechanisms such as insulin resistance (IR), adipose tissue dysfunction, oxidative stress, and gut microbiota dysbiosis, which contribute to their co-occurrence and progression. While the clinical implications of this overlap, including increased cardiovascular, renal, and hepatic risk, are well recognized, current diagnostic and therapeutic approaches remain insufficient due to the clinical and individuals' heterogeneity and complexity of these diseases. This review aims to provide an in-depth exploration of the molecular mechanisms linking MetS and MASLD, identify critical gaps in our understanding, and highlight existing challenges in early detection and treatment. Despite advancements in biomarkers and therapeutic interventions, the need for a comprehensive, integrated approach remains. The review also discusses emerging therapies targeting specific pathways, the potential of precision medicine, and the growing role of artificial intelligence in enhancing research and clinical management. Future research is urgently needed to combine multi-omics data, precision medicine, and novel biomarkers to better understand the complex interactions between MetS and MASLD. Collaborative, multidisciplinary efforts are essential to develop more effective diagnostic tools and therapies to address these diseases on a global scale.

Polymorphisms Involved in Insulin Resistance and Metabolic Inflammation: Influence of Nutrients and Dietary Interventions

Insulin resistance (IR) is a metabolic disorder characterized by an impaired response to insulin. This condition is associated with excess adiposity and metabolic inflammation, contributing to an increased risk for related chronic diseases. Single-nucleotide polymorphisms (SNPs) can affect genes related to metabolic pathways which are related to IR and the individual response to nutrients and dietary patterns, affecting metabolic inflammation and insulin sensitivity. This narrative review explores the current evidence on interactions between genetic variants and dietary factors, specifically their effects in modulating IR and metabolic inflammation. A comprehensive search of the literature was conducted in PubMed, Google Scholar, and Web of Science, and a total of 95 articles were reviewed. The key findings reveal that SNPs in the TCF7L2, ADIPOQ, and TNF genes significantly influence metabolic responses and modulate the effects of the Mediterranean diet on biomarkers of inflammation and IR. Genotype-dependent variations in IR and inflammation biomarkers were observed in the response to different diets for SNPs in the TCF7L2, ADIPOQ, and TNF genes. Additionally, polygenic risk scores (PRSs) can also predict the response to the intake of nutrients and specific diets, and offer a promising tool for assessing genetic predisposition to IR. This review underscores the pivotal role of an individual's genetic background in the effects of their nutrient intake and in the responses to dietetic interventions, thereby laying the foundation for personalized and effective nutritional strategies tailored to each individual's necessity in mitigating IR and its associated risk factors for chronic diseases.

Concurrent Lead and Cadmium Exposure Among Diabetics: A Case-Control Study of Socio-Demographic and Consumption Behaviors

Introduction/Objectives: Type 2 diabetes (T2D) continues to pose a substantial global public health challenge. Current evidence has linked an increase in the risk of T2D to chronic exposure to the heavy metals cadmium (Cd) and lead (Pb). The present study aimed to examine whether the reported links existed in an area of southern Thailand with known Pb contamination. Materials and Methods: A case-control study design was used to recruit 88 diagnosed T2D cases and 90 age-, gender- and locality-matched non-diabetic controls. Blood levels of Cd and Pb were used as exposure indicators. Exposure-related risk factors and socio-demographic data were collected through questionnaires. Results: A significant association was found between blood Pb and T2D diagnosis, but the association between blood Cd and T2D was not statistically significant. Factors related to high Pb exposure were education, occupation, income, smoking habits, alcohol consumption, and dietary patterns, particularly the consumption of sweet and fatty foods. Participants with higher blood Pb levels had poorer glycemic control, thereby suggesting potential interference of Pb with oral hypoglycemic agents. Conclusions: This study confirms the connection between Pb exposure and increased risk of having T2D. Additionally, it identified socio-demographic factors, and consumption habits that contributed to such an enhanced T2D risk. The role of Cd exposure requires further studies, using urinary Cd excretion, which reflects long-term exposure conditions. These findings suggest the need to incorporate environmental and occupational exposure in diabetes care strategies. From the clinical and public health perspectives, targeted interventions should focus on reducing heavy metal exposure, improving risk awareness, and strengthening occupational safety measures to prevent disease progression.

Cyclosorus terminans extract mitigates submandibular gland changes associated with high-fat diet consumption in male rats

OBJECTIVES

To investigate whether the prophylactic effect of Cyclosorus terminans extract mitigates metabolic impairment and submandibular gland changes, as indicated by increased aquaporin5 expression, decreased fibrosis, oxidative stress and inflammation, improved mitochondrial homeostasis/dynamics, and decreased cell death in the submandibular glands of high-fat diet (HFD)-feeding rats.

METHODS

Thirty-two male Wistar rats were assigned to either a normal diet (ND) as control rats (n=8) or a HFD (n=24) for 12 weeks. The HFD-treated rats were divided into 3 subgroups to receive either: 1) vehicle (HDV), 2) Cyclosorus terminans at a dose of 100 mg/kg/d (HF100), or 3) Cyclosorus terminans at a dose of 200 mg/kg/d (HF200). At week 13, metabolic parameters, systemic oxidative stress, and submandibular gland parameters were assessed.

RESULTS

Twelve weeks of HFD-feeding rats induced obese-insulin resistance and submandibular gland changes. Both HF100- and HF200-treated groups improved metabolic parameters and prevented gland changes by reducing fibrosis (TGF-β and p-38), malondialdehyde levels, inflammation (TNF-α, NF-κB, and Ifng), and cell death markers (Caspase 3, GSDMD, and MLKL). Both treatments supported balanced mitochondrial homeostasis/dynamics, as indicated by regulating related genes (Cpt1b, Ndufb8, Mfn1, Mfn2, Opa1, and Dnm1l). However, only the HF200-treated rats restored aquaporin-5 and antioxidants (SOD2 and GPX4) expression to control levels.

CONCLUSIONS

Cyclosorus terminans mitigates metabolic disturbances and submandibular gland changes in HFD-feeding rats. The high dose was more effective, improving gland function by increasing aquaporin5 and antioxidants. These results suggest Cyclosorus terminans may be a promising therapeutic for metabolic disturbances and submandibular gland changes in obese-insulin resistant patients.

Exercise-induced anxiety impairs local and systemic inflammatory response and glucose metabolism in C57BL/6J mice

Introduction

The complex physiological and psychological responses to regular exercise are yet to be fully elucidated. Exercise strongly modulates the immune system, inducing a plethora of dynamic responses involving the innate immune cell function and inflammatory processes that contribute to both potential health benefits and harmful side effects. Indeed, the relationship between physical exercise, stress, immunity, and metabolism serves as a paramount model of neuroimmunoendocrine interaction. Thus, the objective of this study was to conduct a comprehensive analysis of both systemic and local immunophysiological responses together with behavioral responses to a protocol of anxiety-inducing exercise.

Material and methods

C57BL/6J mice were randomly allocated into sedentary or exercised groups, where the anxiety-inducing exercise protocol was based on a 14-day consecutive program of swimming in water at 38 °C. Anxiety-like behavior was corroborated through the elevated plus maze test. Systemic biomarkers of the stress response were assessed using ELISA technique and the expression of systemic inflammatory cytokines with Bio-Plex system. Phagocytic/microbicide activity, the expression of M1/M2 phenotype markers (CD11c, iNOS, CD206, ARG-1) and cytokines of the inflammatory response (MCP-1, IL-8, IL-6, TNF-α, TGF-β, IL-10) of peritoneal macrophages were determined via flow cytometry. Adipose tissue macrophage infiltration was studied through fluorescence immunohistochemistry.

Results

Anxiety-like behavior, elevated circulating glucose concentrations, systemic stress and inflammatory responses, together with increased oxidative stress and inflammatory profile of peritoneal macrophages, and macrophage infiltration in white adipose tissue were observed in exercised animals.

Conclusions

A protocol of exercise that induces anxiety is associated with a neuroimmunoendocrine dysregulation affecting the feedback between the inflammatory and the stress responses, together with detrimental metabolic effects in glucose modulation. Systemic inflammatory alterations are accompanied by detrimental inflammatory responses in tissue macrophage populations. Altogether, these results show that exercise associated with anxiety, stress, pro-inflammatory responses, and hyperglycaemia represents a model of 'dangerous exercise'.

Immune Regulatory Crosstalk in Adipose Tissue Thermogenesis

Brown adipose tissue (BAT) and thermogenic beige fat within white adipose tissue (WAT), collectively known as adaptive thermogenic fat, dissipate energy as heat, offering promising therapeutic potential to combat obesity and metabolic disorders. The specific biological functions of these fat depots are determined by their unique interaction with the microenvironments, composed of immune cells, endothelial cells, pericytes, and nerve fibers. Immune cells residing in these depots play a key role in regulating energy expenditure and systemic energy homeostasis. The dynamic microenvironment of thermogenic fat depots is essential for maintaining tissue health and function. Immune cells infiltrate both BAT and beige WAT, contributing to their homeostasis and activation through intricate cellular communications. Emerging evidence underscores the importance of various immune cell populations in regulating thermogenic adipose tissue, though many remain undercharacterized. This review provides a comprehensive overview of the immune cells that regulate adaptive thermogenesis and their complex interactions within the adipose niche, highlighting their potential to influence metabolic health and contribute to therapeutic interventions for obesity and metabolic syndrome.

Anti-Obesity Properties of Boesenbergia rotunda Rhizome Extract: Regulation of Inflammation, Lipid Metabolism, and Insulin Signaling in ob/ob Mice

Obesity, which is characterized by excessive body fat accumulation and energy imbalance, is a major risk factor for type 2 diabetes mellitus. Boesenbergia rotunda rhizomes (known as fingerroots) exhibit a variety of pharmacological activities and are used in traditional medicine. Pinostrobin was identified as a major constituent of Boesenbergia rotunda rhizome (BR) extract and suppressed nitric oxide production in interleukin 1β-treated hepatocytes. Next, we investigated the anti-obesity effects of BR extract in ob/ob mice, a type 2 diabetes mellitus model. The ob/ob mice were treated with or without 1% BR extract for 14 days and then analyzed for serum insulin and triglyceride levels, liver histology, and liver mRNA expression. The administration of BR extract significantly decreased blood glucose concentrations and increased serum insulin concentrations in ob/ob mice. In addition, this treatment reduced triglyceride levels in both the serum and liver and decreased lipid accumulation in hepatocytes. Microarray analysis revealed that hepatic mRNA affected the expression of genes involved in inflammation, lipid metabolism, lipid synthesis, and insulin signaling, leading to improvements in obesity. Because BR extract has hypoglycemic and antidiabetic effects on ob/ob mice, it might be a promising candidate for addressing obesity and related metabolic disorders.

Impaired Fibroblast Growth Factor 21 (FGF21) Associated with Visceral Adiposity Leads to Insulin Resistance: The Core Defect in Diabetes Mellitus

The Central nervous system (CNS) is the prime regulator of signaling pathways whose function includes regulation of food intake (consumption), energy expenditure, and other metabolic responses like glycolysis, gluconeogenesis, fatty acid oxidation, and thermogenesis that have been implicated in chronic inflammatory disorders. Type 2 diabetes mellitus (T2DM) and obesity are two metabolic disorders that are linked together and have become an epidemic worldwide, thus raising significant public health concerns. Fibroblast growth factor 21 (FGF21) is an endocrine hormone with pleiotropic metabolic effects that increase insulin sensitivity and energy expenditure by elevating thermogenesis in brown or beige adipocytes, thus reducing body weight and sugar intake. In contrast, during starvation conditions, FGF21 induces its expression in the liver to initiate glucose homeostasis. Insulin resistance is one of the main anomalies caused by impaired FGF21 signaling, which also causes abnormal regulation of other signaling pathways. Tumor necrosis factor alpha (TNF-α), the cytokine released by adipocytes and inflammatory cells in response to chronic inflammation, is regarded major factor that reduces the expression of FGF21 and modulates underlying insulin resistance that causes imbalanced glucose homeostasis. This review aims to shed light on the mechanisms underlying the development of insulin resistance in obese individuals as well as the fundamental flaw in type 2 diabetes, which is malfunctioning obese adipose tissue.

Crosstalk between pancreatic cancer and adipose tissue: Molecular mechanisms and therapeutic implications

The incidence rate of pancreatic cancer, a fatal illness with a meager 5-year survival rate, has been on the rise in recent times. When individuals accumulate excessive amounts of adipose tissue, the adipose organ becomes dysfunctional due to alterations in the adipose tissue microenvironment associated with inflammation and metabolism. This phenomenon may potentially contribute to the aberrant accumulation of fat that initiates pancreatic carcinogenesis, thereby influencing the disease's progression, resistance to treatment, and metastasis. This review presents a summary of the impact of pancreatic steatosis, visceral fat, cancer-associated adipocytes and lipid diets on the advancement of pancreatic cancer, as well as the reciprocal effects of pancreatic cancer on adipose tissue. Understanding the molecular mechanisms underlying the relationship between dysfunctional adipose tissue and pancreatic cancer better may lead to the discovery of new therapeutic targets for the disease's prevention and individualized treatment. This is especially important given the rising global incidence of obesity, which will improve the pancreatic cancer treatment options that are currently insufficient.

Spotlight on the Mechanism of Action of Semaglutide

Initially intended to control blood glucose levels in patients with type 2 diabetes, semaglutide, a potent glucagon-like peptide 1 analogue, has been established as an effective weight loss treatment by controlling appetite. Integrating the latest clinical trials, semaglutide in patients with or without diabetes presents significant therapeutic efficacy in ameliorating cardiometabolic risk factors and physical functioning, independent of body weight reduction. Semaglutide may modulate adipose tissue browning, which enhances human metabolism and exhibits possible benefits in skeletal muscle degeneration, accelerated by obesity and ageing. This may be attributed to anti-inflammatory, mitochondrial biogenesis, antioxidant and autophagy-regulating effects. However, most of the supporting evidence on the mechanistic actions of semaglutide is preclinical, demonstrated in rodents and not actually confirmed in humans, therefore warranting caution in the interpretation. This article aims to explore potential innovative molecular mechanisms of semaglutide action in restoring the balance of several interlinking aspects of metabolism, pointing to distinct functions in inflammation and oxidative stress in insulin-sensitive musculoskeletal and adipose tissues. Moreover, possible applications in protection from infections and anti-aging properties are discussed. Semaglutide enhancement of the core molecular mechanisms involved in the progress of obesity and diabetes, although mostly preclinical, may provide a framework for future research applications in human diseases overall.

Adipokines and Gamma-Glutamyl Transferase as Biomarkers of Metabolic Syndrome Risk in Mexican School-Aged Children

Background/Objectives: The prevalence of metabolic syndrome in children has been increasing, raising concerns about early detection and clinical management. Adipokines, which are secreted by adipose tissue, play a critical role in metabolic regulation and inflammation, while gamma-glutamyl transferase (GGT), as a liver enzyme, is linked to oxidative stress and metabolic disorders. The objective was to examine the association of circulating adipokines and GGT with metabolic syndrome risk in school-aged children from Northeast Mexico. Methods: A total of 140 children from 6 to 12 years of age in the state of Nuevo León, Mexico, participated in this study. Obesity was classified according to the BMI z-score by the World Health Organization (WHO, 2007), and metabolic syndrome was classified according to the International Diabetes Federation (IDF, 2007). Serum levels of leptin, adiponectin, TNF-α, IL-6, and GGT were measured. Statistical analysis was performed using the Student's t-test, simple linear regression analysis, and receiver operating characteristic (ROC) curve analysis. Results: Among the 140 participants, 60 children (43%) were classified as obese, and of those children with obesity, 55% were diagnosed with metabolic syndrome. Leptin was significantly associated with waist circumference (WC), systolic blood pressure (SBP), serum glucose, triglycerides, and HDL cholesterol (HDL-c). Adiponectin also showed significant associations with WC, SBP, serum triglycerides, and HDL-c. GGT was significantly correlated with WC and HDL-c, while IL-6 and TNF-α did not indicate significance. Associations were observed among leptin, adiponectin, and GGT, highlighting their combined role as potential markers for metabolic syndrome in children. The ROC curve analysis and Youden's index provided cut-off points for these biomarkers: leptin: 8.3665 ng/mL, adiponectin: 9.87 µg/mL, GGT: 17.8 U/L, IL-6 2.77 pg/mL, and TNF-α: 6.68 pg/mL; Conclusions: These findings emphasize the utility of leptin, adiponectin, and GGT as early biomarkers for identifying children with obesity who are at risk of developing metabolic syndrome.

Experimental cell models of insulin resistance: overview and appraisal

Insulin resistance, a key factor in the development of type 2 diabetes mellitus (T2DM), is defined as a defect in insulin-mediated control of glucose metabolism in tissues such as liver, fat and muscle. Insulin resistance is a driving force behind various metabolic diseases, such as T2DM, hyperlipidemia, hypertension, coronary heart disease and fatty liver. Therefore, improving insulin sensitivity can be considered as an effective strategy for the prevention and treatment of these complex metabolic diseases. Cell-based models are extensively employed for the study of pathological mechanisms and drug screening, particularly in relation to insulin resistance in T2DM. Currently, numerous methods are available for the establishment of in vitro insulin resistance models, a comprehensive review of these models is required and can serve as an excellent introduction or understanding for researchers undertaking studies in this filed. This review examines and discusses the primary methods for establishing and evaluating insulin resistance cell models. Furthermore, it highlights key issues and suggestions on cell selection, establishment, evaluation and drug screening of insulin resistance, thereby providing valuable references for the future research efforts.

Type 2 diabetes: a sacrifice program handling energy surplus

Type 2 diabetes mellitus (T2DM) is closely associated with obesity, while interactions between the two diseases remain to be fully elucidated. To this point, we offer this perspective to introduce a set of new insights into the interpretation of T2DM spanning the etiology, pathogenesis, and treatment approaches. These include a definition of T2DM as an energy surplus-induced diabetes characterized by the gradual decline of β cell insulin secretion function, which ultimately aims to prevent the onset of severe obesity through mechanisms of weight loss. The body employs three adaptive strategies in response to energy surplus: the first one is adipose tissue expansion to store the energy for weight gain under normal weight conditions; the second one is insulin resistance to slow down adipose tissue expansion and weight gain under overweight conditions; and the third one is the onset of T2DM following β cell failure to reverse the weight gain in obese conditions. The primary signaling molecules driving the compensatory responses are adenosine derivatives, such as adenosine triphosphate (ATP), acetyl coenzyme A (acetyl-CoA), and reduced nicotinamide adenine dinucleotide (NADH). These molecules exert their effects through allosteric, post-translational, and transcriptional regulation of metabolic pathways. The insights suggest that insulin resistance and T2DM are protective mechanisms in the defense against excessive adiposity to avert severe obesity. The perspective provides a unified framework explaining the interactions between the two diseases and opens new avenues in the study of T2DM.

A unique compound ameliorating endoplasmic reticulum stress and insulin resistance by binding to β tubulin

Insulin is secreted by the pancreatic β-cells and regulates glucose uptake. Endoplasmic reticulum (ER) stress is known to induce insulin resistance. Identifying novel compounds, which can ameliorate ER stress and insulin resistance may be beneficial in the treatment of diabetes. Since treatment with compounds sourced from edible plants is relatively safe, this study aimed to identify a plant-derived potential compound attenuating insulin resistance. In the present study, we identified apigenin as an effective compound for ameliorating ER stress and insulin resistance. It attenuated ER stress-induced cell death and hepatic insulin resistance and improved abnormal glucose tolerance in a db/db diabetic model. The molecular mechanism of apigenin involved direct binding to β-tubulin and improving tubulin stability, thereby recovering insulin resistance and developing diabetes. To our knowledge, no known antidiabetic drugs are yet known to target β-tubulin. Edible plants containing apigenins, such as onions, oranges, and parsley, have been consumed since a long time. Therefore, the use of natural edible plants as a source may offer a safe strategy for the prevention of diabetes.

Normal Weight Central Obesity and its Impact on Type 2 Diabetes Mellitus

PURPOSE OF REVIEW

The aim of this review is to provide an updated commentary on the current literature examining the impact of normal weight obesity (NWO) and normal weight central obesity (NWCO) on type 2 diabetes mellitus in adults.

RECENT FINDINGS

Total 14 studies were included, comprising 9 cross-sectional and 5 cohort studies with 334,438 subjects. The quality of evidence was mixed. The pooled prevalence of NWO was 16.1% (95% CI: 12.7-19.4) and NWCO was 21.1% (95% CI: 12.2-30.1). The prevalence of NWO and NWCO higher in females and non-Asians. This review also showed that type 2 diabetes was significantly associated with NWO and NWCO (pooled OR: 1.82 [1.62, 2.04], p < 0.01, I2 = 64%). Subgroup analyses revealed consistent relationships between type 2 diabetes and NWO/NWCO across sex, region and definition approach. There was a relative high prevalence of NWO and NWCO, particularly in females and non-Asian populations. There was a consistent association of NWO/NWCO with type 2 diabetes. Implications for future research to guide intervention optimization in clinical practice and public health promotion are provided.

Plant-Based Diets and Phytochemicals in the Management of Diabetes Mellitus and Prevention of Its Complications: A Review

Diabetes mellitus (DM) is currently regarded as a global public health crisis for which lifelong treatment with conventional drugs presents limitations in terms of side effects, accessibility, and cost. Type 2 diabetes (T2DM), usually associated with obesity, is characterized by elevated blood glucose levels, hyperlipidemia, chronic inflammation, impaired β-cell function, and insulin resistance. If left untreated or when poorly controlled, DM increases the risk of vascular complications such as hypertension, nephropathy, neuropathy, and retinopathy, which can be severely debilitating or life-threatening. Plant-based foods represent a promising natural approach for the management of T2DM due to the vast array of phytochemicals they contain. Numerous epidemiological studies have highlighted the importance of a diet rich in plant-based foods (vegetables, fruits, spices, and condiments) in the prevention and management of DM. Unlike conventional medications, such natural products are widely accessible, affordable, and generally free from adverse effects. Integrating plant-derived foods into the daily diet not only helps control the hyperglycemia observed in DM but also supports weight management in obese individuals and has broad health benefits. In this review, we provide an overview of the pathogenesis and current therapeutic management of DM, with a particular focus on the promising potential of plant-based foods.

Regulation of pro-apoptotic and anti-apoptotic factors in obesity-related esophageal adenocarcinoma

BACKGROUND

Obesity is a risk factor for esophageal adenocarcinoma (EAC). It was reported that obesity -associated inflammation correlates with insulin resistance and increased risk of EAC. The objective of the study is to investigate the role of obesity associated inflammatory mediators in the development of EAC.

METHODS

We included 23 obese and nonobese patients with EAC or with or without Barrett's esophagus (BE) after IRB approval. We collected 23 normal, 10 BE, and 19 EAC tissue samples from endoscopy or esophagectomy. The samples were analyzed for the expression levels of pro-apoptotic and anti-apoptotic factors, PKC-δ, cIAP2, FLIP, IGF-1, Akt, NF-kB and Ki67 by immunofluorescence and RT-PCR. We compared the expression levels between normal, BE, and EAC tissue using Students' t-test between two groups.

RESULTS

Our results showed decreased gene and protein expression of pro-apoptotic factors (bad, bak and bax) and increased expression of anti-apoptotic factors (bcl-2, Bcl-xL) in BE and EAC compared to normal tissues. There was increased gene and protein expression of PKC-δ, cIAP2, FLIP, NF-kB, IGF-1, Akt, and Ki67 in BE and EAC samples compared to normal esophagus. Further, an increased folds changes in mRNA expression of proapoptotic factors, antiapoptotic factors, PKC-δ, IGF-1, Akt, and Ki-67 was associated with obesity.

CONCLUSION

Patients with EAC had increased expression of cIAP2 and FLIP, and PKC-δ which is associated with inhibition of apoptosis and possible progression of esophageal adenocarcinoma.

Diet and Survival in Black Women With Epithelial Ovarian Cancer

Importance

Ovarian cancer survival among Black women is the lowest across all racial and ethnic groups. Poor dietary quality also disproportionately affects Black populations, but its association with ovarian cancer survival in this population remains largely unknown.

Objective

To examine associations between dietary patterns and survival among Black women diagnosed with epithelial ovarian cancer (EOC).

Design, Setting, and Participants

This prospective cohort study was conducted among self-identified Black women aged 20 to 79 years newly diagnosed with histologically confirmed EOC in the African American Cancer Epidemiology Study (AACES) between December 2010 and December 2015, with follow-up until October 2022. AACES is a population-based study of ovarian cancer risk and survival among Black women in 11 US regions. Data were analyzed from March 2023 to June 2024.

Exposures

Dietary patterns were assessed by the Healthy Eating Index-2020 (HEI-2020) and Alternative Healthy Eating Index-2010 (AHEI-2010), with scores calculated based on dietary intake in the year prior to diagnosis and collected via the validated Block 2005 Food Frequency Questionnaire. Higher scores indicate better dietary quality.

Main outcomes and measures

Hazard ratios (HRs) and 95% CIs were estimated from multivariable Cox models for the association between adherence to dietary recommendations and overall mortality among all participants and those with high-grade serous ovarian cancer (HGSOC).

Results

Among 483 Black women with EOC (mean [SD] age, 58.1 [10.5] years), 310 deaths were recorded during a median (IQR) follow-up of 4.3 (2.0-8.2) years. No association of dietary patterns with mortality was found among women with EOC overall. However, among 325 women with HGSOC, better adherence to HEI-2020 was associated with decreased mortality in later quartiles compared with the first quartile (HR, 0.63; 95% CI, 0.44-0.92 for quartile 2; HR, 0.67; 95% CI, 0.46-0.97 for quartile 3; HR, 0.63; 95% CI, 0.44-0.91 for quartile 4 ). Similar results were observed with AHEI-2010 among women with HGSOC for the second (HR, 0.62; 95% CI, 0.43-0.89) and fourth (HR, 0.67; 95% CI, 0.45-0.98) quartiles compared with quartile 1.

Conclusions and relevance

In this study, women with moderate and high prediagnosis dietary quality had significantly lower mortality rates from HGSOC compared with women with the lowest prediagnosis dietary quality. These findings suggest that even moderate adherence to dietary guidelines prior to diagnosis may be associated with improved survival among Black women with HGSOC, the most lethal form of ovarian cancer.

The Pathophysiological Associations Between Obesity, NAFLD, and Atherosclerotic Cardiovascular Diseases

Obesity, non-alcoholic fatty liver disease (NAFLD), and atherosclerotic cardiovascular diseases are common and growing public health concerns. Previous epidemiological studies unfolded the robust correlation between obesity, NAFLD, and atherosclerotic cardiovascular diseases. Obesity is a well-known risk factor for NAFLD, and both of them can markedly increase the odds of atherosclerotic cardiovascular diseases. On the other hand, significant weight loss achieved by lifestyle modification, bariatric surgery, or medications, such as semaglutide, can concomitantly improve NAFLD and atherosclerotic cardiovascular diseases. Therefore, certain pathophysiological links are involved in the development of NAFLD in obesity, and atherosclerotic cardiovascular diseases in obesity and NAFLD. Moreover, recent studies indicated that simultaneously targeting several mechanisms by tirzepatide and retatrutide leads to greater weight loss and markedly improves the complications of metabolic syndrome. These findings remind the importance of a mechanistic viewpoint for breaking the association between obesity, NAFLD, and atherosclerotic cardiovascular diseases. In this review article, we mainly focus on shared pathophysiological mechanisms, including insulin resistance, dyslipidemia, GLP1 signaling, inflammation, oxidative stress, mitochondrial dysfunction, gut dysbiosis, renin-angiotensin-aldosterone system (RAAS) overactivity, and endothelial dysfunction. Most of these pathophysiological alterations are primarily initiated by obesity. The development of NAFLD further exacerbates these molecular and cellular alterations, leading to atherosclerotic cardiovascular disease development or progression as the final manifestation of molecular perturbation. A better insight into these mechanisms makes it feasible to develop new multi-target approaches to simultaneously unhinge the deleterious chain of events linking obesity and NAFLD to atherosclerotic cardiovascular diseases.

Body Composition Changes Impact Islet β-Cell Function in Patients With Type 2 Diabetes Mellitus

Background: Identifying β-cells dysregulation in type 2 diabetes mellitus (T2DM) is crucial. Weight fluctuations are frequently observed during diabetes treatment. However, the relationship between body composition changes and islet β-cell function in individuals with T2DM remains insufficiently investigated. Methods: This retrospective longitudinal study encompassed a cohort of 775 T2DM patients, who underwent body composition measuring using dual-energy X-ray absorptiometry (DEXA) and followed up for a median of 2.29 years. Key metrics included body mass index (BMI), fat mass index (FMI), trunk fat mass index (TFMI), muscle mass index (MMI), appendicular skeletal muscle mass index (ASMI), muscle/fat mass ratio (M/F), and the appendicular skeletal muscle mass/trunk fat mass ratio (A/T) were then categorized and grouped. Insulin, C-peptide, and glucose levels were assessed concurrently following a glucose load. β-cell function included insulin resistance (HOMA-IR), insulin sensitivity (Matsuda index (MI)), and insulin secretion evaluated by HOMA-β and C-peptidogenic index (CGI). Results: Although no significant changes in BMI were observed, patients with T2DM at readmission exhibited higher FMI, TFMI, and ASMI, as well as elevated levels of HOMA-IR, MI, and CGI compared to baseline measurements. And lower MI, higher levels of CGI, and HOMA-IR were observed in BMI increased group. Univariate correlation analysis revealed a negative association between changes in BMI (ΔBMI) and ΔMI, while positive associations were observed in both ΔHOMA-IR and ΔCGI. Among body composition indexes, ΔFMI exhibited the strongest correlation with ΔHOMA-IR (r = 0.255, p < 0.001), and ΔASMI was positively associated with ΔMI and ΔCGI (r = 0.131 and 0.194, respectively). Moreover, increased levels of BMI and FMI were associated with a greater risk of progressive insulin resistance compared to the decreased, whereas the trend was converse in ASMI and A/T. Conclusions: Increased FMI may partially contribute to the deterioration of insulin resistance, while increased ASMI is associated with improved insulin sensitivity and secretion. Maintaining an appropriate BMI and muscle/fat ratio is conductive to prevent the progression of insulin resistance in patients with T2DM.

Association of different obesity indexes with diabetic kidney disease in patients with type 2 diabetes mellitus: a cross-sectional study

The objective of this study is to investigate the association between diabetic kidney disease (DKD) and various adiposity indexes, including the visceral adiposity index (VAI), lipid accumulation product index (LAPI), visceral fat area (VFA), and subcutaneous fat area (SFA) in type 2 diabetes mellitus (T2DM) patients. 1176 T2DM patients was stratified into normoalbuminuria (NO), microalbuminuria (MI), and macroalbuminuria (MA) groups based on their urinary albumin-creatinine ratio (UACR) levels. To analyse the correlation between DKD and VAI, LAPI, VFA, and SFA. Multiple linear, restricted cubic spline (RCS), subgroup analyses, and multinomial logistic regression were employed. After adjusting for confounding variables, UACR levels were positively associated with VAI, LAPI, and VFA. RCS curves demonstrated a J-shaped dose-response relationship between VAI and LAPI levels with UACR levels, while a linear correlation was observed between UACR levels and VFA. Using the NO and MI as reference groups, the MA group was analysed as the observational group. DKD severity was positively associated with VAI, LAPI and VFA. When evaluating DKD prognostic risk, with the low-risk and medium-risk groups serving as reference categories, a significant positive correlation was identified with prognostic risk and VAI, LAPI, and VFA in the high-risk or very high-risk groups. In patients with T2DM, DKD severity and prognostic risk were positively correlated with VAI, LAPI, and VFA levels.

Triglyceride-Glucose Index (TyG Index) in Association with Blood Pressure in Adults: A Retrospective Study

Background

High blood pressure (BP) is a major risk factor for cardiovascular disease. The triglyceride-glucose (TyG) index is a useful tool for identifying insulin resistance at an early stage and has been proposed as a cost-effective predictor for hypertension. However, available studies are limited. This study aims to investigate the association between the TyG index and BP.

Methods

Retrospective hospital data of a large cohort (n=1596) of adults aged ≥18 in Saudi Arabia were analyzed. The TyG index was calculated. Lipid markers, systolic BP (SBP), diastolic BP (DBP), and body mass index (BMI) were included.

Results

Across quartiles of the TyG index, SBP was significantly higher in those with higher vs lower TyG (p<0.03). No significant association was observed for DBP. A 2-SD higher SBP was significantly associated with a TyG difference of 1.7 (95% CI: 0.1, 3.3). In subgroup analysis, the relationship prevailed in females only [1.8 (95% CI: 0.3, 3.3)]. Across BMI categories (normal, overweight, obesity), the association between SBP and TyG was observed in participants with obesity only.

Conclusions

The TyG index may act as a cost-effective predictive marker for high blood pressure, especially among specific subgroups. Future prospective studies are needed to confirm this relationship.

DYNamic Assessment of Multi-Organ level dysfunction in patients recovering from COVID-19: DYNAMO COVID-19

We evaluated the impacts of COVID-19 on multi-organ and metabolic function in patients following severe hospitalised infection compared to controls. Patients (n = 21) without previous diabetes, cardiovascular or cerebrovascular disease were recruited 5-7 months post-discharge alongside controls (n = 10) with similar age, sex and body mass. Perceived fatigue was estimated (Fatigue Severity Scale) and the following were conducted: oral glucose tolerance (OGTT) alongside whole-body fuel oxidation, validated magnetic resonance imaging and spectroscopy during resting and supine controlled exercise, dual-energy X-ray absorptiometry, short physical performance battery (SPPB), intra-muscular electromyography, quadriceps strength and fatigability, and daily step-count. There was a greater insulin response (incremental area under the curve, median (inter-quartile range)) during the OGTT in patients [18,289 (12,497-27,448) mIU/min/L] versus controls [8655 (7948-11,040) mIU/min/L], P < 0.001. Blood glucose response and fasting and post-prandial fuel oxidation rates were not different. This greater insulin resistance was not explained by differences in systemic inflammation or whole-body/regional adiposity, but step-count (P = 0.07) and SPPB scores (P = 0.004) were lower in patients. Liver volume was 28% greater in patients than controls, and fat fraction adjusted liver T1, a measure of inflammation, was raised in patients. Patients displayed greater perceived fatigue scores, though leg muscle volume, strength, force-loss, motor unit properties and post-exercise muscle phosphocreatine resynthesis were comparable. Further, cardiac and cerebral architecture and function (at rest and on exercise) were not different. In this cross-sectional study, individuals without known previous morbidity who survived severe COVID-19 exhibited greater insulin resistance, pointing to a need for physical function intervention in recovery.

Exploring effects of melatonin supplementation on insulin resistance: An updated systematic review of animal and human studies

BACKGROUND

Insulin resistance (IR), defined as an impaired response to insulin stimulation of target tissues, is a substantial determinant of many metabolic disorders. This study aimed to update the findings of the previous systematic review evidence regarding the effect of melatonin on factors related to IR, including hyperinsulinemia, hyperglycemia, homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI).

METHODS

We systematically reviewed the evidence on the impact of melatonin supplementation on IR indices, fasting insulin, and fasting plasma glucose. PubMed, ScienceDirect, SCOPUS, and Google Scholar databases were searched until March 2024.

RESULTS

We identified 6114 potentially relevant articles during the search. Eighteen animal studies and 15 randomized clinical trials met the inclusion criteria. The results indicated that melatonin supplementation reduced fasting plasma glucose (FPG, 14 out of 29 studies), fasting insulin (22 out of 28 studies), HOMA-IR (28 out of 33 studies), and increased QUICKI (7 out of 7 studies). According to RCT studies, melatonin treatment at a dosage of 10 mg reduced HOMA-IR levels in individuals with various health conditions.

CONCLUSION

According to most evidence, melatonin supplementation may decrease fasting insulin and HOMA-IR and increase QUICKI but may not affect FPG.

Exogenous Nucleotides Ameliorate Insulin Resistance Induced by Palmitic Acid in HepG2 Cells through the IRS-1/AKT/FOXO1 Pathways

Nucleotides (NTs) act as pivotal regulatory factors in numerous biological processes, playing indispensable roles in growth, development, and metabolism across organisms. This study delves into the effects of exogenous NTs on hepatic insulin resistance using palmitic-acid-induced HepG2 cells, administering interventions at three distinct dosage levels of exogenous NTs. The findings underscore that exogenous NT intervention augments glucose consumption in HepG2 cells, modulates the expression of glycogen-synthesis-related enzymes (glycogen synthase kinase 3β and glycogen synthase), and influences glycogen content. Additionally, it governs the expression levels of hepatic enzymes (hexokinase, phosphoenolpyruvate carboxykinase, and glucose-6-phosphatase). Moreover, exogenous NT intervention orchestrates insulin signaling pathway (insulin receptor substrate-1, protein kinase B, and forkhead box protein O1) and AMP-activated protein kinase (AMPK) activity in HepG2 cells. Furthermore, exogenous NT intervention fine-tunes the expression levels of oxidative stress-related markers (malondialdehyde, glutathione peroxidase, and NADPH oxidase 4) and the expression of inflammation-related nuclear transcription factor (NF-κB). Lastly, exogenous NT intervention regulates the expression levels of glucose transporter proteins (GLUTs). Consequently, exogenous NTs ameliorate insulin resistance in HepG2 cells by modulating the IRS-1/AKT/FOXO1 pathways and regulate glucose consumption, glycogen content, insulin signaling pathways, AMPK activity, oxidative stress, and inflammatory status.

A Systematic Review of Semaglutide's Influence on Cognitive Function in Preclinical Animal Models and Cell-Line Studies

Since we aim to test new options to find medication for cognitive disorders, we have begun to assess the effect of semaglutide and to conduct a review gathering studies that have attempted this purpose. This systematic review focuses on the cognitive effects of semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1 RA), in the context of neurological and cognitive impairment. Semaglutide, a synthetic GLP-1 analog, showcased neuroprotective effects beyond metabolic regulation. It mitigated apoptosis and improved cognitive dysfunction in cerebrovascular disease, suggesting broader implications for neurological well-being. Also, studies highlighted GLP-1 RAs' positive impact on olfactory function in obese individuals with type 2 diabetes, on neurodegenerative disorders, multiple sclerosis, and endotoxemia. In order to analyze current studies that assess the impact of semaglutide on cognitive function, a literature search was conducted up to February 2024 on two online databases, MEDLINE (via PubMed) and Web of Science Core Collection, as well as various websites. Fifteen studies on mice populations and two studies on cell lines were included, analyzed, and assessed with bias-specific tools. The neuroprotective and anti-apoptotic properties of GLP-1 and its analogs were emphasized, with animal models and cell line studies demonstrating enhanced cognitive function. While promising, limitations include fewer studies, highlighting the need for extensive research, particularly in the human population. Even though this medication seems promising, there are significant limitations, one of which is the lack of studies on human subjects. Therefore, this review aims to gather current evidence.

Associations between non-insulin-based insulin resistance indices and heart failure prevalence in overweight/obesity adults without diabetes mellitus: evidence from the NHANES 2001-2018

BACKGROUND

The triglyceride glucose (TyG) index and triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio are recognized as simple non-insulin-based insulin resistance indices. Our study aimed to explore the relationship between these two indicators and heart failure (HF) in overweight or obesity individuals without diabetes.

METHODS

This cross-sectional study selected 13,473 participants from the National Health and Nutrition Examination Survey (NHANES) 2001-2018 dataset. Weighted multivariable logistic regression and subgroup analysis were employed to evaluate the relationships between TyG index, TG/HDL-C ratio, and HF prevalence, respectively. Additionally, smooth curve fitting was utilized to analyze the dose-response relationships.

RESULTS

A total of 13,473 obesity or overweight people without diabetes were included in this study through screening, among whom 291 (2.16%) had comorbid HF. The results of multivariable logistic regression suggested that the highest TyG index (OR = 2.4, 95% CI = 1.4-4.2, p = 0.002) and the highest TG/HDL-C ratio (OR = 1.2, 95% CI = 1.1-1.3, p < 0.001) both increased the prevalence of HF, especially in the non-Hispanic population. Dose-response relationships suggested nonlinear relationships between these two indicators and HF.

CONCLUSION

Our study demonstrated that elevated TyG index and TG/HDL-C ratio were closely associated with the prevalence of HF, and both exhibited nonlinear relationships with HF prevalence in overweight/obesity adults without diabetes. Based on these findings, additional prospective studies are needed for further validation.

Epicardial fat and insulin resistance in healthy older adults: a cross-sectional analysis

Insulin resistance (IR) and cardiovascular diseases (CVD) are relevant concerns in the elderly population; as the world's population ages, IR and CVD are two universal public health problems. While a link between IR a CVD has been established, the mediating mechanisms are uncertain and rigorous investigations are needed to fully elucidate them. The study aimed at assessing the relationship between epicardial fat (EF), an indicator of cardiovascular risk, and IR in Italian free-living elderly (n = 89). Baseline data from a previous cohort was used. Anthropometric measurements, EF, and IR-related variables, including the HOMA-IR index and other biochemical parameters were obtained. The correlation between EF and IR was explored. Further analysis was conducted to identify significant differences regarding IR variables among EF quartiles. EF correlated positively with glucose levels in females, males and the total population. The pairwise comparison among EF quartiles showed significant differences in glucose levels, HOMA-IR index, triglycerides, and total cholesterol levels. To our knowledge, this is the only study assessing the relationship between EF and IR in healthy elderly, while most of the studies have investigated EF and IR in diseased populations. Further research with a longitudinal approach should be conducted to design concrete conclusions about this relationship.

Relationship between blood lead (Pb) concentration with risk of diabetes mellitus in women living in mining area

Diabetes is a global health concern with significant implications for individuals and societies. Diabetes results from a complex interaction between genes and environmental factors, including metal exposure. Lead or plumbum (Pb) is a heavy metal pollutant and is predicted to be associated with the morbidity of diabetes. The aim of this study was to assess the relationship between blood Pb level and possible risk factors (body mass index insulin resistance, carbohydrate intake, sugar intake, and physical activity) with fasting blood sugar (FBS) level in women living in the mining area. A cross-sectional study was conducted in a mining area of Indonesia located in Pemali District, Bangka Belitung Regency, involving women aged 30-49, selected through purposive sampling. Logistic regression was used to assess the relationship between the risk factors and FBS level, while the Spearman correlation was used to analyze the correlations between the risk factors and FBS level. Our data indicated that blood Pb concentration and other risk factors (carbohydrate intake, sugar intake and physical activity) were neither associated nor correlated with FBS level. However, as predicted, insulin resistance was associated with FBS level with OR: 9.66; 95%CI: 1.13-82.29; p=0.038. In addition, the Homeostatic Model Assessment Insulin Resistance (HOMA-IR) score was also correlated with FBS level (r=0.316, p=0.002). This study highlights the level of Pb is not associated with the risk of diabetes in women living in mining area.

Insulin Resistance: The Increased Risk of Cancers

Insulin resistance, also known as impaired insulin sensitivity, is the result of a decreased reaction of insulin signaling to blood glucose levels. This state is observed when muscle cells, adipose tissue, and liver cells, improperly respond to a particular concentration of insulin. Insulin resistance and related increased plasma insulin levels (hyperinsulinemia) may cause metabolic impairments, which are pathological states observed in obesity and type 2 diabetes mellitus. Observations of cancer patients confirm that hyperinsulinemia is a major factor influencing obesity, type 2 diabetes, and cancer. Obesity and diabetes have been reported as risks of the initiation, progression, and metastasis of several cancers. However, both of the aforementioned pathologies may independently and additionally increase the cancer risk. The state of metabolic disorders observed in cancer patients is associated with poor outcomes of cancer treatment. For example, patients suffering from metabolic disorders have higher cancer recurrence rates and their overall survival is reduced. In these associations between insulin resistance and cancer risk, an overview of the various pathogenic mechanisms that play a role in the development of cancer is discussed.

Insulin resistance is a cardiovascular risk factor in hypertensive adults without type 2 diabetes mellitus

BACKGROUND

Metabolic syndrome refers to the association among several cardiovascular risk factors: obesity, dyslipidemia, hyperglycemia, and hypertension. It is associated with increased cardiovascular risk and the development of type 2 diabetes mellitus. Insulin resistance is the underlying mechanism of metabolic syndrome, although its role in increased cardiovascular risk has not been directly identified.

OBJECTIVE

We investigated the association between insulin resistance and increased cardiovascular risk in hypertensive adults without diabetes mellitus.

DESIGN AND PARTICIPANTS

We enrolled participants without diabetes from an outpatient setting in a retrospective, longitudinal study. Several demographic, clinical, and laboratory parameters were recorded during the observation period. Plasma insulin and homeostatic model assessment for insulin resistance (HOMA-IR) were used to determine insulin resistance and four cardiovascular events (acute coronary disease, acute cerebrovascular disease, incident heart failure, and cardiovascular mortality) were combined into a single outcome. Logistic regression and Cox proportional hazards models were fitted to evaluate the association between covariates and outcomes.

RESULTS

We included 1899 hypertensive adults without diabetes with an average age of 53 years (51.3% women, 23% had prediabetes, and 64.2% had metabolic syndrome). In a logistic regression analysis, male sex (odds ratio, OR = 1.66) having high levels of low-density lipoprotein (LDL, OR = 1.01), kidney function (OR = 0.97), and HOMA-IR (OR = 1.06) were associated with the incidence of cardiovascular events; however, in a survival multivariate analysis, only HOMA-IR (hazard ratio, HR 1.4, 95% confidence interval, CI: 1.05-1.87, p = 0.02) and body mass index (HR 1.05, 95% CI: 1.02-1.08, p = 0.002) were considered independent prognostic variables for the development of incident cardiovascular events.

CONCLUSION

Insulin resistance and obesity are useful for assessing cardiovascular risk in hypertensive people without diabetes but with preserved kidney function. This work demonstrates the predictive value of the measurement of insulin, and therefore of insulin resistance, in an outpatient setting and attending to high-risk patients.

Pathophysiological-Based Nutritional Interventions in Cirrhotic Patients with Sarcopenic Obesity: A State-of-the-Art Narrative Review

In recent decades, following the spread of obesity, metabolic dysfunction has come to represent the leading cause of liver disease. The classical clinical presentation of the cirrhotic patient has, therefore, greatly changed, with a dramatic increase in subjects who appear overweight or obese. Due to an obesogenic lifestyle (lack of physical activity and overall malnutrition, with an excess of caloric intake together with a deficit of proteins and micronutrients), these patients frequently develop a complex clinical condition defined as sarcopenic obesity (SO). The interplay between cirrhosis and SO lies in the sharing of multiple pathogenetic mechanisms, including malnutrition/malabsorption, chronic inflammation, hyperammonemia and insulin resistance. The presence of SO worsens the outcome of cirrhotic patients, affecting overall morbidity and mortality. International nutrition and liver diseases societies strongly agree on recommending the use of food as an integral part of the healing process in the comprehensive management of these patients, including a reduction in caloric intake, protein and micronutrient supplementation and sodium restriction. Based on the pathophysiological paths shared by cirrhosis and SO, this narrative review aims to highlight the nutritional interventions currently advocated by international guidelines, as well as to provide hints on the possible role of micronutrients and nutraceuticals in the treatment of this multifaceted clinical condition.

Mechanism of Obesity-Related Lipotoxicity and Clinical Perspective

The link between cellular exposure to fatty acid species and toxicity phenotypes remains poorly understood. However, structural characterization and functional profiling of human plasma free fatty acids (FFAs) analysis has revealed that FFAs are located either in the toxic cluster or in the cluster that is transcriptionally responsive to lipotoxic stress and creates genetic risk factors. Genome-wide short hairpin RNA screen has identified more than 350 genes modulating lipotoxicity. Hypertrophic adipocytes in obese adipose are both unable to expand further to store excess lipids in the diet and are resistant to the antilipolytic action of insulin. In addition to lipolysis, the inability of packaging the excess lipids into lipid droplets causes circulating fatty acids to reach toxic levels in non-adipose tissues. Deleterious effects of accumulated lipid in non-adipose tissues are known as lipotoxicity. Although triglycerides serve a storage function for long-chain non-esterified fatty acid and their products such as ceramide and diacylglycerols (DAGs), overloading of palmitic acid fraction of saturated fatty acids (SFAs) raises ceramide levels. The excess DAG and ceramide load create harmful effects on multiple organs and systems, inducing chronic inflammation in obesity. Thus, lipotoxic inflammation results in β cells death and pancreatic islets dysfunction. Endoplasmic reticulum stress stimuli induce lipolysis by activating cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA) and extracellular signal-regulated kinase (Erk) 1/2 signaling in adipocytes. However, palmitic acid-induced endoplasmic reticulum stress-c-Jun N-terminal kinase (JNK)-autophagy axis in hypertrophic adipocytes is a pro-survival mechanism against endoplasmic reticulum stress and cell death induced by SFAs. Endoplasmic reticulum-localized acyl-coenzyme A (CoA): glycerol-3-phosphate acyltransferase (GPAT) enzymes are mediators of lipotoxicity, and inhibiting these enzymes has therapeutic potential for lipotoxicity. Lipotoxicity increases the number of autophagosomes, which engulf palmitic acid, and thus suppress the autophagic turnover. Fatty acid desaturation promotes palmitate detoxification and storages into triglycerides. As therapeutic targets of glucolipotoxicity, in addition to caloric restriction and exercise, there are four different pharmacological approaches, which consist of metformin, glucagon-like peptide 1 (GLP-1) receptor agonists, peroxisome proliferator-activated receptor-gamma (PPARγ) ligands thiazolidinediones, and chaperones are still used in clinical practice. Furthermore, induction of the brown fat-like phenotype with the mixture of eicosapentanoic acid and docosahexaenoic acid appears as a potential therapeutic application for treatment of lipotoxicity.

Differences in nutritional profile by chronotype among 12-h day shift and night shift nurses

Acute care nurses may suffer substantial fatigue if working night shift or if assigned a shift contrasting their preferred sleep-wake patterns, called chronotype. Nurses are at higher risk for diet-related, metabolic diseases compared to other healthcare professionals. Yet, the impact of preferred chronotype and mismatch to assigned shift on nutritional intake and risk for metabolic disease among acute care nurses is unclear. This observational study analyzed dietary data from 52 acute care nurses. Participants completed the revised morningness-eveningness questionnaire which gives a total score between 4 and 26. Lower scores (<12) were flagged as evening type (E-type), higher scores (>17) defined as morning type (M-type), and scores between 12 and 17 were categorized as neither types (N-type). N-type participants were considered chronotype matched when assigned to either shift, whereas E-types were only considered matched if assigned to night shift, and M-types matched only if assigned to day shift. Participants also recorded all dietary intake for 7 d (reflecting a typical workweek) in the MyFitnessPal phone application. Findings indicated that eveningness nurses had markers of MetS, including a significantly larger body mass index and waist circumference than N-types (p < 0.05). E-types also consumed, on average, more calories than other chronotypes (m = 1833.7 kcal), although this was not a statistically significant finding. Mismatched day (n = 7, 13.4%) and night (n = 5, 9.6%) nurses in our sample consumed, on average, more calories (m = 1935.1 kcal, m = 1981.2 kcal, respectively) than matched day (n = 24, 46.2%, m = 1642.6 kcal) or night (n = 16, 30.8%, m = 1599.1 kcal) nurses, although this finding was not statistically significant. Mismatched day nurses consumed significantly less fiber than day matched nurses (median = 10.9 g versus median = 18.5 g, p = 0.04), while night mismatched consumed significantly more fiber compared to night matched (median = 21 g versus median = 12.2 g, p = 0.05) nurses. Participant diets overall did not follow recommendations by the United States Department of Agriculture (USDA), who consumed a higher percentage of calories from saturated fats and a smaller percentage of calories from fiber, habits which increase risk for metabolic syndrome. Further research surrounding nutritional pathways utilizing larger samples is needed to uncover relationships with metabolic syndrome especially for eveningness-type nurses or if working a shift mismatched with preferred chronotype.

Relationship between inflammatory biomarkers and insulin resistance in excess-weight Latin children

BACKGROUND

Excess weight, inflammation, and insulin resistance (IR) are associated, but the prevalence of and biomarkers for IR in Latin children are unknown.

PURPOSE

This study aimed to determine the prevalence of IR in prepubertal and pubertal Latin children with excess weight and explore the usefulness of different biomarkers of low-grade inflammation for identifying IR status.

METHODS

Sixty-eight children (31 boys, 37 girls; approximately 11 years of age) with excess weight (overweight and obese) and 20 healthy normal-weight children (12 boys, 8 girls; approximately 12 years of age) were included. Anthropometric parameters, insulin, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, tumor necrosis factor- α (TNF-α), interleukin (IL)-6, monocyte chemoattractant protein-1 (MCP-1), soluble CD40 ligand (sCD40L), high-sensitivity C-reactive protein (hs-CRP), and myeloperoxidase were assessed and IR was determined by homeostasis model assessment index (cutoff points: 2.67 and 2.22 in prepubertal boys and girls and 5.55 and 3.82 in pubertal boys and girls, respectively). Intergroup differences were compared, correlations were investigated using Pearson correlation coefficient, and stepwise multiple linear regression analyses were performed to estimate the relationship between inflammatory biomarkers and IR.

RESULTS

The prevalence of IR among overweight children was 62%. IL-6 levels differed between overweight and obese boys, while erythrocyte sedimentation rate, MCP-1, TNF-α, IL-6, hs-CRP, and sCD40L differed between obese and normal-weight boys. In contrast, sCD40L levels were increased in overweight versus normal-weight girls, while MCP-1, TNF-α, IL-6, and sCD40L differed between obese and normal-weight girls. Furthermore, MCP-1 and sCD40L levels and erythrocyte sedimentation rate were positively correlated with IR; however, a stepwise regression analysis that adjusted for the body mass index (BMI) z score, sex, and age showed that none were good predictors of IR status.

CONCLUSION

The prevalence of IR is high among Latin children with excess weight. Although some inflammatory biomarkers differed among groups, none robustly predicted IR.

Causes of Low Milk Supply: The Roles of Estrogens, Progesterone, and Related External Factors

Low milk supply (LMS) poses a significant challenge to exclusive and continued breastfeeding, affecting ∼10% to 15% of mothers. Milk production is intricately regulated by both endocrine and autocrine control mechanisms, with estrogens and progesterone playing pivotal roles in this process. In addition to endogenously produced hormones, external substances capable of interfering with normal hormonal actions, including phytoestrogens, mycoestrogens, synthetic estrogens, and hormonal contraceptives, can influence milk production. The effects of these extrinsic hormones on milk production may vary based on maternal body mass index. This comprehensive review examines the multifaceted causes of LMS, focusing on the involvement of estrogens, progesterone, and related external factors in milk production. Furthermore, it investigates the interplay between hormonal factors and obesity, aiming to elucidate the endocrine mechanisms underlying obesity-associated LMS. Insights from this review provide valuable perspectives for developing interventions to improve milk production and address the challenges associated with LMS.

Postprandial Dysmetabolism and Its Medical Implications

An unbalanced diet increases the risk of developing a variety of chronic diseases and cancers, leading to higher morbidity and mortality rates worldwide. Low-grade systemic chronic inflammation mediated by the activation of the innate immune system is common to all these pathologies. Inflammation is a biological response of the body and a normal part of host defense to combat the effects of bacteria, viruses, toxins and macronutrients. However, when the innate immune system is constantly activated, it can promote the development of low-grade systemic chronic inflammation, which could play an important role in the development of chronic diseases and cancer. Since most chronic inflammatory diseases are associated with diet, a balanced healthy diet high in anti-inflammatory food components could prevent chronic diseases and cancer. The cells of the body's immune system produce chemokines and cytokines which can have pro-inflammatory and tumor-promoting as well as anti-inflammatory and tumor-fighting functions. A challenge in the future will be to assess whether polymorphisms in immune-related genes may play a role in promoting pro-inflammatory activity. Thanks to this duality, future research on immune regulation could focus on how innate immune cells can be modified to convert a pro-inflammatory and tumor-friendly microenvironment into an anti-inflammatory and anti-tumor one. This review describes inflammatory responses mediated by the innate immune system in various diseases such as hyperglycemia and/or hyperlipemia, obesity, type II diabetes, cardiovascular disease and cancer.

The role of AMPK in macrophage metabolism, function and polarisation

AMP-activated protein kinase (AMPK) is a ubiquitous sensor of energy and nutritional status in eukaryotic cells. It plays a key role in regulating cellular energy homeostasis and multiple aspects of cell metabolism. During macrophage polarisation, AMPK not only guides the metabolic programming of macrophages, but also counter-regulates the inflammatory function of macrophages and promotes their polarisation toward the anti-inflammatory phenotype. AMPK is located at the intersection of macrophage metabolism and inflammation. The metabolic characteristics of macrophages are closely related to immune-related diseases, infectious diseases, cancer progression and immunotherapy. This review discusses the structure of AMPK and its role in the metabolism, function and polarisation of macrophages. In addition, it summarises the important role of the AMPK pathway and AMPK activators in the development of macrophage-related diseases.

Protective effect of empagliflozin against palmitate-induced lipotoxicity through AMPK in H9c2 cells

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have recently emerged as novel cardioprotective agents. However, their direct impact on cardiomyocyte injury is yet to be studied. In this work, we investigate the underlying molecular mechanisms of empagliflozin (EMPA), an SGLT2 inhibitor, in mitigating palmitate (PA)-induced cardiomyocyte injury in H9c2 cells. We found that EMPA significantly attenuated PA-induced impairments in insulin sensitivity, ER stress, inflammatory cytokine gene expression, and cellular apoptosis. Additionally, EMPA elevated AMP levels, activated the AMPK pathway, and increased carnitine palmitoyl transferase1 (CPT1) gene expression, which collectively enhanced fatty acid oxidation and reduced stress signals. This study reveals a novel mechanism of EMPA's protective effects against PA-induced cardiomyocyte injury, providing new therapeutic insights into EMPA as a cardioprotective agent.

A low-carbohydrate diet with different fatty acids' sources in the treatment of obesity: Impact on insulin resistance and adipogenesis

BACKGROUND

The search for nutritional intervention strategies against obesity has grown, highlighting the low-carbohydrate diet model. However, little is known about the impact of the quality of fatty acids consumed in this diet. Thus, we aim to investigate the influence of fatty acid quality on dietary strategy on obesity.

METHODS

Male Swiss mice were diet-induced to obesity. Afterward, mice consume a low-carb diet with different types of fat: saturated, polyunsaturated ω-3, ω-6, and monounsaturated ω-9 fatty acids. Weight gain and food consumption were monitored weekly. An oral glucose tolerance test was performed and blood and tissue samples were collected for analysis of insulin resistance markers. Protein expression of insulin signaling pathway molecules, lipid metabolism, mitochondrial function, macrophage polarization, and cytokine production were analyzed.

RESULTS

The high-fat diet was able to induce obesity and glucose intolerance. The switch to a low-carbohydrate dietary pattern reversed the glucose intolerance, with better results in the ω-3 and ω-9 groups. After the low-carbohydrate diet, groups ω-3 and ω-9 presented improved fasting serum glucose, insulin, and HOMA indexes. The low-carbohydrate diet also increased the activity of insulin pathway proteins such as IR, IRS1, and AKT. Furthermore, the ω-3 diet group showed greater activity of mitochondrial complexes and AMPK signaling pathway proteins. The ω-6 and ω-9 -rich diet induced M2-type macrophage polarization, as well as cytokine production modulation by the low-carbohydrate diet in the ω-3 and ω-9 groups.

CONCLUSIONS

Consuming a low-carbohydrate diet pattern promotes weight loss and improves glucose intolerance in obesity. Also, the quality of lipids has a direct influence, demonstrating that the consumption of ω-3 polyunsaturated and ω-9 monounsaturated lipids can lead to more favorable outcomes for the improvement of glucose intolerance, lipid metabolism, and anti-inflammatory effects.

Alanine aminotransferase to high- density lipoprotein cholesterol ratio is positively correlated with the occurrence of diabetes in the Chinese population: a population-based cohort study

Objective

Both alanine aminotransferase (ALT) and high-density lipoprotein cholesterol (HDL-C) are closely related to glucose homeostasis in the body, and the main objective of this study was to investigate the association between ALT to HDL-C ratio (ALT/HDL-C ratio) and the risk of diabetes in a Chinese population.

Methods

The current study included 116,251 participants who underwent a healthy physical examination, and the study endpoint was defined as a diagnosis of new-onset diabetes. Multivariate Cox regression models and receiver operator characteristic curves were used to assess the association of the ALT/HDL-C ratio with diabetes onset.

Results

During the average observation period of 3.10 years, a total of 2,674 (2.3%) participants were diagnosed with new-onset diabetes, including 1,883 (1.62%) males and 791 (0.68%) females. After fully adjusting for confounding factors, we found a significant positive association between the ALT/HDL-C ratio and the risk of diabetes [Hazard ratios 1.06, 95% confidence intervals: 1.05, 1.06], and this association was significantly higher in males, obese individuals [body mass index ≥ 28 kg/m2] and individuals aged < 60 years (All P interaction < 0.05). In addition, the ALT/HDL-C ratio was significantly better than its components ALT and HDL-C in predicting diabetes in the Chinese population.

Conclusion

There was a positive relationship between ALT/HDL-C ratio and diabetes risk in the Chinese population, and this relationship was significantly stronger in males, obese individuals, and individuals younger than 60 years old.

Insulin Resistance in Adolescents and Youth With Type 1 Diabetes: A Review of Problems and Solutions

Though insulin resistance (IR) was previously considered a feature of only type 2 Diabetes (T2DM), its development in type 1 Diabetes (T1DM) is not an uncommon occurrence, the causes of which are multifactorial (gender, pubertal status, diabetes duration, ethnicity, genetics, adiposity, glycemic control, chronic inflammation). Despite improvements in glucose, blood pressure and lipid profile, vascular complications (coronary artery disease and nephropathy) continue to remain common causes of morbidity and mortality in T1DM. Aggressive glycemic control reduces but does not eliminate the risk of IR. IR accelerates the development of micro and macrovascular complications, many of which can be potentially reversed if diagnosed and managed early. Lack of endogenous insulin production makes estimation of insulin sensitivity in T1DM difficult. As hyperinsulinemic-euglycemic clamp studies are cumbersome and invasive, the use of prediction equations for calculating estimated insulin sensitivity may prove to be useful. Along with intensive insulin therapy, dietary modifications and increasing physical activity, the role of Metformin in managing IR in T1DM is becoming increasingly popular. Metformin adjunct therapy in T1DM has been shown to improve insulin sensitivity, glycemic control, lipid profile, body composition, vascular smooth muscle function, thereby reducing the risk of vascular complications, as well as reversal of early vascular dysfunction. However, further studies to assess long-term efficacy and safety of Metformin use in adolescents and youth with T1DM are needed. This review aims at revisiting the pathophysiology of IR in T1DM and techniques of identifying those at risk so as to put into action various strategies for management of the same.

Interactions between Metabolic Syndrome, MASLD, and Arterial Stiffening: A Single-Center Cross-Sectional Study

Metabolic-associated steatotic liver disease (MASLD), previously termed non-alcoholic fatty liver disease (NAFLD), has emerged as a prominent global cause of chronic liver disease and is increasingly recognized as associated with atherosclerotic vascular illness, consolidating its position along traditional cardiovascular risk factors. Individuals with MASLD exhibit a combination of metabolic syndrome risk factors, carotid atherosclerosis, and increased arterial stiffness, hinting at shared pathogenesis. In this study, we aim to explore liver involvement and arterial stiffness within metabolic syndrome. We enrolled 75 patients (30 male and 45 female) with either liver steatosis on conventional ultrasound, altered liver function tests, or the presence of cardiometabolic risk factors after excluding liver pathology other than MASLD. Clinical evaluation, laboratory measurements, abdominal and carotid ultrasounds, vibration-controlled transient elastography (VCTE, Fibroscan), and assessment with the Arteriograph (Tensiomed) were performed. The 26 patients diagnosed with MetS had significantly higher liver involvement as quantified via the hepatic steatosis index (HSI), Fibrosis-4 (FIB4), aspartate aminotransferase to platelet ratio index (APRI) category, and VCTE measurements, as well as Agile 3+ and Agile 4 scores which use a combination of clinical and laboratory parameters together with results obtained from VCTE to reflect the probability of advanced liver fibrosis or cirrhosis. Patients with MetS also exhibited more pronounced vascular involvement as quantified via arterial stiffness measurements and CIMT (carotid intima-media thickness). We applied a two-step clustering algorithm to enhance our analysis, which gave us pertinent insight into the interplay between metabolic syndrome elements and typologies of hepatic steatosis and arterial stiffness degrees. Notably, of the three obtained clusters, the cluster showing increased levels of hepatic steatosis and arterial stiffness also exhibited the highest prevalence of metabolic syndrome and its constituting components. The results have significant clinical implications, advocating for a comprehensive diagnostic approach when MetS or MASLD is suspected.

Cellular mechanism of diabetes remission by bariatric surgery

Bariatric surgery is a powerful therapy for type 2 diabetes in patients with obesity. The mechanism of insulin sensitization by surgery has been extensively investigated in weight loss-dependent and weight loss-independent conditions. However, a consensus remains to be established regarding the underlying mechanisms. Energy deficit induced by calorie restriction (CR), that occurs both before and after surgery, represents a unique physiological basis for insulin sensitization regardless of weight loss. In support, we integrate evidence in the literature to provide an energy-based view of insulin sensitization as follows: surgery improves insulin sensitivity through the energy deficit induced by CR, leading to correction of mitochondrial overload in multiple cell types; this then triggers functional reprogramming of relevant tissues leading to diabetes remission.

The degree of food processing can influence serum fatty acid and lipid profiles in women with severe obesity

Background

The increase in the prevalence of obesity is associated with the increase in the consumption of ultra-processed foods and may be related to the increase in the disorders involving metabolism and the transport and storage of fatty acids.

Objective

To evaluate the effect of processed food consumption according to the degree of processing on the serum fatty acid levels and lipid profile of women with severe obesity.

Methods

This was a cross-sectional study. Data were collected from anthropometric assessments, the food frequency questionnaire (FFQ), and blood tests for lipidogram studies and serum fatty acid measurements. The foods consumed were identified through the FFQ and classified according to the degree of processing based on the NOVA rating, and the frequencies of consumption were transformed into scores, as proposed by Fornés methodology. Data were analyzed using IBM SPSS Statistics, version 21. The significance level for the analysis was set at 5%.

Results

This study included 44 women with a mean age of 40.59 years and mean body mass index of 48.61 kg/m2. An inverse association was observed between the consumption of unprocessed and the occurrence of hypertriglyceridemia (p = 0.021) and levels of triglycerides (p = 0.047), total cholesterol (p = 0.030), and very low-density lipoprotein-cholesterol (p = 0.039). The consumption of processed foods was positively associated with the presence of hypertriglyceridemia (p = 0.044) and omega 6/3 ratio (p = 0.001) and negatively associated with total omega 3 levels (p = 0.011). The consumption of processed foods was positively associated with total cholesterol (p = 0.041) and negatively associated with the omega 3/6 ratio (p = 0.001). A negative correlation was found between the average consumption of ultra-processed foods (at least once a week) and serum level of high-density lipoprotein (p = 0.035).

Conclusion

The consumption of processed and ultra-processed foods was associated with unfavorable lipid profiles and fatty acid levels in women with severe obesity. These results emphasize the importance of promoting the consumption of unprocessed food to mitigate metabolic disorders linked to processed food intake.

Glucose-dependent inflammatory responses in obese compared to lean individuals

PURPOSE

Obesity is characterized by chronic inflammation that may contribute to insulin resistance and promote type 2 diabetes. We have investigated whether inflammatory responses to glycemic and insulinemic variations are altered in obese individuals.

METHODS

Eight obese and eight lean individuals without diabetes had undergone hyperinsulinemic-euglycemic-hypoglycemic and hyperglycemic clamps in a previous study. Using Proximity Extension Assay, 92 inflammatory markers were analyzed from plasma samples at fasting, hyperinsulinemia-euglycemia, hypoglycemia and hyperglycemia.

RESULTS

In all participants, hyperinsulinemia, hypoglycemia and hyperglycemia led to reductions of 11, 19 and 62 out of the 70 fully evaluable biomarkers, respectively. FGF-21 increased during both hypoglycemia and hyperglycemia while IL-6 and IL-10 increased during hypoglycemia. In obese vs lean participants, Oncostatin-M, Caspase-8 and 4E-BP1 were more markedly suppressed during hypoglycemia, whereas VEGF-A was more markedly suppressed during hyperglycemia. BMI correlated inversely with changes of PD-L1 and CD40 during hyperinsulinemia, Oncostatin-M, TNFSF14, FGF-21 and 4EBP-1 during hypoglycemia and CCL23, VEGF-A and CDCP1 during hyperglycemia (Rho ≤ -0.50). HbA1c correlated positively with changes of MCP-2 and IL-15-RA during hyperinsulinemia (Rho ≥ 0.51) and inversely with changes of CXCL1, MMP-1 and Axin-1 during hypoglycemia (Rho ≤ -0.55). M-value correlated positively with changes of IL-12B and VEGF-A during hyperglycemia (Rho ≥ 0.51). Results above were significant (p < 0.05).

CONCLUSION

Overall, hyperinsulinemia, hypo- and hyperglycemia led to suppression of several inflammatory markers and this tended to be more marked in individuals with obesity, insulin resistance and dysglycemia. Thus, acute glycemic or insulinemic variations do not seem to potentiate possible inflammatory pathways in the development of insulin resistance and disturbed glucose metabolism.

Early prediction of body composition parameters on metabolically unhealthy in the Chinese population via advanced machine learning

Background

Metabolic syndrome (Mets) is considered a global epidemic of the 21st century, predisposing to cardiometabolic diseases. This study aims to describe and compare the body composition profiles between metabolic healthy (MH) and metabolic unhealthy (MU) phenotype in normal and obesity population in China, and to explore the predictive ability of body composition indices to distinguish MU by generating machine learning algorithms.

Methods

A cross-sectional study was conducted and the subjects who came to the hospital to receive a health examination were enrolled. Body composition was assessed using bioelectrical impedance analyser. A model generator with a gradient-boosting tree algorithm (LightGBM) combined with the SHapley Additive exPlanations method was adapted to train and interpret the model. Receiver-operating characteristic curves were used to analyze the predictive value.

Results

We found the significant difference in body composition parameters between the metabolic healthy normal weight (MHNW), metabolic healthy obesity (MHO), metabolic unhealthy normal weight (MUNW) and metabolic unhealthy obesity (MUO) individuals, especially among the MHNW, MUNW and MUO phenotype. MHNW phenotype had significantly lower whole fat mass (FM), trunk FM and trunk free fat mass (FFM), and had significantly lower visceral fat areas compared to MUNW and MUO phenotype, respectively. The bioimpedance phase angle, waist-hip ratio (WHR) and free fat mass index (FFMI) were found to be remarkably lower in MHNW than in MUNW and MUO groups, and lower in MHO than in MUO group. For predictive analysis, the LightGBM-based model identified 32 status-predicting features for MUNW with MHNW group as the reference, MUO with MHO as the reference and MUO with MHNW as the reference, achieved high discriminative power, with area under the curve (AUC) values of 0.842 [0.658, 1.000] for MUNW vs. MHNW, 0.746 [0.599, 0.893] for MUO vs. MHO and 0.968 [0.968, 1.000] for MUO and MHNW, respectively. A 2-variable model was developed for more practical clinical applications. WHR > 0.92 and FFMI > 18.5 kg/m2 predict the increased risk of MU.

Conclusion

Body composition measurement and validation of this model could be a valuable approach for the early management and prevention of MU, whether in obese or normal population.