Why does obesity cause diabetes?

Comparative effectiveness of Roux-en-Y gastric bypass and sleeve gastrectomy in achieving diabetes remission in patients with diabetes-related vascular diseases: A multicentred study

Metabolic and bariatric surgeries (MBS), including Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG), have proven effective in promoting long-term diabetes remission among patients with type-2 diabetes (T2D). In this multicentre retrospective cohort study, we investigated the effectiveness of RYGB and SG in achieving diabetes remission, specifically among patients with T2D and vascular complications, while accounting for similar baseline diabetes severity. Although various scores predict diabetes remission after bariatric surgery, they do not consider diabetes-related vascular complications, which can influence outcomes even in patients with similar baseline T2D severity. We collected preoperative data on microvascular (retinopathy, nephropathy, neuropathy) and macrovascular comorbidities (coronary artery disease, cerebrovascular accidents, peripheral artery disease) to compare the efficacy of RYGB and SG. Among 961 patients analysed, those with vascular complications showed higher remission rates with RYGB (OR: 1.97) compared to SG, despite similar baseline diabetes severity. Notably, RYGB patients with microvascular complications had a significant advantage in achieving T2D remission (OR: 2.95). However, no significant differences in remission were observed in patients with macrovascular complications. These findings suggest that RYGB may be more effective than SG in specific patient populations, particularly those with microvascular complications, emphasizing the need for personalized treatment strategies.

Zebrafish navigating the metabolic maze: insights into human disease - assets, challenges and future implications

Zebrafish (Danio rerio) have become indispensable models for advancing our understanding of multiple metabolic disorders such as obesity, diabetes mellitus, dyslipidemia, and metabolic syndrome. This review provides a comprehensive analysis of zebrafish as a powerful tool for dissecting the genetic and molecular mechanisms of these diseases, focusing on key genes, like pparγ, lepr, ins, and srebp. Zebrafish offer distinct advantages, including genetic tractability, optical transparency in early development, and the conservation of key metabolic pathways with humans. Studies have successfully used zebrafish to uncover conserved metabolic mechanisms, identify novel disease pathways, and facilitate high-throughput screening of potential therapeutic compounds. The review also highlights the novelty of using zebrafish to model multifactorial metabolic disorders, addressing challenges such as interspecies differences in metabolism and the complexity of human metabolic disease etiology. Moving forward, future research will benefit from integrating advanced omics technologies to map disease-specific molecular signatures, applying personalized medicine approaches to optimize treatments, and utilizing computational models to predict therapeutic outcomes. By embracing these innovative strategies, zebrafish research has the potential to revolutionize the diagnosis, treatment, and prevention of metabolic disorders, offering new avenues for translational applications. Continued interdisciplinary collaboration and investment in zebrafish-based studies will be crucial to fully harnessing their potential for advancing therapeutic development.

An enhanced harmonic densely connected hybrid transformer network architecture for chronic wound segmentation utilising multi-colour space tensor merging

Chronic wounds and associated complications present ever growing burdens for clinics and hospitals world wide. Venous, arterial, diabetic, and pressure wounds are becoming increasingly common globally. These conditions can result in highly debilitating repercussions for those affected, with limb amputations and increased mortality risk resulting from infection becoming more common. New methods to assist clinicians in chronic wound care are therefore vital to maintain high quality care standards. This paper presents an improved HarDNet segmentation architecture which integrates a contrast-eliminating component in the initial layers of the network to enhance feature learning. We also utilise a multi-colour space tensor merging process and adjust the harmonic shape of the convolution blocks to facilitate these additional features. We train our proposed model using wound images from light skinned patients and test the model on two test sets (one set with ground truth, and one without) comprising only darker skinned cases. Subjective ratings are obtained from clinical wound experts with intraclass correlation coefficient used to determine inter-rater reliability. For the dark skin tone test set with ground truth, when comparing the baseline results (DSC=0.6389, IoU=0.5350) with the results for the proposed model (DSC=0.7610, IoU=0.6620) we demonstrate improvements in terms of Dice similarity coefficient (+0.1221) and intersection over union (+0.1270). Measures from the qualitative analysis also indicate improvements in terms of high expert ratings, with improvements of >3% demonstrated when comparing the baseline model with the proposed model. This paper presents the first study to focus on darker skin tones for chronic wound segmentation using models trained only on wound images exhibiting lighter skin. Diabetes is highly prevalent in countries where patients have darker skin tones, highlighting the need for a greater focus on such cases. Additionally, we conduct the largest qualitative study to date for chronic wound segmentation. All source code for this study is available at: https://github.com/mmu-dermatology-research/hardnet-cws.

Effect of metabolic disorders on reactive gliosis and glial scarring at the early subacute phase of stroke in a mouse model of diabetes and obesity

It is well recognized that type II Diabetes (T2D) and overweight/obesity are established risk factors for stroke, worsening also their consequences. However, the underlying mechanisms by which these disorders aggravate outcomes are not yet clear limiting the therapeutic opportunities. To fill this gap, we characterized, for the first time, the effects of T2D and obesity on the brain repair mechanisms occurring 7 days after stroke, notably glial scarring. In the present study, by performing a 30-minute middle cerebral artery occlusion (MCAO) on db/db (obese diabetics mice) and db/+ (controls) mice, we demonstrated that obese and diabetic mice displayed larger lesions (i.e. increased infarct volume, ischemic core, apoptotic cell number) and worsened neurological outcomes compared to their control littermates. We then investigated the formation of the glial scar in control and db/db mice 7 days post-stroke. Our observations argue in favor of a stronger and more persistent activation of astrocytes and microglia in db/db mice. Furthermore, an increased deposition of extracellular matrix (ECM) was observed in db/db vs control mice (i.e. chondroitin sulfate proteoglycan and collagen type IV). Consequently, we demonstrated for the first time that the db/db status is associated with increased astrocytic and microglial activation 7 days after stroke and resulted in higher deposition of ECM within the damaged area. Interestingly, the injury-induced neurogenesis appeared stronger in db/db as shown by the labeling of migrating neuroblast. This increase appeared correlated to the larger size of lesion. It nevertheless raises the question of the functional integration of the new neurons in db/db mice given the observed dense ECM, known to be repulsive for neuronal migration. Carefully limiting glial scar formation after stroke represents a promising area of research for reducing neuronal loss and limiting disability in diabetic/obese patients.

Obesity and type 2 diabetes mellitus: insights from skeletal muscle extracellular matrix remodeling

Obesity and type 2 diabetes mellitus (T2DM) are metabolic diseases at epidemic proportions. The economic burden for these diseases is at an all-time high, and as such, there is an urgent need for advancements in identifying targets for treating these complex disorders. The extracellular matrix (ECM), comprising collagen, fibronectin, laminin, elastin, and proteoglycan, surrounds skeletal muscles and plays a critical role in maintaining tissue homeostasis by providing structural support and facilitating cell-to-cell communication. Disruption of the ECM signaling results in changes to its micro/macroenvironment, thereby modifying tissue homeostasis. Skeletal muscle ECM remodeling has been shown to be associated with insulin resistance, an underlying feature of obesity and T2DM. This narrative review explores the critical components of skeletal muscle ECM and its accumulation and remodeling in metabolic diseases. In addition, we discuss potential treatments to mitigate the effects of ECM remodeling in skeletal muscle. We conclude that targeting ECM remodeling in skeletal muscle represents a promising yet underexplored therapeutic avenue in the management of metabolic disorders.

Association of BMI with mortality and health-related quality of life among 4.4 million adults: Evidence from a nationwide, population-based, prospective cohort study

AIMS

The body mass index (BMI), as an easy-to-calculate measure of body fatness, is closely associated with all-cause mortality, but few studies with a large enough scale have examined the relationship between BMI and quality of life. A comprehensive and precise insight into a new range is needed.

MATERIALS AND METHODS

Based on the ChinaHEART (Health Evaluation And risk Reduction through nationwide Teamwork), a nationwide, population-based cohort study, 4,485,773 participants living in 20,159 communities or villages were passively followed for death records, through a linkage of data with the National Mortality Surveillance System and Vital Registration. Firstly, we conducted Cox proportional-hazards regression models to assess the hazard ratios (HRs) of BMI on the risk of all-cause and cause-specific mortality. Secondly, we used logistic regression models to examine associations between BMI and health-related quality of life (HRQL). Fully adjusted models were adjusted for age, sex, annual household income, occupation, education level, marriage, medical insurance, urbanity, tobacco smoking, alcohol consumption and the history of hypertension, diabetes mellitus, dyslipidaemia and cardiovascular disease (CVD).

RESULTS

Among the 4 485 773 included participants with an average age of 56.4 ± 10.0 years, 59.0% were female. During the follow-up period, which had a median duration of 5.3 years, a total of 142 004 cases of all-cause mortality were confirmed. After adjusting for participant characteristics and lifestyles, we observed the U-shaped association between BMI and all-cause mortality with an inflection of 26-27 kg/m2, and the estimated HR per 1 kg/m2 increase in BMI was 0.92 (95% CI 0.92-0.93) and 1.03 (95% CI 1.03-1.04) below and above the turning point, respectively. An inverted J-shape pattern between BMI and HRQL with a peak of 22-23 kg/m2 was found, in which the odd ratio per 1 kg/m2 increase in BMI was 0.98 (95% CI 0.98, 0.99) below 22-23 kg/m2 and 1.03 (95% CI 1.03-1.03) above this point.

CONCLUSIONS

We found distinct ranges of BMI for minimized mortality risk and maximized HRQL. The BMI range corresponding to the HRQL is lower than the BMI range corresponding to the lowest risk of death generally. Therefore, it is worth considering how to define the new recommended range for a new BMI based on the goal of 'living a longer and healthier life'.

Adiponectin: its role in diabetic and pancreatic cancer

Adiponectin (ApN) is an antidiabetic and anti-inflammatory protein synthesized by adipose tissue. It is essential in regulating insulin sensitivity, glucose, and lipid metabolism by controlling AMPK, PPARα, and MAPK signals. It is an anti-inflammatory property that protects pancreatic β-cells. Often, low levels of ApN are linked to obesity, type II diabetes and the development of PDAC. However, changes in lifestyle and the use of certain drugs can improve ApN function and insulin sensitivity. PDAC is a highly aggressive cancer linked to obesity, type II diabetes, and insulin resistance. ApN plays a complex role in PDAC progression and can suppress PDAC development by weakening β-catenin signaling. Decreases in ApN levels are associated with increased PDAC risk in diabetic patients. PDAC and diabetes are interconnected through the development of insulin resistance, islet dysfunction, change in immunological response, inflammation, oxidative stress, and altered hormone secretion. Genetic studies highlight specific genes like HNF4G and PDX1 that influence both conditions and miRNAs such as miR-19a promote tumor progression through the PI3K/AKT pathway. This review discusses the role of ApN in diabetes and PDAC and the interrelation between diabetes and PDAC.

The antidiabetic properties of lignans: a comprehensive review

BACKGROUND

Diabetes mellitus (DM) is a chronic metabolic disease with a high global prevalence. Lignans, a class of plant natural compounds found in commonly consumed foods, are well-tolerated by humans and have demonstrated promising potential in the management of DM. Consumption of lignan-rich foods has been associated with improved overall health and quality of life.

PURPOSE

The clinical and preclinical evidence on the role of lignans in managing DM are critically examined.

METHODS

A thorough literature search was conducted across major scientific databases, focusing on studies that reported the effects of individual lignans on key diabetes indicators, such as glucose utilisation and insulin sensitivity, in both human and animal models, as well as in cell-based studies.

RESULTS

A total of 180 lignans were included in the review. Out of these, only three were investigated in randomised clinical trials in humans and 31 in animal models. The reviewed evidence suggests some beneficial effects of lignans in preventing the development of obesity-related diabetes. Their therapeutic benefits in preventing diabetes-related complications, particularly diabetic nephropathy, in both type 1 and type 2 diabetes, are also supported. Metabolites of various lignans, produced by microbial metabolism in the gut and serum enzymes, appear to be key bioactive forms, highlighting the need for detailed pharmacodynamic studies, optimised dosage designs, and the use of the appropriate lignan molecules for cell-based screening.

CONCLUSION

Lignans and their microbial metabolites show promise in preventing obesity-related diabetes and mitigating diabetes-related complications such as diabetic nephropathy, though further clinical studies are needed to optimize their therapeutic potential.

Plant-Derived Natural Products for Dietary Intervention in Overweight and Obese Individuals: A Systematic Review and Network Meta-Analysis

Growing rates of overweight and obesity worldwide call for novel approaches to treatment, and plant-derived natural products present a promising therapeutic option. Evaluate the efficacy of plant-derived natural products as dietary interventions for overweight and obesity through a systematic review and network meta-analysis. We conduct a systematic review and network meta-analysis following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. We searched from five databases and registries up to March 2024, selecting randomized controlled trials examining dietary interventions with plant-derived natural products for adults with obesity or overweight. The frequentist approach was used for the network meta-analysis, assessing 13 metabolic and obesity-related outcomes. Our review included 39 studies with 2513 participants with PROSPERO registration ID CRD42024520305. African Mango emerged as the most effective intervention, reducing body weight (MD: -10.00 kg, 95% CI: -16.74 to -3.26), waist circumference (MD: -11.70 cm, 95% CI: -17.15 to -6.25), total cholesterol (MD: -44.01 mg/dL, 95% CI: -58.95 to -29.08), triglycerides (MD: -42.65 mg/dL, 95% CI: -79.70 to -5.60), and random blood glucose (MD: -14.95 mg/dL, 95% CI: -18.60 to -11.30). Green coffee led to the largest reduction in body fat percentage (MD: -2.90%, 95% CI: -4.88 to -0.92) and BMI (MD: -3.08 kg/m2, 95% CI: -6.35 to 0.19). Ephedra was most effective in reducing fasting blood glucose (MD: -4.60 mg/dL, 95% CI: -5.49 to -3.71) and HOMA-IR (MD: -16.20, 95% CI: -18.66 to -13.74). There were too few direct comparisons between various metabolites; thus, most of the comparisons were indirect comparisons through placebo. Plant-derived natural products significantly impact obesity management, notably in body weight, waist circumference, and lipid profile reduction; however, further high-quality and rigorous studies were needed to establish the clinical efficacy of the plant-derived natural products.

Obesity and global warming: A two-way relationship?

Our modern society has to face several health problems, among which climate change characterized by global warming and increased pollution and obesity epidemic and associated morbidities are prominent ones. Interestingly, several epidemiological studies argue for a closed connection between these two health concerns, in fact pointing out a bidirectional relationship. Global warming and its associated exposure to pollutants could contribute to weight gain through different mechanisms, including some endocrine disorders linked to adipocyte dysfunction (adiposopathy) and reduced thermogenesis, as well as a reluctance to physical activity in a hot ambient temperature. Conversely, obesity epidemic may play a role in global warming by an increased consumption of energetic ultra-processed foods and an enhanced energy waste for transportation, both leading to increased greenhouse gas emission. Thus, there is an urgent need for greater action to slow the process of global warming also to prevent harmful effects on health linked to obesity epidemic.

Enhanced Transdermal Delivery of Liraglutide for Sustained Obesity Management

Liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, is recognized for its effectiveness in glycemic control and weight reduction. However, the pain associated with the traditional subcutaneous administration of liraglutide and needle phobia in some patients will seriously affect medication adherence. Transdermal delivery represents a promising alternative to subcutaneous injection for its convenience, noninvasiveness, and painlessness, and it can bypass the first-pass metabolism and multiple biological barriers of oral administration and be delivered in a controlled manner, resulting in steady drug levels. Nonetheless, due to skin barriers, effective transdermal delivery of peptide-based drugs like liraglutide remains challenging. This study developed a two-step platform for preparing peptide nanoparticles based on flash nanocomplexation (FNC) technology to improve the efficacy of transdermal liraglutide delivery. Liraglutide was first encapsulated in nanoparticles formed by tannic acid (TA) and aluminum ions (Al3+), wherein coordination interactions between TA and Al3+, as well as hydrogen bonding interactions involving TA and liraglutide. Then, liraglutide nanoparticles were coated with positively charged hydroxypropyl trimethylammonium chloride chitosan (HTCC) to improve transdermal delivery efficacy. The resulting liraglutide nanoparticles exhibited superior transdermal penetration, durable hypoglycemic effects, and long-acting therapeutic efficacy for obesity, indicating that the developed Lira nanoparticle offers a promising platform for the transdermal delivery of peptide-based drugs.

Which adiposity index is best? Comparison of five indicators and their ability to identify type 2 diabetes risk in a population study

AIMS

We compared ability of five adiposity indicators [body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-by-height0.5 (WHT.5R), and a body shape index (ABSI)] to identify current diabetes and their prospective associations with diabetes.

METHODS

Baseline data were from 7,979 participants of UK Whitehall II study, of whom 7,488 diabetes-free participants were followed-up (median = 16.0 years) for incident diabetes (n = 940). According to five indices' cut-points, participants were separately classified into low-value groups and high-value groups. We cross-sectionally investigated ability of the indicators to identify existing diabetes by receiver operating characteristic curve analysis, and explored prospective associations between elevated indices and diabetes using Cox regression analysis.

RESULTS

Waist-based indicators were superior to BMI in identifying diabetes. High WHtR (≥0.5) demonstrated the highest multivariable-adjusted HR [2.64 (95 % CI 2.29, 3.03)]. Across all indicators, associations between elevated indicators and diabetes were stronger in younger participants. In combined analyses, "low BMI but high WHtR" had higher risk for diabetes [2.20 (95 % CI 1.65, 2.95)] than "high BMI but low WHtR" [1.34 (95 % CI 1.05, 1.70)].

CONCLUSION

Waist-based indicators are more strongly associated with diabetes than BMI. WHtR, an easy-to-calculate, waist-based index with a sex- and race-independent cut-point, may be useful for diabetes prevention.

Insulin Sensitivity and Skeletal Muscle Mitochondrial Respiration in Black and White Women With Obesity

OBJECTIVES

Non-Hispanic Black women (BW) have a greater risk of type 2 diabetes (T2D) and insulin resistance (IR) compared to non-Hispanic White women (WW). The mechanisms leading to these differences are not understood, and it is unclear whether synergistic effects of race and obesity impact disease risk. To understand the interaction of race and weight, hepatic and peripheral IR were compared in WW and BW with and without obesity.

METHODS

Hepatic and peripheral IR were measured by a labeled, hyperinsulinemic-euglycemic clamp in BW (n = 32) and WW (n = 32) with and without obesity. Measurements of body composition, cardiorespiratory fitness, and skeletal muscle (SM) respiration were completed. Data were analyzed by mixed model ANOVA.

RESULTS

Subjects with obesity had greater hepatic and peripheral IR and lower SM respiration (P < .001). Despite 14% greater insulin (P = .066), BW tended to have lower peripheral glucose disposal (Rd; P = .062), which was driven by women without obesity (P = .002). BW had significantly lower glucose production (P = .005), hepatic IR (P = .024), and maximal coupled and uncoupled respiration (P < .001) than WW. Maximal coupled and uncoupled SM mitochondrial respiration was strongly correlated with peripheral and hepatic IR (P < .01).

CONCLUSION

While BW without obesity had lower Rd than WW, race and obesity did not synergistically impact peripheral IR. Paradoxically, WW with obesity had greater hepatic IR compared to BW. Relationships between SM respiration and IR persisted across a range of body weights. These data provide support for therapies in BW, like exercise, that improve SM mitochondrial respiration to reduce IR and T2D risk.

Nano-Based Drug Delivery Systems for Managing Diabetes: Recent Advances and Future Prospects

Diabetes mellitus is a chronic metabolic disorder, which is characterized by high blood glucose levels, and this can lead to serious diabetic complications. According to the World Health Organization, approximately 830 million adults worldwide are living with diabetes in 2024, with its prevalence continuing to rise steadily over the years. To treat this disease, researchers have developed a variety of first-line drugs, such as sulfonylureas and thiazolidinediones. Despite their long clinical use, there are still many drawbacks and limitations. One of the main drawbacks is low bioavailability, this causes the diabetic patients to take the drugs frequently to lower the blood glucose levels continuously. Some patients may have to take multiple drugs to increase the effectiveness of lowering blood glucose levels. To address these limitations, nano-based drug delivery systems have emerged to overcome these problems. It has emerged as a promising approach for diabetes management, which offers controlled and localized release of anti-diabetic drugs, thus enhancing therapeutic efficacy. This review discusses recent advances in the field of nano-based drug delivery systems for diabetes management, safety and toxicity profiles of anti-diabetic drugs, and future perspectives for the development of nanomedicine in diabetic treatment. Literature search was conducted using electronic databases, and only English literatures were used and published between 2014 and 2024. Recent advancements in nanotechnology have facilitated the development of various nanocarriers, such as polymeric carrier nanoparticles, nanoliposomes, nanocrystals, nanosuspension and inorganic nanoparticles, which enhance drug stability, bioavailability, and efficacy. These systems can deliver anti-diabetic drugs and natural compounds more effectively, thereby minimizing side effects and improving patient compliance. As the field continues to evolve, the successful clinical implementation of nanodrugs could revolutionize the management of diabetes and improve the quality of life for millions of diabetic patients worldwide.

Reprogramming and targeting of cholesterol metabolism in tumor-associated macrophages

Cholesterol, as a major component of cell membranes, is closely related to the metabolic regulation of cells and organisms; tumor-associated macrophages play an important push role in tumor progression. We know that tumor-associated macrophages are polarized from macrophages, and the abnormalities of cholesterol metabolism that may be induced during their polarization are worth discussing. This manuscript focuses on metabolic abnormalities in tumor-associated macrophages, and first provides a basic summary of the regulatory mechanisms of abnormal macrophage polarization. Subsequently, it comprehensively describes the features of abnormal glucose, lipid and cholesterol metabolism in TAMs as well as the different regulatory pathways. Then, the paper also discusses the link between abnormal cholesterol metabolism in TAMs and tumors, chronic diseases and aging. Finally, the paper summarizes cancer therapeutic strategies targeting cholesterol metabolism that are already in clinical trials, as well as nanomaterials capable of targeting cholesterol metabolism that are in the research stage, in the hope of providing value for the design of targeting materials. Overall, elucidating metabolic abnormalities in tumor-associated macrophages, particularly cholesterol metabolism, could provide assistance in tumor therapy and the design of targeted drugs.

Tirzepatide and health-related quality of life in adults with obesity or overweight: Results from the SURMOUNT-3 phase 3 randomized trial

AIMS

Tirzepatide reduced weight significantly more than placebo in adults with obesity/overweight who had already achieved ≥5% weight reduction with a 12-week intensive lifestyle intervention (randomized population) in SURMOUNT-3, a phase 3, 72-week, randomized, double-blind clinical trial. This analysis evaluated health-related quality of life (HRQoL) with tirzepatide versus placebo treatment in the SURMOUNT-3 randomized population and selected subgroups.

MATERIALS AND METHODS

The randomized population received placebo (N = 292) or tirzepatide maximum tolerated dose (N = 287) for 72 weeks. HRQoL was assessed from randomization to week 72 using the Short Form-36 Version 2 Health Survey acute form, Impact of Weight on Quality of Life-Lite Clinical Trials Version, 5-level EQ-5D version Health State Index, EQ visual analogue scale and the Patient Global Impression of Status (PGIS) for Physical Activity. In tirzepatide recipients, changes in HRQoL scores from randomization to week 72 were descriptively summarized by achievement of weight reduction thresholds, and for those with versus without physical function limitations at randomization (identified with PGIS for Physical Activity).

RESULTS

Tirzepatide was associated with significantly larger improvements than placebo in most HRQoL measures from randomization to 72 weeks. Improvements in tirzepatide recipients were generally numerically larger in those who met greater weight reduction thresholds. HRQoL score changes showed greater improvements for adults with versus without physical function limitations for all measures.

CONCLUSIONS

Tirzepatide improved HRQoL in adults with obesity/overweight and was generally associated with larger improvements in adults meeting greater weight reduction thresholds and in adults with versus without reported physical function limitations at randomization.

PLAIN LANGUAGE SUMMARY

What is the context and purpose of this research study? In a clinical trial called SURMOUNT-3, tirzepatide was significantly better than placebo for reducing weight in adults with obesity/overweight who had already lost ≥5% weight following a 12-week intensive lifestyle programme. This analysis looked at the effects of tirzepatide compared with placebo for 72 weeks on quality of life (QoL) in SURMOUNT-3. In addition, among tirzepatide recipients, the relationship between meeting different weight reduction thresholds and changes in QoL was described as was the association of tirzepatide with QoL in study participants who had physical limitations at randomization. What was done? Eligible adults with obesity/overweight were enrolled in a 12-week intensive lifestyle programme. Those who lost ≥5% of initial weight at the end of the 12 weeks were invited to continue participating in the study and were randomly assigned to receive injections of either their maximum tolerated dose of tirzepatide (10 or 15 mg) or placebo for 72 weeks via single-dose pens. QoL was measured using a number of well-established surveys that assessed general health, the impact of weight on QoL and the impact of health on the level of physical ability in day-to-day life. These surveys were completed by the study participants when they were first assigned treatment with tirzepatide or placebo (randomization) and again after 72 weeks of treatment. The difference in scores from randomization to week 72 was then calculated to determine whether or not the QoL of participants had improved with treatment. In addition, in participants who took tirzepatide, changes in QoL scores from randomization to week 72 were summarized by weight reduction thresholds (≥5%, ≥10%, ≥15%, ≥20%, ≥25%), and for those with versus without physical limitations at randomization. What were the main results? Adults with obesity/overweight who had already lost ≥5% weight with a 12-week intensive lifestyle programme who then took tirzepatide for 72 weeks not only had significantly more weight loss compared with those taking placebo, but they also had significantly improved QoL. These improvements in QoL were generally larger with greater weight loss and in adults who reported physical limitations at randomization compared to those who reported no such limitations. The improvements in QoL were observed in physical function as well as in general mental health and weight-related psychological and social functions. What is the originality and relevance of this study? Findings of this study show that in addition to reducing weight in people who have already lost ≥5% weight after lifestyle interventions, tirzepatide improved QoL. This is important because other studies have shown that people with obesity have reduced QoL. Tirzepatide was generally associated with improved QoL the most in adults who had greater weight loss and in adults who reported physical limitations at randomization.

Behaviour Change Techniques Used in the Dietary Management of Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis

AIMS AND OBJECTIVE

To evaluate the effects of dietary intervention and the commonly used behaviour change techniques (BCTs) on clinical outcomes in patients with T2DM.

BACKGROUND

Effective dietary management is crucial in the management of diabetes. Behavioural change strategies are important in improving dietary adherence, but limited understanding of available evidence currently exists.

DESIGN

A systematic review and meta analysis using the PRISMA checklist were used to synthesise the evidence.

METHODS

Systematic review of five databases was completed using selected key terms. Meta-analysis was conducted to test the effects of the dietary interventions and to identify effective BCTs.

RESULTS

Nine studies were included in this research. Overall, the dietary interventions showed significant HbA1c reduction, with merits from personalised dietary interventions tailored to patient characteristics. Meanwhile, there was a sustained reduction in HbA1c after three, six, and twelve months post intervention. Moreover, significant improvements in weight and lipid profile were observed by the sixth month. Regarding employed BCTs, 'Credible Source' and'Conserving Mental Resources' were deemed to be both clinically and statistically significant in reducing HbA1c (> 0.3%), while 14 other BCTs were identified as being associated with a clinically meaningful reduction in HbA1c (> 0.3%).

CONCLUSION

Comprehensive dietary interventions incorporating selective BCTs significantly improved HbA1c, weight, and lipid profiles in patients with T2DM. Identified BCTs and the commonly used intervention features tailored to patient characteristics were most effective in dietary behaviour interventions.

RELEVANCE TO CLINICAL PRACTICE

It is suggested that, besides the commonly used BCTs (e.g., 'Goals and Planning' and 'Feedback on Behavior'), the application of 'Conserving Mental Resources' and ensuring 'Credible Source' should be incorporated into dietary interventions for patients with T2DM in clinical practice.

PATIENT OR PUBLIC CONTRIBUTION

The is no patient or public contribution in this paper.

TRIAL REGISTRATION

This study was registered at the International Prospective Register of Systematic Reviews.

PROSPERO ID

CRD42023459274.

Injectable multifunctional hydrogels for adipose tissue remodeling to treat obesity and alleviate metabolic syndrome

Dysfunction of adipose tissue in obese individuals is associated with metabolic imbalances. Current treatments focus on reducing calorie intake and increasing exercise but have unsatisfactory efficacy and significant side effects. Here, a subcutaneously in situ formed therapeutic hydrogel (RL lip@gel) that can simultaneously modulate the inflammatory environment of adipose tissue and induce adipocyte browning is developed to combat obesity. The alginate solution encapsulates the anti-inflammatory natural flavonoid luteolin and rosiglitazone-loaded liposomes (RL lip), which can be formed as an in situ hydrogel through crosslinking with divalent metal ions in adipose tissue following subcutaneous injection. RL lip@gel not only reprograms M1-like adipose tissue macrophages into an M2-like phenotype but diminishes the expression of proinflammatory cytokine, thereby decreasing systemic glucose resistance and lipid storage. Meanwhile, rosiglitazone embedded within the adipose tissue promotes the browning of white adipocytes, and boosts energy expenditure, with further enhancement from luteolin, as demonstrated by decreased white adipose tissue masses. This localized intervention not only ensures the efficacy of combating obesity systemically but enhances overall metabolism while minimizing side effects.

Functional regulation of macrophages by Ces1d-mediated lipid signaling in immunometabolism

OBJECTIVE

Macrophage accumulation in metabolically active tissues during obesity is common in both animals and humans, but the lipid signaling mechanisms that trigger macrophage inflammation remain unclear. This study investigates the role of Ces1d, an unconventional lipase, in regulating macrophage inflammation under nutritional stress.

METHODS

A myeloid-specific Ces1d knockout (LysM-Cre-Ces1d floxed/floxed, KO) mouse model was used for the studies. For in vitro tests, bone marrow-derived macrophages (BMDMs) from control (Ces1d floxed/floxed, WT) and KO mice were assessed for migration, polarization, and activation. For in vivo experiments, WT and KO mice were induced to obesity via a high-fat diet (HFD) and subjected to metabolic characterization. Adipose tissue, liver, and serum samples were analyzed histologically and biochemically. Endogenous macrophages and T cells from adipose tissue were isolated and analyzed for functional interactions by flow cytometry.

RESULTS

Ces1d expression changes during the differentiation of monocytes into macrophages in both mice and humans. Loss of Ces1d causes larger lipid droplets, with increased accumulation of triacylglycerol (TAG) and diacylglycerol (DAG), and impaired lipid signaling in KO macrophages. Lipid dysregulation in macrophages triggers pro-inflammatory activation, enhancing migration, activation, and polarization toward an M1-like phenotype. The pro-inflammatory macrophages further promote CD3+CD8+ T cell accumulation in obese adipose tissue, which contributes to worsened metabolic disorders, including more severe fatty liver, increased local inflammation in adipose tissue, and impaired systemic glucose tolerance in KO mice on a high-fat diet.

CONCLUSIONS

This study demonstrates Ces1d is a crucial factor in maintaining lipid homeostasis in macrophages. Loss of Ces1d leads to metabolic dysregulation in macrophages and other immune cells during obesity.

Epigallocatechin gallate prevents and alleviates type 2 diabetes mellitus (T2DM) through gut microbiota and multi-organ interactions in Wistar healthy rats and GK T2DM rats

INTRODUCTION

As the main active ingredient of the first FDA-approved phytochemical drug, epigallocatechin gallate (EGCG) can effectively alleviate glucolipid metabolic disorders. However, existing studies mainly focuses on the treatment of EGCG in disease models, with limited focus on its preventive effect on diseases in healthy models.

OBJECTIVES

This study investigated how EGCG prevents and alleviates T2DM through gut microbiota and multi-organ interactions in Wistar healthy rats and GK T2DM rats.

METHODS

The GK T2DM rat strain was established through repeated selective breeding of Wistar rats with glucose intolerance. Whether and how EGCG prevents and alleviates T2DM were evaluated, including glucose production and absorption efficiency, glucose transport, glucose metabolism, glucose excretion, T2DM-related tissue damage, gut microbiota, and liver transcriptome.

RESULTS

The health benefits of EGCG are primarily reliant on the involvement of the gut microbiota. Our study showed that although the specific microbial communities involved differ, the bidirectional interaction between EGCG and gut microbiota is widespread in healthy rats and T2DM rats. EGCG intervention elevated the relative abundance of specific microbial communities, which in turn promoted the metabolic processing of EGCG in the gut, producing numerous EGCG metabolites that may contribute to preventing and alleviating T2DM. In healthy rats, EGCG intervention selectively enhanced insulin secretion and serum insulin levels to prevent T2DM. In T2DM rats, EGCG intervention selectively lowered blood glucose levels, improved insulin resistance, delayed glucose production and absorption, and promoted urinary glucose excretion to alleviate T2DM. In both healthy and T2DM rats, EGCG intervention universally reduced gut microbiota-derived lipopolysaccharides, maintained systemic oxidative stress homeostasis, alleviated liver and kidney damage, increased muscle glycogen content, and promoted beige thermogenesis in white fat, thus demonstrating potential for preventing and alleviating T2DM.

CONCLUSION

As a natural active ingredient, EGCG could prevent and alleviate T2DM through gut microbiota and multi-organ interactions.

Polysaccharides in the medicine and food homology to combat obesity via gut-liver axis: A review of possible mechanisms

Polysaccharides, as macromolecular carbohydrates present in various medicine and food homology, have gained growing recognition for their potential in combating obesity through multiple mechanisms. Their natural origin and favorable safety profile have made polysaccharides from medicine and food homology (PMFH) an area of significant research interest, particularly in the context of developing effective, safe, and sustainable interventions for obesity management. This review summarized the classification and biological properties of PMFH and then elucidated the pathological characteristics of obesity. We primarily focused on the effects of PMFHs on obesity, with particular attention to the potential mechanisms mediated through the gut-liver axis. These mechanisms encompassed the improvement of fat metabolism imbalances, manager of appetite and energy balance, adjustment of intestinal microbial imbalances, and alleviation of oxidative stress and inflammation. The findings provided critical theoretical insights and data to support the development of anti-obesity dietary and pharmaceutical products. In brief, this review outlined future research directions regarding the potential mechanisms underlying the anti-obesity effects of PMFH, particularly those involving the gut-liver axis.

Relationships between atherogenic index of plasma and body mass index with the risk of type 2 diabetes mellitus: insights from CHARLS

BACKGROUND

The complex relationship between obesity and dyslipidemia in type 2 diabetes mellitus (T2DM) remains an area of interest but is not fully understood. This study aimed to evaluate the intricate links between atherogenic index of plasma (AIP), body mass index (BMI), and T2DM risk.

METHODS

Based on data from the China Health and Retirement Longitudinal Study, this analysis comprised 6754 individuals aged 45 and over, free of T2DM in 2011. BMI and AIP were the exposures, with T2DM incidence as the primary focus. Logistic regression models generated odds ratios (ORs), and a thorough decomposition of BMI's impact on T2DM revealed natural indirect and direct effects. The study also examined the complex interactions and combined effects of these two exposures.

RESULTS

By the end of 2018, 972 individuals were diagnosed with T2DM. The AIP played a significant association in the relationship between BMI and T2DM, explaining 21.7% and 18.9% of the association in different BMI ranges. A significant additive effect was observed between BMI and AIP, with a relative excess risk due to interaction of 0.62. BMI ≥ 24.0 kg/m2 and AIP above the median together conferred the highest risk of T2DM, with an OR of 2.31 and a 95% confidence interval (CI) of 1.92-2.79.

CONCLUSION

Exposure to overweight/obesity or high AIP raises T2DM risk among Chinese ≥ 45 years, AIP partly mediates BMI-T2DM link.

May Patients Receiving GLP-1 Agonists Be at Lower Risk of Prostate Cancer Aggressiveness and Progression?

INTRODUCTION

GLP-1 receptor agonists are valuable therapeutic agents for managing obesity and type 2 diabetes. The link between prostate cancer and obesity was described. The modulation of incretin hormone-dependent pathways may decrease the prostate cancer aggressiveness and progression.

OBJECTIVES

The purpose of this study was to review and summarize the literature on the role of GLP-1 agonists in prostate cancer.

MATERIAL & METHODS

We performed a scoping literature review of PubMed from January 2002 to February 2025. Search terms included "glucagon-peptide like 1", "incretin hormone", "GLP-1 receptor agonist", and "prostate cancer". Secondary search involved reference lists of eligible articles. The key criterion was to identify studies that included GLP-1 receptor, incretin hormones, GLP-1 receptor agonists, and their role in prostate cancer development.

RESULTS

77 publications were selected for inclusion in this review. The studies contained in publications allowed us to summarize the data on the role of GLP-1 receptor and it's agonists in prostate cancer biology and development. The following review aims to discuss and provide information about the role of incretin hormones in prostate cancer pathogenesis and its clinical implication in patients with prostate cancer.

CONCLUSION

Incretin hormone-dependent pathways play an important role in prostate cancer pathogenesis. Moreover, GLP-1 receptor agonists seems to be a promising therapeutical agents when it comes to finding new therapies in patients with more aggressive and/or advanced stages of prostate cancer.

Type 2 diabetes and the role of nurses in its management

Type 2 diabetes has become a significant global public health issue. Its increasing prevalence is closely linked to sedentary lifestyles, suboptimal diets and high obesity levels. This article provides an overview of type 2 diabetes epidemiology, pathophysiology, clinical presentation, diagnostic tests, risk factors, complications and management. It also describes the role of nurses, which involves: advising patients on weight management, diet, physical activity, smoking cessation and alcohol reduction; encouraging adherence to care plans and drug treatment regimens; and providing ongoing support, education and monitoring to prevent or delay the onset of complications.

Adipose Tissue-Derived Extracellular Vesicles Loaded with miR-141-3p Regulate Obesity-Induced Insulin Resistance by Targeting Glycogen Synthesis and Gluconeogenesis

Purpose

Insulin resistance, a hallmark feature of type 2 diabetes and cardiovascular diseases, is critically influenced by liver-adipose tissue crosstalk, offering a novel therapeutic strategy for its management. Emerging evidence indicates that extracellular vesicles (EVs) secreted from adipose tissue serve as essential carriers of miRNA-mediated interorgan communication. This study aimed to investigate the regulatory effects of adipose tissue-derived EVs on obesity-induced hepatic insulin resistance and to elucidate the underlying molecular mechanisms by which EV-mediated signaling contributes to metabolic dysfunction.

Methods

EVs with miR-141-3p knockout or overexpression were constructed and administered to both in vitro cell models and in vivo mouse models to investigate the regulatory role and underlying mechanisms of miR-141-3p-mediated adipose tissue-derived EVs in obesity-induced hepatic insulin resistance.

Results

miR-141-3p is significantly upregulated in adipose tissue-derived EVs from high-fat diet (HFD)-fed mice, as well as in other obesity-related conditions. Furthermore, the knockdown of miR-141-3p in EVs from chow diet (CD-EVs) counteracted the effect in improving obesity-induced hepatic insulin resistance, whereas the overexpression of miR-141-3p in HFD-EVs improved hepatic insulin resistance. Mechanistically, EVs-derived miR-141-3p directly targets PTEN to promote PI3K/AKT signaling, thereby mediating hepatic glucose homeostasis through the regulation of hepatic gluconeogenesis and glycogen synthesis.

Conclusion

In summary, our results highlight the emerging role of miR-141-3p in mediating adipose tissue-derived EVs to alleviate obesity-induced hepatic insulin resistance, providing potential therapeutic targets for type 2 diabetes.

Tirzepatide Was Associated with Improved Health-Related Quality of Life in Adults with Obesity or Overweight and Type 2 Diabetes: Results from the Phase 3 SURMOUNT-2 Trial

INTRODUCTION

In SURMOUNT-2, a phase 3, randomized clinical trial, tirzepatide treatment resulted in clinically meaningful reduction in bodyweight among people with obesity or overweight and T2D. The current analysis evaluated the effects of tirzepatide treatment on self-reported health-related quality of life (HRQoL) outcomes among SURMOUNT-2 participants.

METHODS

SURMOUNT-2 participants were randomly assigned (1:1:1) to receive either tirzepatide 10 mg (n = 312), tirzepatide 15 mg (n = 311), or placebo (n = 315) for 72 weeks as an adjunct to diet and exercise. Self-reported HRQoL was assessed in terms of changes from baseline to week 72 in Short Form-36 Version 2 Health Survey acute form (SF-36v2), Impact of Weight on Quality of Life-Lite-Clinical Trials Version (IWQOL-Lite-CT), EQ-5D 5-level Version (EQ-5D-5L) Health State Index (UK) and associated EQ visual analog scale (VAS), and Patient Global Impression of Status (PGIS) for Physical Activity. Post hoc analyses evaluated changes in HRQoL outcomes by categorical percent weight reduction targets (> 0 to < 5%, ≥ 5%, ≥ 10%, ≥ 15%, ≥ 20%, ≥ 25%, and ≥ 30%) and by self-reported baseline physical function limitations (based on PGIS) among tirzepatide-treated participants.

RESULTS

At week 72, tirzepatide treatment was associated with significantly larger improvements than placebo in the SF-36v2 Physical Component Summary score, SF-36v2 physical functioning, bodily pain, general health, vitality, and social functioning domain scores, all IWQOL-Lite-CT scores, and EQ VAS score. Tirzepatide-treated participants who achieved greater weight reduction targets showed numerically larger improvements in HRQoL scores relative to those with lower percent weight reduction. For all HRQoL measures, participants with physical function limitations at baseline showed greater improvements than those without limitations.

CONCLUSIONS

Tirzepatide treatment was associated with improved self-reported HRQoL outcomes compared with placebo among people with obesity or overweight with T2D. Participants achieving greater bodyweight reductions and those with physical function limitations at baseline showed greater improvements in HRQoL. CLINICAL TRIAL REGISTRATION NUMBER FOR SURMOUNT-2: NCT04657003.

Enhancing adipose tissue plasticity: progenitor cell roles in metabolic health

Adipose tissue demonstrates considerable plasticity and heterogeneity, enabling metabolic, cellular and structural adaptations to environmental signals. This adaptability is key for maintaining metabolic homeostasis. Impaired adipose tissue plasticity can lead to abnormal adipose tissue responses to metabolic cues, which contributes to the development of cardiometabolic diseases. In chronic obesity, white adipose tissue undergoes pathological remodelling marked by adipocyte hypertrophy, chronic inflammation and fibrosis, which are linked to local and systemic insulin resistance. Research data suggest that the capacity for healthy or unhealthy white adipose tissue remodelling might depend on the intrinsic diversity of adipose progenitor cells (APCs), which sense and respond to metabolic cues. This Review highlights studies on APCs as key determinants of adipose tissue plasticity, discussing differences between subcutaneous and visceral adipose tissue depots during development, growth and obesity. Modulating APC functions could improve strategies for treating adipose tissue dysfunction and metabolic diseases in obesity.

Altered gray matter structural covariance networks in young adults with obesity

BACKGROUND

Overwhelming evidence showed that obesity was associated with abnormal brain functional networks. However, the changes of structural covariance networks (SCNs) based on cortical thickness (CT) and cortical surface area (CSA) in obesity is still unclear.

METHODS

In this study, 243 young adults with obesity and matched 243 lean individuals were enrolled from the Human Connectome Project Release S1200 dataset. All participants underwent magnetic resonance imaging scans following clinical and neuropsychological assessments. SCNs matrices were constructed by Brain Connectivity Toolbox based on both CT and CSA. Nonparametric permutation tests were adopted to examine group differences of these matrices.

RESULTS

Young adults with obesity exhibited lower CSA of left entorhinal cortex, but higher CT of both left rostral anterior cingulate cortex and right superior parietal lobule, as well as lower CT of left temporal pole. While in terms of global network measures, there were no significant group differences; in terms of nodal network measures, young adults with obesity exhibited alterations in widespread brain regions including left posterior cingulate cortex, bilateral superior frontal gyrus, left entorhinal cortex and right insula.

CONCLUSIONS

Young adults with obesity exhibited abnormal nodal network measures in widespread brain regions involved in default mode network, central executive network and salience network. These findings indicate the adverse effects of obesity on young adults might be associated with the altered triple network.

Risk of Incident Type 2 Diabetes and Prediabetes in Patients With Direct Acting Antiviral-Induced Cure of Hepatitis C Virus Infection

BACKGROUND

Data regarding the risk of incident type 2 diabetes (T2D) and prediabetes among patients with hepatitis C virus (HCV) achieving direct-acting antivirals (DAAs)-induced sustained virologic response (SVR12) remains limited.

METHODS

A total of 1079 patients, including 589 with normoglycemia and 490 with prediabetes, who underwent biannual fasting glucose and glycosylated haemoglobin (HbA1c) assessment for a median post-SVR12 follow-up of 5.5 years, were enrolled. We reported the crude (cIRs) and age-standardised incidence rates (ASIRs) of T2D and prediabetes. Factors associated with incident T2D and prediabetes were assessed using the Cox proportional hazards models.

RESULTS

The cIRs of T2D and prediabetes were 1.18 and 8.99 per 100 person-years of follow-up (PYFU), respectively. Additionally, the ASIRs of T2D and prediabetes were 1.09 (95% CI: 0.76-1.53) and 8.47 (95% CI: 7.23-9.90) per 100 PYFU. Prediabetes (adjusted hazard ratio [aHR]: 4.71; 95% confidence interval (CI): 2.55-8.70, p < 0.001), body mass index (BMI) per kg/m2 increase (aHR: 1.17; 95% CI: 1.09-1.26, p < 0.001) and liver stiffness measurement (LSM) per kPa increase (aHR: 1.05; 95% CI: 1.02-1.09, p = 0.001) were associated with a higher risk of incident T2D. Age per year increase (aHR: 1.02; 95% CI: 1.01-1.03, p < 0.001) was associated with a higher risk of incident prediabetes.

CONCLUSION

The incidence rates of T2D and prediabetes remain substantial among patients after HCV eradication. Lifestyle modification, drug therapy and regular monitoring of glycemic status are crucial for patients at risk of developing T2D and prediabetes following HCV clearance.

The relationship between longitudinal changes in triglyceride-glucose-body mass index and new-onset diabetes in middle-aged and elderly adults: Evidence from a nationwide Chinese cohort study

OBJECTIVE

This study investigates the association between changes in TyG-BMI and the risk of diabetes mellitus (DM) in middle-aged and elderly adults in China, as prior research has mainly focused on single baseline measurements.

METHODS

Data were obtained from CHARLS, a nationwide prospective cohort study. TyG-BMI changes (2011-2015) were analyzed using K-means clustering. Cox proportional hazards regression models assessed the relationship between TyG-BMI changes, cumulative TyG-BMI, and DM risk, with sensitivity and subgroup analyses ensuring robustness.

RESULTS

Compared to individuals with consistently low TyG-BMI (class 1), hazard ratios (HRs) for DM were 1.474, 2.250, and 3.142 for participants with moderately sustained and slowly increasing TyG-BMI (class 2), slowly increasing high level of TyG-BMI (class 3), and the highest and increasing TyG-BMI levels (class 4), respectively. △TyG-BMI2015-2011 (per 10-unit) yielded HRs of 1.064 for class 2, 1.108 for class 3, and 1.079 for class 4. Cumulative TyG-BMI (per 10-unit) had an HR of 1.029.

CONCLUSION

TyG-BMI changes and sustained exposure to high TyG-BMI levels are independently linked to increased DM risk. Monitoring long-term fluctuations in TyG-BMI could be an important strategy for preventing DM, and effectively controlling high TyG-BMI through various interventions may significantly reduce DM risk.

Sleep Phenotypes, Genetic Susceptibility, and Risk of Obesity in Patients With Type 2 Diabetes: A National Prospective Cohort Study

BACKGROUND

To determine the associations between sleep phenotypes and the risks of specific obesity types and weight gain in patients with type 2 diabetes (T2D), especially in different genetic risk groups.

MATERIALS AND METHODS

We conducted a prospective study involving 58 890 participants. Sleep and napping were assessed according to the standardized questionnaire. General and abdominal obesity were defined by BMI or visceral fat area (VFA), respectively. Multivariable Cox regression, stratified, and joint analysis were performed to explore potential correlations. Furthermore, mediation models were constructed to figure out the mediating role of metabolic factors (blood pressure, UACR, and HbA1c).

RESULTS

During a median 3.05-year follow-up period, short sleep increased the risk of obesity (HR 1.42, 95% CI 1.17-1.71; 1.33, 1.08-1.65) and weight gain (1.21, 1.09-1.34; 1.17, 1.06-1.29), while long sleep and napping were unrelated to abdominal obesity and weight gain. Mediation analysis showed that systolic blood pressure, UACR, and HbA1c mediated the statistical association between night sleep duration and general obesity with proportions (%) of 7.9, 1.8, and 8.8, respectively. Joint analysis showed both sleep and napping groups had no significance among the low genetic risk group, while long napping, short sleep, and long sleep increased the risk of general obesity in medium to high risk patients.

CONCLUSIONS

Short sleep, long sleep, and long napping increased the risk of general obesity and BMI-defined weight gain, and were more pronounced in the medium to high genetic risk group. Napping was unrelated to abdominal obesity. Metabolic factors partially explain the mechanism between sleep and obesity.

The dual challenge of diabesity: pathophysiology, management, and future directions

Diabesity, the concurrent occurrence of obesity and type-2 diabetes mellitus (T2DM), represents a pressing global health challenge characterized by intricate pathophysiological mechanisms and a wide range of associated comorbidities. Central to its development are insulin resistance, metabolic syndrome, and chronic low-grade inflammation mediated by dysregulated adipokine secretion and systemic metabolic dysfunction. These mechanisms underpin the progression of diabesity and its complications, including cardiovascular disease and hypertension. Management strategies encompass lifestyle interventions focusing on tailored dietary modifications and structured physical activity, pharmacological treatments targeting both glycemic control and weight loss, and surgical interventions such as bariatric surgery, which have demonstrated efficacy in achieving durable outcomes. Clinical trials and meta-analyses underscore the comparative advantages of different treatment modalities in terms of efficacy, safety, and sustainability. Moreover, long-term follow-up studies emphasize the critical need for sustained multidisciplinary interventions to prevent relapse and enhance patient outcomes. Future advancements in management include exploring precision medicine approaches that integrate individual metabolic profiles, lifestyle factors, and emerging therapeutic innovations. A multidisciplinary approach combining advanced therapeutic strategies and patient-centered care remains pivotal for optimizing management and improving prognoses for individuals with diabesity. This review highlights the complex interplay between obesity and T2DM, offering comprehensive insights into their pathophysiology, clinical presentation, and management paradigms.

The Therapeutic Potential of Theobromine in Obesity: A Comprehensive Review

Obesity, characterized by chronic low-grade inflammation, is a significant health concern. Phytochemicals found in plants are being explored for therapeutic use, particularly in combating obesity. Among these, theobromine, commonly found in cocoa and chocolate, shows promise. Although not as extensively studied as caffeine, theobromine exhibits positive effects on human health. It improves lipid profiles, aids in asthma treatment, lowers blood pressure, regulates gut microbiota, reduces tumor formation, moderates blood glucose levels, and acts as a neuroprotective agent. Studies demonstrate its anti-obesity effects through mechanisms such as browning of white adipose tissue, activation of brown adipose tissue, anti-inflammatory properties, and reduction of oxidative stress. This study aims to suggest theobromine as a potential therapeutic agent against obesity-related complications.

How Effective Are Machine Learning and Doubly Robust Estimators in Incorporating High-Dimensional Proxies to Reduce Residual Confounding?

BACKGROUND

Residual confounding presents a persistent challenge in observational studies, particularly in high-dimensional settings. High-dimensional proxy adjustment methods, such as the high-dimensional propensity score (hdPS), are widely used to address confounding bias by incorporating proxies for unmeasured confounders. Extensions of hdPS have integrated machine learning, such as LASSO and super learner (SL), and doubly robust estimators, such as targeted maximum likelihood estimation (TMLE). However, the comparative performance of these methods, especially under different learner configurations and high-dimensional proxies, remains unclear.

METHOD

We conducted plasmode simulations to evaluate the performance of standard methods, SL, TMLE, and double cross-fit TMLE (DC-TMLE) under varying exposure and outcome prevalence scenarios. Learner libraries included: 1 learner (logistic regression), 3 learners (logistic regression, MARS, and LASSO), and 4 learners (adding XGBoost, a non-Donsker learner). Metrics included bias, coverage, and variability.

RESULTS

Methods without proxies exhibited the highest bias and poorest coverage, highlighting the critical role of proxies in confounding adjustment. Standard methods incorporating high-dimensional proxies showed robust performance, achieving low bias and near-nominal coverage. TMLE and DC-TMLE reduced bias but exhibited worse coverage compared to standard methods, particularly with larger learner libraries. Notably, DC-TMLE, expected to address under-coverage issues, failed to perform adequately in high-dimensional settings with non-Donsker learners, further emphasizing the instability introduced by complex libraries.

CONCLUSION

Our findings underscore the utility of high-dimensional proxies in standard methods and the importance of tailoring learner configurations in SL and TMLE to ensure reliable confounding adjustment in high-dimensional contexts.

The small GTPase Rap1 in POMC neurons regulates leptin actions and glucose metabolism

The hypothalamic leptin-proopiomelanocortin (POMC) pathway is critical for regulating metabolism. POMC neurons in the arcuate nucleus respond to leptin and play a pivotal role in mediating energy and glucose balance. However, during diet-induced obesity (DIO), these neurons often develop resistance to exogenous leptin. Recently, the small GTPase Rap1 has been implicated as an inhibitor of neuronal leptin signaling; however, its specific role within POMC neurons remains unexplored. We generated tamoxifen-inducible, POMC neuron-specific Rap1 knockout mice to selectively delete both Rap1a and Rap1b isoforms in POMC neurons. By analyzing these mice through metabolic phenotyping, immunohistochemistry, and biochemical assays, we show that deleting Rap1a and Rap1b in POMC neurons prior to exposing the mice to a high-fat diet significantly prevented weight gain compared to control mice. Furthermore, while DIO mice with intact Rap1 failed to respond to exogenous leptin, genetically removing the Rap1 genes from DIO mice enhanced the ability of exogenous leptin to induce anorectic effects. Remarkably, acute deletion of Rap1 in POMC neurons of already obese mice improved hyperglycemia within one week, with minimal effect on body weight. This glycemic improvement was accompanied by improved glucose tolerance, enhanced insulin sensitivity, and improved cellular insulin signaling. Collectively, these findings suggest that loss of Rap1 in POMC neurons enhances leptin sensitivity, acutely improves glucose balance, and may offer a potential strategy to lower hyperglycemia in dietary obesity.

Adropin: A cardio-metabolic hormone in the periphery, a neurohormone in the brain?

Whole-body metabolic homeostasis is regulated by physiological responses across organs and tissues to proteins and peptides (<50 amino acids) released into the interstitial and circulatory spaces. These secreted factors integrate signals of metabolic status at both the cellular and systemic level, regulate the intake and distribution of ingested and stored energy substrates across tissues, and minimize toxicity from excessive excursions in circulating concentrations of energy substrates (for example, glucotoxicity and lipotoxicity). The proteins and peptides that are known to be secreted into circulation that are involved in regulating metabolic processes represent a fraction of the secretome predicted by the Human Proteome Atlas. Many undiscovered leads for targeting new therapies for metabolic diseases may therefore exist. In this review, we discuss the biology of adropin, the peptide encoded by the Energy Homeostasis Associated (ENHO) gene. First described as a feeding-responsive, liver-secreted peptide ("hepatokine") involved in metabolic homeostasis, > 2 decades of research indicate adropin is a stress-responsive peptide acting across multiple tissues, vascular, and organ systems. Adropin modulates the responses of liver and muscle to insulin and glucagon in regulating glucose homeostasis. Adropin inhibits hepatic glucose production and stimulates glycolysis but also inhibits tissue fibrosis and maintains vascular health in aging and metabolic disease states. Adropin is also highly expressed in the central nervous system where recent data suggest neuroprotective actions. Collectively, these results suggest the potential for targeting adropin in reducing risk of both metabolic (metabolic syndrome/type-2 diabetes) and neurodegenerative diseases in the context of aging and obesity.

The obesity pandemic and its impact on non-communicable disease burden

The rising prevalence of overweight and obesity across the globe is a major threat both to public health and economic development. This is mainly due to the link of obesity with the development and outcomes of non-communicable diseases (NCDs). NCDs are a leading cause of global death and disability, and reducing the burden of NCDs on patients and healthcare systems is of critical importance to improve public health. Obesity is projected to be the number one preventable risk factor for NCDs by 2035, and there is an urgent need to tackle the growing obesity rates in order to reduce NCD incidence and severity. Here, we review the current understanding of the impact of obesity on NCD burden in general, as well as the epidemiological and mechanistic relationship between obesity and some of the most common classes of NCDs. By literature review, we found that over 70% of NCDs have a documented association with obesity, highlighting the importance of a better understanding of the pathophysiologies underlying obesity/overweight as well as the interaction between obesity and NCDs in order to reduce global disease burden.

Genetic predisposition to adiposity, and type 2 diabetes: the role of lifestyle and phenotypic adiposity

AIMS

Genetic predisposition to adiposity is associated with type 2 diabetes (T2D), even in the absence of phenotypic adiposity (obesity and central obesity). We aimed to quantify the overall contribution of obesity and modifiable lifestyle factors to the association between genetic predisposition to adiposity and the development of T2D.

METHODS

This prospective cohort study involved 220 703 White British participants from the UK Biobank. It examined the associations between genetic predisposition to adiposity [body mass index polygenic risk (BMI-PRS) and waist-hip ratio polygenic risk (WHR-PRS)] and incident T2D, as well as interactions and mediation via lifestyle factors (diet quality, physical activity levels, total energy intake, sleep duration, and smoking and alcohol intake) and phenotypic adiposity.

RESULTS

People with high phenotypic adiposity and high adiposity PRS values (>1 SD above the mean) had the highest risk of incident T2D (versus non-obese/central obese and non-high PRS). This was the case for BMI-PRS [hazard ratio (HR) = 3.72] and WHR-PRS (HR = 4.17). Lifestyle factors explained 30.5% of the BMI-PRS/T2D association (2.0% mediation; 28.5% effect modification), and lifestyle and obesity together explained 92.1% (78.8% mediation; 13.3% effect modification). Lifestyle factors explained 20.4% of the WHR-PRS/T2D association (3.4% mediation; 17.0% effect modification), and lifestyle and central obesity together explained 72.8% (41.1% mediation; 31.7% effect modification).

CONCLUSIONS

Whilst phenotypic adiposity explains a large proportion of the association between BMI-PRS/WHR-PRS and T2D, modifiable lifestyle factors also make contributions. Promoting healthy lifestyles among people prone to adiposity is important in reducing the global burden of T2D.

The Efficacy and Safety of Tirzepatide in Patients with Diabetes and/or Obesity: Systematic Review and Meta-Analysis of Randomized Clinical Trials

Background: Obesity and type 2 diabetes (T2D) are major public health concerns. Tirzepatide has shown promise in recent clinical trials. This systematic review and meta-analysis aim to evaluate the efficacy and safety of tirzepatide in adults with obesity or type 2 diabetes, compared to placebo, GLP-1 receptor agonists (GLP-1 RAs), and insulin. Method: PubMed, Embase, and the Cochrane Library were searched on 17 January 2024, focusing on phase II and III randomized controlled trials (RCTs). We included studies involving adults with T2D or obesity, comparing tirzepatide to placebo, GLP-1 RAs, or insulin. The primary outcomes were the proportion of participants achieving ≥5%, ≥10%, and ≥15% weight loss targets. Secondary outcomes included changes in body weight, waist circumference, HbA1c levels, and blood pressure. Safety outcomes focused on adverse event rates. Meta-analyses were performed, and risk of bias was assessed using the Cochrane Risk-of-Bias tool version 2. Results: Fourteen RCTs involving 14,713 patients were included. Tirzepatide significantly increased the proportion of participants achieving weight loss targets, and reduced body weight, waist circumference, HbA1c, and blood pressure versus placebo and insulin. Compared with GLP-1 RAs, tirzepatide provided comparable or better outcomes in weight loss, waist circumference, and glycemic control. The incidence of gastrointestinal adverse events was significantly higher at all doses of tirzepatide compared to placebo and insulin. When compared with GLP-1 RAs, higher doses of tirzepatide were associated with increased risk of nausea, diarrhea, and decreased appetite, but not vomiting. Conclusions: Tirzepatide is an effective option for managing weight and improving metabolic outcomes in patients with T2D or obesity. However, it is associated with an increased risk of gastrointestinal adverse events, especially at higher doses. Therefore, close monitoring should be considered in clinical practice. Registration: PROSPERO CRD42021283449.

Relationship Between Systemic Inflammation and Glycemic Control in Firefighters

Background: Firefighters are at risk for developing metabolic diseases such as type 2 diabetes due to occupational-related stress and poor health behaviors. Firefighters often experience chronic inflammatory responses that may contribute to the development of insulin resistance. This study examined the relationship between systemic inflammation markers and glycemic control markers in firefighters. Methods: Blood samples were collected from twenty full-time male firefighters to assess HbA1c, fasting glucose, and insulin to estimate the Homeostatic Model of Assessment of Insulin Resistance (HOMA-IR), C-reactive protein (CRP), and homocysteine. Body composition and cardiovascular metrics were also recorded. Pearson partial correlation analyses were performed to evaluate relationships between homocysteine and CRP and the variables HOMA-IR and HbA1c while controlling for age and body fat percentage (BF%). SPSS version 29 was used for all analyses (α = 0.05). Data transformation was used where appropriate to ensure the normal distribution of each variable. Results: A significant positive correlation was found between homocysteine and HbA1c before (p = 0.006, r = 0.605) and after controlling for age and BF% (ppartial = 0.013, rpartial = 0.588), indicating that homocysteine levels are associated with impaired glycemic control in firefighters. No other relationships were found to be significant. Conclusions: The findings support a potential link between systemic inflammation and poor glycemic control in firefighters. Due to the occupational hazards that contribute to chronic inflammation, targeted interventions such as dietary modifications may help decrease the risk of diabetes and cardiovascular disease in this high-risk population.

Effects of Carnosine Supplementation on Cognitive Outcomes in Prediabetes and Well-Controlled Type 2 Diabetes: A Randomised Placebo-Controlled Clinical Trial

Background: Trends in global ageing underscore the rising burden of age-related cognitive decline and concomitant cardiometabolic diseases, including type 2 diabetes mellitus (T2DM). Carnosine, a naturally occurring dipeptide with anti-inflammatory, antioxidant and anti-glycating properties, has shown promise in animal models and limited human studies for improving cognitive function, insulin resistance and T2DM, but its therapeutic effects on cognition remain unclear. The aim of this study is to assess the effects of carnosine on cognitive function in individuals with prediabetes or well-controlled T2DM. Methods: This is a secondary analysis of a double-blind randomised controlled trial (RCT), whereby 49 adults with prediabetes or early-stage well-controlled T2DM were randomised to receive 2 g of carnosine or identical placebo daily for 14 weeks. At baseline and follow-up, cognitive function was assessed as a secondary outcome using the Digit-Symbol Substitution Test, Stroop test, Trail Making Tests A & B, and the Cambridge Automated Neuropsychological Test Battery (CANTAB). Results: In total, 42 adults (23 males and 19 females) completed the trial. There were no differences in participant anthropometry or cognitive functioning between carnosine and placebo groups at baseline (all p > 0.1). After the 14-week supplementation period, there were no differences between carnosine and placebo groups in change and follow-up values for any cognitive measures including Stroop, Digit Symbol Substitution Sest, Trail Making A/B or CANTAB (all p > 0.05). Adjustments for baseline cognitive scores, diabetic status, level of education, age or interaction effects with participants' sex did not change the results. Conclusions: Carnosine supplementation did not improve cognitive measures in individuals with prediabetes or T2DM in this study. While larger trials may provide further insights, alternative factors-such as the relatively young and healthy profile of our cohort-may have contributed to the lack of observed effect. Future research should examine individuals with existing cognitive impairment or those at higher risk of cognitive decline to better define the therapeutic potential of carnosine in this context.

Effect of Dietary Approaches to Stop Hypertension (DASH) diet on lipid profile in individuals with overweight/ obesity: A GRADE-assessed systematic review and meta-analysis of clinical trials

BACKGROUND AND AIM

Obesity is a major nutritional disease that increases the risk of developing serious health conditions like dyslipidemia. Plant-based diets, like DASH (dietary approaches to stop hypertension), can help lower the risk of dyslipidemia. However, evidence on the effect of DASH diet on lipid profile in populations with overweight/obesity is inconsistent. This meta-analysis of controlled trials investigated the effects of the DASH diet on lipid profile in individuals with overweight/obesity.

METHODS AND RESULTS

A search for relevant studies was conducted in databases like PubMed, Web of Science, and Scopus until January 2024. The calculation of weighted-mean differences (WMDs) and 95 % confidence intervals (CIs) was performed based on the random-effects model. Sensitivity, meta-regression and publication bias analyses were also conducted. 22 eligible studies with 26 arms and 3562 participants were included. DASH diet significantly reduced total cholesterol (TC) (WMD: 5.05 mg/dl, 95 % CI: 8.78, -1.31, p = 0.008), low-density lipoprotein cholesterol (LDL-C) (WMD: 5.33 mg/dl, 95 % CI: 8.54, -2.11, p = 0.001) and very low-density lipoprotein cholesterol (VLDL-C) (WMD: 3.26, 95 % CI: 6.19, -0.34, p = 0.029) levels. Greater reductions were observed in studies with durations ≤8 weeks. All of the included studies were classified as high quality except two, which were classified as moderate quality. LDL-C and VLDL-C were categorized as high-grade evidence, while others were categorized as moderate.

CONCLUSIONS

DASH diet could improve the lipid profile of individuals with overweight/obesity by decreasing TC, LDL-C and VLDL-C levels. However, it doesn't have significant effects on high-density lipoprotein cholesterol and triglyceride levels.

Design, synthesis, and biological evaluation of novel quinoline carboxylic acid based styryl/alkyne hybrid molecule as a potent anti-adipogenic and antidyslipidemic agent via activation of Wnt/β-catenin pathway

Obesity has emerged as the root cause for various metabolic disorders worldwide and hence demands for urgent attention. In the same stride, a series of quinoline carboxylic acid-based styryl/alkyne hybrids were designed, synthesized, and evaluated for their anti-adipogenic activity. Based on the structure-activity relationship, functional groups and essential substituents to potentiate the anti-adipogenic activity were identified. The potent compound (E)-6-fluoro-2-(4-(4-methylstyryl)phenyl)quinoline-4-carboxylic acid (5m) suppresses the adipogenesis with IC50 value of 0.330 μM. In vitro studies in 3T3-L1 preadipocytes cell line show that compound 5m prevents adipogenesis by stopping the cell cycle at the early phase of differentiation, which is caused by stimulation of the Wnt3a/β-catenin pathway. Further compound 5m improves the blood lipid profile and reduces adipogenic marker proteins in the epididymal white adipose tissue (eWAT) of dyslipidemic hamster at 100 mg/kg/day oral dose. Treatment with compound 5m reduces the hypertrophied adipose tissue along with the decrease in the levels of adipogenic marker proteins such as PPARγ and CEBPα. The pharmacokinetic result establishes the molecule 5m to be stable with significant oral bioavailability. Henceforth, the present study provides a unique insight into the anti-adipogenic/anti-dyslipidemic properties of a novel styryl-quinoline carboxylic acid scaffold with a scope to enhance the anti-adipogenic potency for therapeutic intervention of obesity.

Progressive Weight Loss-Induced Remission of Insulin Resistance/Hyperinsulinemia and Improvements in Cardiovascular Risk Factors

Background

Hyperinsulinemia (HI) is a common endocrine metabolic disorder in obesity and is closely associated with cardiovascular disease.

Aim

This study aims to investigate the effects of progressive weight reduction on HI and cardiovascular risk factors.

Methods

We enrolled 68 patients with overweight or obesity. Body composition assessments, clinical indicator sampling and a 75g-oral glucose tolerance test were conducted at baseline and after 12-month weight loss to assess HI and insulin sensitivity. And the people were divided into four groups based on the percent of weight loss (<10%, ~20%, ~30%, >30%) to study the remission of HI and changes in body composition and cardiovascular risk factors.

Results

A total of 66 participants were studied at the end. Progressive weight loss significantly reduced plasma glucose and insulin (P<0.001, P for trend <0.001) and did not progressively reduce cardiovascular risk factors (P for trend <0.001). The greater the percentage of weight loss, the greater the remission rate of insulin resistance and hyperinsulinemia (P for trend <0.001), which reaches 100% when weight loss exceeds 30%. After adjusting for factors such as age, gender, and medication usage, remission of HI was still associated with progressive weight loss.

Conclusion

With progressive weight loss, people with overweight or obesity experienced further improvements in glycemic outcomes, body compositions, HI and insulin resistance.

Potential Association Between Atherogenic Coefficient, Prognostic Nutritional Index, and Various Obesity Indices in Diabetic Nephropathy

Background/Objectives: Type 2 diabetes mellitus (T2DM), is a rapidly growing global health concern, often accompanied by chronic kidney disease (CKD) and metabolic disturbances. Obesity-related indices, such as the visceral adiposity index (VAI) and body adiposity index (BAI), have been linked to cardiovascular and renal complications in diabetic patients. However, studies integrating both the atherogenic coefficient (AC) and prognostic nutritional index (PNI) for evaluating diabetic nephropathy (DN) remain limited. This study aimed to assess the associations of obesity-related indices with immunological and nutritional factors in patients with T2DM and prediabetes (PreDM). Methods: A retrospective, cross-sectional study was conducted over six months at a university clinical hospital in Dolj County, Romania. The study enrolled 268 newly diagnosed T2DM patients and 150 PreDM patients. Anthropometric parameters, laboratory tests, and demographic data were collected. AC and PNI were calculated using standard formulas, and statistical analyses were performed to determine their associations with metabolic and inflammatory markers. Results: Our study found that T2DM patients had significantly lower PNI values, indicating mild malnutrition, while PreDM patients maintained a normal nutritional status. AC was significantly higher in T2DM patients, correlating with lipid profile alterations and systemic inflammation. Obesity indices, particularly VAI, were significantly elevated in T2DM patients with higher AC values. Statistically significant differences in total cholesterol, low-density lipoprotein cholesterol (LDL-c), and triglycerides were observed between AC subgroups, reinforcing its role in cardiovascular risk assessment. Conclusions: The findings highlight the potential of AC and PNI as biomarkers for assessing nutritional, inflammatory, and lipemic status in diabetic patients. The significant associations between obesity-related indices, lipid profiles, and inflammation markers suggest that early assessment of these parameters may potentially aid in predicting diabetic complications. Further studies are needed to explore the clinical utility of AC and PNI in managing T2DM and CKD progression. Future research should investigate how the lipidic spectrum alters the progression of DN across various patient groups with diabetes and prediabetes.

Therapeutic Potential of Sotagliflozin in Animal Models of Non-alcoholic Fatty Liver Disease with and without Diabetes

Sotagliflozin, a dual SGLT1/2 inhibitor, enhances glucagon like peptide-1 (GLP-1) levels and GLP-1 receptor agonists are used to manage non-alcoholic fatty liver disease (NAFLD). Study investigates the effects of sotagliflozin on NAFLD, alone and combined with linagliptin, comparing outcomes in normoglycemic and hyperglycemic animal models.Obese fatty liver disease (FLD) model was induced by high-fat diet (HFD) feeding, while a diabetic non-alcoholic steatohepatitis (NASH) model was developed by administering a single dose of streptozotocin to neonatal mice, followed by HFD feeding post-weaning. At termination of the study, parameters including biochemical markers, inflammatory cytokines, hepatic lipid content, and histopathology were assessed.In NASH mice, sotagliflozin and linagliptin reduced hepatic triglycerides by 60% and 44%, respectively, and cholesterol by 46% and 49%. Their combination further decreased triglycerides by 68.5% and cholesterol by 83.9%. In FLD mice, sotagliflozin and linagliptin reduced triglycerides by 33% and 17%, respectively, and cholesterol by 46% and 21%. Combination treatment offered no benefit, reducing triglycerides by 38% and cholesterol by 27%. Both the treatments improved plasma fibroblast growth factor 21, hepatic interlukin-6, glucose tolerance, steatosis and mitigated fat pad weight, but their combination did not show additional benefit. However, combination treatment demonstrated added benefit in modulating NAFLD activity score, liver enzymes, glycogenated hepatic nuclei, plasma glucose and active GLP-1 levels.Study underscores sotagliflozin's potential to mitigate NAFLD and highlights the benefit of combining it with linagliptin in hyperglycemic NASH model, which showed limited efficacy in normoglycemic FLD mice.

Obesity, composite dietary antioxidant index, and their interactive association with the risk of cardiometabolic multimorbidity in the elderly from a large national survey

BACKGROUND

Dietary antioxidants and obesity are considered significant targets for disease prevention in the elderly. However, a possible cardiometabolic multimorbidity (CMM) correlated to dietary antioxidants and obesity is unknown. This study aimed to examine the relationship between dietary antioxidants and obesity with CMM in the older population.

METHODS

We used data from the NHANES 2003-2018 cycles, including older adults aged 60 and above. Dietary antioxidant status was assessed using the CDAI, calculated from six micronutrients (vitamins A, C, E, selenium, zinc, and carotenoids), and obesity was classified based on BMI. We applied restricted cubic spline models to explore nonlinear associations and logistic regression to assess the associations between pro-oxidant diet, obesity, and CMM. The joint effects of pro-oxidant diet and obesity on CMM were evaluated using additive interaction indices: RERI, AP, and SI, to determine the synergistic impact of these factors. Subgroup analyses by age, sex, ethnicity, and hypertension status were also conducted to assess the synergistic effect of these factors within different population groups.

RESULTS

A total of 13,178 older adults (mean age 69.85 ± 0.10 years; 45.1% male) were included in this study. A pro-oxidant diet and obesity jointly increased CMM risk, with the Pro-oxidant diet & Obese group having the highest risk (adjusted OR 3.11, 95% CI: 2.39-4.04), indicating that their likelihood of CMM was more than three times higher compared to the reference group (Anti-oxidant diet & Non-Obese group). The Anti-oxidant diet & Obese group (adjusted OR 2.03, 95% CI: 1.59-2.59) and the Pro-oxidant diet & Non-Obese group (adjusted OR 1.33, 95% CI: 1.08-1.64) also showed elevated risks, although to a lesser extent. These findings suggest that both dietary factors and obesity independently contribute to CMM risk, but their combined effect is more pronounced. The interaction between a pro-oxidant diet and obesity was synergistic, with the RERI indicating a positive interaction (0.75, 95% CI: 0.21, 1.29), the AP showing 24% of the combined effect due to their interaction, and the SI indicating a synergistic effect greater than additive (SI 1.55, 95% CI: 1.11-2.16). Subgroup analyses showed stronger interactions in females, younger individuals, non-Hispanic Whites, and those with hypertension.

CONCLUSIONS

Obesity and a pro-oxidative diet are correlated with the occurrence of CMM; there exists an interaction between obesity and a pro-oxidative diet concerning the initiation and advancement of CMM. Subgroup studies revealed more pronounced interactions among females, younger adults, non-Hispanic Whites, and individuals with hypertension.

The miRNomics of antiretroviral therapy-induced obesity

Human immunodeficiency virus (HIV) is a retrovirus that incorporates its genetic material into the host's chromosome. The resulting diseases and related conditions constitute a global health problem as there are no treatments to eliminate HIV from an infected individual. However, the potent, complex, and active antiretroviral therapy (ART) strategies have been able to successfully inhibit HIV replication in patients. Unfortunately, obesity following ART is frequent among HIV-infected patients. The mechanism underlying ART-induced obesity is characterized based on expression of traditional markers such as genes and proteins. However, little is known about, yet another key component of molecular biology known as microRNAs (miRNAs). Micro-RNAs are ~ 22 base-long non-coding nucleotides capable of regulating more than 60% of all human protein-coding genes. The interest in miRNA molecules is increasing and their roles in HIV and obesity are beginning to be apparent. In this review, we provide an overview of HIV and its associated diseases, ART-induced obesity, and discuss the roles and plausible benefits of miRNAs in regulating obesity genes in HIV-infected patients. Understanding the roles of miRNAs in ART-induced obesity will aid in tracking the disease progression and designing beneficial therapeutic approaches.

Rational design of dual-agonist peptides targeting GLP-1 and NPY2 receptors for regulating glucose homeostasis and body weight with minimal nausea and emesis

There is an urgent need for effective treatments targeting comorbidities of type 2 diabetes (T2DM) and obesity. Developing dual agonists of glucagon-like peptide 1 receptor (GLP-1R) and neuropeptide Y receptor type 2 (NPY2R) with combined PYY3-36 and GLP-1 bioactivity is promising. However, designing such dual agonists that effectively control glycemia and reduce weight while minimizing gastrointestinal side effects is challenging. In this study, we systematically evaluated the side effects induced by co-administering various GLP-1R agonists and PYY3-36 analogue. Our findings revealed that different GLP-1R agonist-PYY analogue combinations elicited gastrointestinal side effects of varying intensities. Among these, the co-administration of bullfrog GLP-1 analogue (bGLP-1) with PYY3-36 analogue resulted in lower gastrointestinal side effects. Thus, bGLP-1 was selected as the preferred candidate for designing dual GLP-1R/NPY2R agonists. Through stepwise structural design, optimization of linker arms, and durability enhancements, coupled with in vitro receptor screening, the novel peptide bGLP/PYY-19 emerged as the lead candidate. Notably, experimental results in mice and rats showed a significant reduction in emesis with bGLP/PYY-19 compared to semaglutide and bGLP-1 long-acting analogue (LAbGLP-1). Furthermore, bGLP/PYY-19 significantly outperformed semaglutide and LAbGLP-1 in reducing body weight in diet-induced obese (DIO) mice, without inducing nausea-associated behavior. These findings underscore the potential of dual-targeting single peptide conjugates as a promising strategy for developing glucoregulatory treatments that offer superior weight loss benefits and are better tolerated compared to treatments targeting GLP-1R alone.