Visceral adipose tissue and residual cardiovascular risk: a pathological link and new therapeutic options

Mechanisms of GLP-1 Receptor Agonist-Induced Weight Loss: A Review of Central and Peripheral Pathways in Appetite and Energy Regulation

Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have become central in managing obesity and type 2 diabetes, primarily through appetite suppression and metabolic regulation. This review explores the mechanisms underlying GLP-1 RA-induced weight loss, focusing on central and peripheral pathways. Centrally, GLP-1 RAs modulate brain regions controlling appetite, influencing neurotransmitter and peptide release to regulate hunger and energy expenditure. Peripherally, GLP-1 RAs improve glycemic control by enhancing insulin secretion, reducing glucagon release, delaying gastric emptying, and regulating gut hormones. They also reduce triglycerides and low-density lipoprotein cholesterol, mitigate adipose tissue inflammation, and minimize ectopic fat deposition, promoting overall metabolic health. Emerging dual and triple co-agonists, targeting GLP-1 alongside glucose-dependent insulinotropic polypeptide, and glucagon pathways, may enhance weight loss and metabolic flexibility. Understanding these mechanisms is crucial as the therapeutic landscape evolves, offering clinicians and researchers insights to optimize the efficacy of current and future obesity treatments.

The effect of hypertension, obesity, and type 2 diabetes on lacunar stroke: A network Mendelian randomization study

BACKGROUND AND AIMS

Previous studies have reported an association of lacunar stroke with hypertension, obesity, and type 2 diabetes (T2D). The aim of this study was to investigate whether the association was causal and whether body mass index mediated the effect of hypertension on lacunar stroke.

METHODS AND RESULTS

The independence and causal association of hypertension, obesity, and T2D with lacunar stroke were assessed by multivariate Mendelian randomization (MVMR) and network Mendelian randomization (NMR) with inverse variance weighting (IVW). The reliability of the results was increased by sensitivity analyses including MR-Egger, Cochrane's Q test, Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO), and leave-one-out. MVMR analysis found that genetically predicted hypertension had a 42 % higher lacunar stroke risk (OR: 1.42, 95 % CI: 1.29-1.56, P < 0.001) when adjusted for obesity and T2D, genetically predicted T2D had a 9 % higher lacunar stroke risk (OR: 1.09, 95 % CI: 1.03-1.16, P < 0.004) when adjusted for hypertension and obesity, and genetically predicted obesity had a 15 % lower lacunar stroke risk (OR: 0.85, 95 % CI: 0.77-0.93, P < 0.001) when adjusted for hypertension and T2D. NMR found that 44 % of the association between hypertension and lacunar stroke risk was mediated by obesity.

CONCLUSION

This genetic association study found novel independent genetic associations between hypertension and T2D with high risk of lacunar stroke, whereas obesity attenuated the risk of lacunar stroke. The findings emphasize the importance of individualized lacunar stroke prevention strategies rather than uniform weight management optimize medical care in high-risk populations.

Improving Cardiovascular Clinical Competencies for the Menopausal Transition: A Focus on Cardiometabolic Health in Midlife

Cardiovascular disease (CVD) is the leading cause of death in women with an increase in risk after menopause. Over the past 20 years, longitudinal studies have helped differentiate the influence of chronological aging from ovarian aging on cardiovascular health. In addition to the pronounced sex hormone changes of the menopause transition (MT), the MT is also often accompanied by vasomotor symptoms, sleep problems, and mental health changes that impact women's cardiovascular health. The purpose of this invited review is to highlight the key changes that can alter CVD risk. Given the gaps in medical training, we also describe the need for specialized postgraduate curriculum in managing the MT with an aim to improve MT screening and management of CVD during this universal life stage. Finally, we propose a multidisciplinary approach led by experts in women's cardiovascular health and present an approach utilizing validated screening tools and CVD risk scores to discuss the candidacy of systemic menopause hormone therapy.

Obesity- and High-Fat-Diet-Induced Neuroinflammation: Implications for Autonomic Nervous System Dysfunction and Endothelial Disorders

Obesity is a multifactorial condition linked to severe health complications, including cardiovascular diseases and endothelial dysfunction. Both obesity and high-fat diets (HFDs) are strongly associated with neuroinflammation, particularly in the hypothalamus. The autonomic nervous system (ANS), which controls involuntary physiological processes, is critical for maintaining cardiovascular health, and its dysfunction is implicated in endothelial disorders. With its homeostatic control centers located in the hypothalamus and brainstem, a crucial question arises: could obesity- and HFD-induced neuroinflammation disrupt central ANS structures, leading to ANS dysfunction and subsequent endothelial disorders? This review examined whether neuroinflammation caused by obesity and HFD contributes to endothelial dysfunction through the dysregulation of the ANS. Our analysis revealed that hypothalamic inflammation linked to obesity and an HFD is associated with sympathetic hyperactivity and endothelial disorders. Identified molecular mechanisms include the influence of inflammatory cytokines, activation of the NF-κB/IKK-β pathway, microglial activation mediated by angiotensin II, circulating mitochondria triggering cGAS activation, and the stimulation of the TLR4 pathway. Our findings suggest that hypothalamic inflammation may play a central role in the interplay between obesity/an HFD, ANS dysfunction, and endothelial disorders.

Impaired sensitivity to thyroid hormones is associated with increased body fat mass/muscle mass ratio (F/M) in the euthyroid population

OBJECTIVE

To explore the relationship between body fat mass/muscle mass ratio (F/M) and thyroid hormone sensitivity in the euthyroid population.

METHODS

Body compositions of 845 check-up individuals were determined using bioelectrical impedance analysis (BIA). Biochemical indexes including blood glucose, blood lipids, liver and kidney functions and thyrotropic hormones (THs) were detected. Free triiodothyronine to free thyroxine ratio (FT3/FT4), Thyroid Feedback Quantile-based Index (TFQI), Thyrotropin Thyroxine Resistance Index (TT4RI) and TSH Index (TSHI) were calculated for analysis.

RESULTS

TT4RI and TSHI showed increased trends with statistical difference, while FT3/FT4 and TFQI showed no difference among F/M quartile groups. After adjusting for confounding factors, F/M exhibited no correlation with FT3/FT4, but positive correlations with TFQI, TT4RI and TSHI. Gender subgroup analysis showed that F/M exhibited positive relationship with TFQI in females; exhibited positive correlations with TFQI, TT4RI and TSHI before the inflection points, but no correlations thereafter in males. Age subgroup analysis showed that F/M exhibited positive correlations with TFQI, TT4RI and TSHI, but no correlation with FT3/FT4 in age < 65 years group; exhibited no relationship with thyroid hormone sensitivity in age ≥ 65 years group. BMI subgroup analysis showed that F/M exhibited no relationship with thyroid hormone sensitivity in BMI < 25 kg/m2 group; exhibited positive correlations with TFQI, TT4RI and TSHI before the inflection points, but no correlations thereafter in BMI ≥ 25, < 30 kg/m2 group; exhibited positive correlation with TFQI before the inflection point, but no correlation thereafter in BMI ≥ 30 kg/m2 group; exhibited no correlations with TT4RI and TSHI before the inflection points, but negative correlations with them thereafter in BMI ≥ 30 kg/m2 group.

CONCLUSION

Impaired central, but not peripheral sensitivity to thyroid hormones was associated with increased body fat mass/muscle mass ratio (F/M), this association was obvious in males, individuals with age < 65 years and BMI ≥ 25 kg/m2, with different inflection points. Maybe F/M independently affects thyroid hormone sensitivity, we need more clinical and basic studies in the future.

Metabolic score for visceral fat is correlated with all-cause and cardiovascular mortality among individuals with non-alcoholic fatty liver disease

BACKGROUND

Metabolic score for visceral fat (METS-VF) as an effective marker of visceral obesity has been correlated with non-alcoholic fatty liver disease (NAFLD). This study aims to explore the correlation between METS-VF and both all-cause mortality and cardiovascular disease (CVD)-related mortality among individuals with NAFLD.

METHODS

A cohort of 6,759 subjects diagnosed with NAFLD was selected from the NHANES during the period from 1999 to 2018. Within this cohort, the prognostic utility of METS-VF for predicting CVD-related and all-cause mortality was assessed.

RESULTS

There was a total of 1254 all-cause deaths (18.6%) and 418 CVD-related deaths (6.2%) at a median follow-up for 9.3 years. Multivariate Cox regression analysis and restricted cubic splines analysis indicated that METS-VF can exhibit a positive non-linearly correlation with CVD mortality (HR: 4.15, 95% CI: 2.31-7.44, p < 0.001) and all-cause mortality (HR: 5.27, 95% CI: 3.75-7.42, p < 0.001), with an identified inflection point at 7.436. Subgroup analyses further revealed a stronger correlation between METS-VF and all-cause mortality among subjects without diabetes. Furthermore, the areas under the curve (AUC) for 1-, 3-, 5-, and 10-year survival rates were 0.756, 0.740, 0.747 and 0.746 for all-cause mortality, and 0.774, 0.751, 0.746 and 0.758 for CVD mortality, respectively, which performs better than the other obesity and IR related index.

CONCLUSION

Elevated METS-VF independently contributes to an increased risk of both all-cause and CVD mortality in individuals with NAFLD.

CLINICAL TRIAL NUMBER

Not applicable.

Sex Difference in the Association Between Regional Adipose Tissue and Left Ventricular Hypertrophy

Background: Left ventricular hypertrophy (LVH) is a key predictor of cardiovascular disease. This study aimed to investigate the correlation between LVH and regional adipose tissue deposits, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and epicardial adipose tissue (EAT), and sex-related differences in these correlations. Methods: A total of 416 individuals (median age 66 years, range 20-95), without structural heart disease or a history of hypertension and coronary artery disease, underwent echocardiography and abdominal computed tomography. Statistical analyses included logistic and linear regression to assess the associations between adipose tissue measures and LVH. Results: LVH was associated with older age, higher systolic blood pressure, and increased EAT thickness. EAT thickness was independently associated with LVH in women (OR 1.21, 95% CI 1.03-1.44, p = 0.024) but not in men. Scatter plot analysis revealed a positive correlation between EAT and left ventricular mass index (LVMI) in women (r = 0.366, p < 0.001) and a negative correlation in men (r = -0.153, p = 0.038). Conclusions: VAT and SAT showed no significant associations with LVMI or LVH in either sex. These findings suggest that EAT, but not VAT or SAT, is linked to cardiac remodeling in a sex-specific manner.

Eligibility for and practical implications of Semaglutide in overweight and obese patients with acute coronary syndrome

AIMS

Semaglutide has been shown to reduce cardiovascular events in non-diabetic patients with preexisting cardiovascular disease and overweight/obesity in the SELECT trial. Data on the applicability of these results to clinical practice are limited. We evaluated the eligibility for and practical implications of semaglutide in overweight/obese non-diabetic patients with recent acute coronary syndrome (ACS) from a contemporary real-world registry.

METHODS

Patients from the multicenter START-ANTIPLATELET registry (NCT02219984) were stratified to investigate the proportion of patients eligible for semaglutide >60 days after discharge for ACS (post-acute phase), according to the SELECT trial eligibility criteria: age ≥ 45 years; body mass index ≥27 kg/m2; history of myocardial infarction (MI), stroke, or peripheral artery disease; no diabetes. Major adverse cardiovascular events (MACE), defined as a composite of all-cause death, MI, target vessel revascularization, or stroke, and net adverse clinical events (NACE), a composite of all-cause death, MI, stroke, or major bleeding, were assessed at 1-year follow-up.

RESULTS

The study population comprised 2940 consecutive ACS patients. At 60 days after discharge, 807 patients (27.4 %) met the SELECT eligibility criteria (SELECT-like group) and 2133 patients were ineligible (not-eligible group). At 1 year, incidence of MACE (4.6 % vs. 8.2 %; p = 0.004) and NACE (3.6 % vs. 7.6 %; p < 0.001) was lower in the SELECT-like group compared to the not-eligible group.

CONCLUSIONS

In a contemporary real-world registry, a significant proportion of post-ACS patients were eligible for semaglutide according to the SELECT trial criteria. Future studies are needed to evaluate the potential implications of semaglutide for secondary prevention.

Non-invasive vestibular nerve stimulation (VeNS) reduces visceral adipose tissue: results of a randomised controlled trial

Across multiple species, chronic vestibular stimulation activates hypothalamic regions involved in energy homeostasis and reduces body fat. This first-in-human randomised controlled trial evaluated the efficacy and safety of electrical vestibular nerve stimulation (VeNS) as a means of reducing excess body weight and fat. Overweight and obese adults were randomised 1:1 to receive 60 min of daily VeNS (n = 117) or sham stimulation (n = 124) for 6 months, together with a hypocaloric diet. The primary endpoints were weight loss based. Secondary endpoints included reduction in visceral adipose tissue (VAT). It is VAT, more than subcutaneous fat depots, which is particularly associated with the risks associated with obesity. The weight loss based primary endpoints were not met. However, mean change in VAT was significantly greater in the active (- 12.6%) versus the sham (- 4.7%) group (p = 0.03). This suggests that regular VeNS may cause a clinically meaningful reduction in VAT.

Effect of once-weekly subcutaneous semaglutide on abdominal visceral fat area in Japanese adults with overweight and obesity: A post hoc analysis of the STEP 6 trial

OBJECTIVE

A post hoc analysis of a subset of participants with visceral fat area (VFA) measurements in the STEP 6 trial was conducted to examine both the correlation between VFA and clinical parameters and the effect of semaglutide on VFA in key subgroups.

METHODS

Participants were Japanese adults aged ≥ 20 years with obesity disease, randomized to once-weekly subcutaneous semaglutide 2.4 mg, semaglutide 1.7 mg, or placebo, plus lifestyle recommendations, for 68 weeks. Correlation between baseline VFA (and change in VFA from baseline to week 68) and clinical parameters (body weight, body mass index [BMI], waist circumference, hepatic parameters, glycated hemoglobin, blood pressure, lipids, high-sensitivity C-reactive protein, and plasminogen activator inhibitor-1 [PAI-1]) was evaluated. Percentage change in VFA between semaglutide and placebo was compared across subgroups.

RESULTS

Among 180 participants (semaglutide 2.4 mg, n = 89; semaglutide 1.7 mg, n = 46; placebo, n = 45), mean VFA was 170.0 cm2 across subgroups. A positive correlation (Pearson's correlation coefficient [r] ≥0.3) was observed between baseline VFA and body weight (r = 0.415), BMI (r = 0.374), and both JASSO and WHO criterion waist circumference (r = 0.458 and r = 0.555). Correlation between changes in VFA and body weight, waist circumference, high-density and very low-density lipoprotein cholesterol, triglycerides, PAI-1, aspartate aminotransferase, and alanine transaminase were observed in ≥ 1 treatment arm. Semaglutide 2.4 mg and 1.7 mg reduced VFA compared with placebo in all subgroups.

CONCLUSIONS

VFA partially correlated with clinical parameters in Japanese adults with obesity disease. Subcutaneous semaglutide was an efficacious treatment option for the reduction of VFA, regardless of clinical characteristics.

TRIAL REGISTRY NAME

CT.gov TRIAL REGISTRATION IDENTIFICATION NUMBER: NCT03811574.

Comprehensive assessment of distinct abdominal fat compartments beyond liver content in overweight/obese patients using MRI and ultrasound imaging

BACKGROUND

Ectopic fat deposition, involving lipid infiltration within organs and fat accumulating surrounding organs, plays a crucial role in the development of metabolic abnormalities in obesity. Current imaging measurements of obesity primarily focus on lipid infiltration within liver, neglecting fat deposition in other areas. This study aims to explore the methods of measuring and correlating different types of abdominal ectopic fat deposition in obese patients using magnetic resonance imaging (MRI) and ultrasound techniques, and to investigate the relationship between these fat parameters and obesity-related metabolic markers.

METHODS

Abdominal ectopic fat deposition including liver fat content, mesenteric fat thickness (MFT), perirenal fat thickness (PrFT) and preperitoneal fat thickness (PFT) were measured in 220 overweight/obese patients using both MRI and ultrasound techniques. Correlation analysis validated the concordance of fat parameters at specific sites between the two imaging methods and identified the cutoff values of hepatic attenuation coefficient (AC) for diagnosis of liver steatosis. Additionally, we investigated the correlation between fat parameters by both methods and obesity-related metabolic markers.

RESULTS

Ultrasonic measurement of PrFT and hepatic AC both had high correlation with PrFT (r = 0.829, p < 0.001) and hepatic Proton-density fat fraction (PDFF, r = 0.822, p < 0.001) measured via MR. Hepatic AC cutoff values for diagnosing mild, moderate, and severe fatty liver were 0.705 dB/cm/MHz (AUC = 0.922), 0.755 dB/cm/MHz (AUC = 0.923), and 0.875 dB/cm/MHz (AUC = 0.890) respectively. Hepatic AC correlated significantly with AST and ALT (r = 0.477 ~ 0.533, p < 0.001). MFT measured by ultrasound were positively associated with glycated hemoglobin (r = 0.324 ~ 0.371, p < 0.001) and serum triglyceride levels (r = 0.303 ~ 0.353, p < 0.001). PrFT measured by both methods showed significant positive correlations with serum creatinine levels (r = 0.305 ~ 0.308, p < 0.001).

CONCLUSIONS

Both MRI and ultrasound demonstrate metabolic correlations in quantifying mesenteric, hepatic, and perirenal fat. In addition to assessment of liver fat content, the measurements of ectopic fat deposition by MRI or ultrasound are a simple and crucial way for comprehensive fat evaluation in individuals with overweight/obesity.

Discrepancies Between Physician-Perceived and Calculated Cardiovascular Risk in Primary Prevention: Implications for LDL-C Target Achievement and Appropriate Lipid-Lowering Therapy

INTRODUCTION

Accurate risk assessment is critical in cardiovascular (CV) prevention, yet physicians often underestimate CV risk, leading to inadequate preventive measures.

AIM

This study evaluates the concordance between physician-perceived CV risk and calculated CV risk in a primary prevention setting.

METHODS

This cross-sectional study included primary prevention patients from the Cardiology Outpatient Clinic of Caserta Hospital, Italy. Two independent cardiologists evaluated the physician-perceived risk, and a third resolved discrepancies. CV risk was calculated using SCORE2 for patients with 70 years or less and SCORE2-OP for those with more than 70 years. The concordance between perceived and calculated risks was assessed using Cohen's kappa coefficient. Multivariate logistic regression analysis was performed to examine the influence of risk estimation on achieving low-density lipoprotein cholesterol (LDL-C) targets recommended by the ESC.

RESULTS

389 patients had complete data for CV risk calculation. Physician-perceived risk categorized 8.7% of patients as low/moderate, 37.8% as high, and 53.5% as very-high risk. In contrast, calculated CV risk according to the SCORE2/SCORE2-OP classified 8% as low/moderate, 5.7% as high, and 86.4% as very-high risk. The concordance between perceived and calculated CV risk was poor (Cohen's kappa 0.208, p < 0.001). Underestimated patients reached LDL-C targets in 16% of cases, well-estimated in 34.5%, and overestimated in 76.9%. Statin use was significantly lower in patients with underestimated CV risk (29.2%) compared to well-estimated (50%) and overestimated (76.9%) groups (p < 0.001). Multivariate analysis showed that patients with overestimated risk were more likely to achieve LDL-C targets (OR 5.33, CI 1.33-21.42, p = 0.018), whereas underestimated patients were 47% less likely (OR 0.53, CI 0.3-0.93, p = 0.027).

CONCLUSIONS

A significant discrepancy exists between physician-perceived and calculated CV risk, leading to risk underestimation in over one-third of patients. This underestimation is associated with lower LDL-C target achievement and reduced statin use.

Protective effects of Mycobacterium vaccae ATCC 15483 against "Western"-style diet-induced weight gain and visceral adiposity in adolescent male mice

The prevalence of noncommunicable inflammatory disease is increasing in modern urban societies, posing significant challenges to public health. Novel prevention and therapeutic strategies are needed to effectively deal with this issue. One promising approach is leveraging microorganisms such as Mycobacterium vaccae ATCC 15483, known for its anti-inflammatory, immunoregulatory, and stress-resilience properties. This study aimed to assess whether weekly subcutaneous administrations of a whole-cell, heat-killed preparation of M. vaccae ATCC 15483 (eleven injections initiated one week before the onset of the diet intervention), relative to vehicle injections, in adolescent male C57BL/6N mice can mitigate inflammation associated with Western-style diet-induced obesity, which is considered a risk factor for a number of metabolic and inflammatory diseases. Our results show that treatment with M. vaccae ATCC 15483 prevented Western-style diet-induced excessive weight gain, visceral adipose tissue accumulation, and elevated plasma leptin concentrations. The Western-style diet, relative to a control diet condition, decreased alpha diversity and altered the community composition of the gut microbiome, increasing the Bacillota to Bacteroidota ratio (formerly referred to as the Firmicutes to Bacteroidetes ratio). Despite the finding that M. vaccae ATCC 15483 prevented Western-style diet-induced excessive weight gain, visceral adipose tissue accumulation, and elevated plasma leptin concentrations, it had no effect on the diversity or community composition of the gut microbiome, suggesting that it acts downstream of the gut microbiome to alter immunometabolic signaling. M. vaccae ATCC 15483 reduced baseline levels of biomarkers of hippocampal neuroinflammation and microglial priming, such as Nfkbia and Nlrp3, and notably decreased anxiety-like defensive behavioral responses. The current findings provide compelling evidence supporting the potential for M. vaccae ATCC 15483 as a promising intervention for prevention or treatment of adverse immunometabolic outcomes linked to the consumption of a Western-style diet and the associated dysbiosis of the gut microbiome.

Different factors modulate visceral and subcutaneous fat accumulation in adults: a single-center study in Brazil

Background

Abdominal adipose tissue consists of visceral and subcutaneous fat deposits, each with unique metabolic and functional properties. Identifying the characteristics that influence different obesity phenotypes can support targeted prevention and intervention strategies.

Objective

To identify predictive factors associated with visceral and subcutaneous adipose tissue accumulation.

Methods

This is a cross-sectional study including adults of both sexes aged ≥20 years under outpatient care in a public healthcare service in Northeast Brazil. Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured via ultrasound. Anthropometric, clinical, sociodemographic, and behavioral variables were incorporated into the predictive model.

Results

A total of 347 individuals were included. They were median age of 47.0 years (interquartile range: 39.0 to 56.0). Visceral obesity was found in 79.3% of the sample. Adjusted analysis demonstrated that physical inactivity (OR 2.3; 95% CI 1.1-4.7; p = 0.023) and elevated waist circumference (WC) (OR 6.4; 95% CI 2.6-15.8 p < 0.001) were associated with VAT accumulation. Alcohol consumption increased the likelihood of SAT accumulation by 2.2 times (95% CI 1.3-3.7; p = 0.005), while elevated WC raised this likelihood by 4.5 times (95% CI 2.1-9.8; p < 0.001). The VAT/SAT ratio was significantly higher in older adults (OR 5.5; 95%CI 2.0-14.8; p = 0.001), among individuals of Mixed Race and Black, those with lower educational levels (OR 2.4; 95%CI 1.1-5.2; p = 0.028), and in diabetics (OR 2.4; 95%CI 1.2-4.9; p = 0.017).

Conclusion

Distinct factors influence visceral and subcutaneous obesity. Sedentary behavior emerged as an independent predictor of visceral obesity, while alcohol consumption was associated with a subcutaneous obesity pattern. Diabetes and sociodemographic factors (older age, non-White race, and lower education) were predictive of an elevated VAT/SAT ratio.

Association between metabolic score for insulin resistance (METS-IR) and hypertension: a cross-sectional study based on NHANES 2007-2018

BACKGROUND

Insulin resistance (IR) reduces insulin efficacy and heightens the danger of cardiovascular diseases including hypertension. The Metabolic Score for Insulin Resistance (METS-IR), which is based on triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), and fasting glucose levels, provides a simpler way to assess IR. As the hypertension's prevalence increases, particularly in those with metabolic disorders, exploring the relationship between hypertension and METS-IR has become crucial.

METHODS

16,310 individuals from the 2007-2018 National Health and Nutrition Examination Survey dataset was included. Hypertension was defined by asking participants about their medical history and blood pressure measurements. METS-IR was calculated as follows: ln([ HDL-C (mg/dL)] × [2 × fasting glucose (mg/dL)] + TG (mg/dL) × BMI (kg/m2)). The study adjusted for covariates like sex; age; race; poverty-income ratio; marital status; educational background; total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and serum creatinine levels; smoking; stroke; alcohol consumption; diabetes; and coronary heart disease (CHD). This study was conducted using a multi-factor regression model.

RESULTS

This research demonstrated a significant positive relationship between hypertension and METS-IR. Each 1-unit rise in METS-IR corresponds to a 3% higher chance of hypertension (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.03-1.04). In model 3, METS-IR exhibited a notable correlation with hypertension (OR, 3.31; 95% CI, 2.64-4.14; P < 0.001). A threshold effect analysis demonstrated a nonlinear association. Finally, subgroup analyses supported the stability of the relationship between METS-IR and factors such as sex, race, alcohol consumption, CHD, smoking, and stroke (P > 0.05).

CONCLUSIONS

METS-IR showed a strong relationship with hypertension and may be an important marker for evaluating metabolic health and the early hypertension danger.

Detection of Myocardial Deformation Patterns and Prognostic Value of Routine Echocardiographic Parameters in Patients with Cardiac Sarcoidosis Versus Extracardiac Sarcoidosis: Systematic Review and Meta-Analysis

Background: Sarcoidosis is a multisystem disorder characterized by non-caseating granulomas in various organs. While cardiac sarcoidosis (CS) is clinically rare, it has significant implications, including heart failure, ventricular arrhythmias, and sudden cardiac death. Speckle-tracking echocardiography has emerged as a promising tool for detecting subclinical myocardial dysfunction, which is cost-efficient and readily available. This meta-analysis aims to evaluate differences in functional echocardiographic parameters between patients with CS and extracardiac sarcoidosis (ECS) to improve early recognition and management. Methods: A comprehensive search of major bibliographic databases was conducted to identify studies up to December 2024. Mean differences (MDs) with 95% CIs were pooled using the inverse-variance random-effect model. Results: Seven studies with 478 patients with sarcoidosis (CS: 159 and ECS: 319) were included. Patients with CS had a significant reduction in left ventricular global longitudinal strain (MD: -2.73; 95% CI: -4.09, -1.38; p < 0.0001) and tricuspid annular plane systolic excursion (MD: -0.59; 95% CI: -1.12, -0.05; p = 0.03) compared to patients with ECS. No significant differences in the LV global circumferential strain, interventricular septum thickness, left ventricular ejection fraction, E/A ratio, E/E' ratio, LV end-diastolic diameter, and LV end-systolic diameter were noted. Conclusions: LV GLS and TAPSE are promising parameters for the early detection of cardiac involvement in sarcoidosis, with significant prognostic implications. Although STE provides a cost-effective and accessible alternative to CMR and FDG-PET, further research is needed to standardize its use and validate diagnostic cut-offs.

Visceral Adipose Tissue is Associated with Recurrent Cardiovascular Events in Premature Coronary Artery Disease: Sub-analysis of the GEA study cohort

BACKGROUND

Visceral adipose tissue (VAT) has been related to coronary artery disease (CAD), but its association with recurrent major adverse cardiovascular events (MACE) in premature CAD (pCAD) has not been fully explored. Thus, we aimed to investigate the impact of VAT on recurrent MACE in patients with pCAD.

METHODS

This was a retrospective sub-analysis of 853 patients with pCAD from the GEA cohort study. VAT was measured by computed tomography at baseline. The primary outcome was the recurrence of MACE over 5 years of follow-up. Likewise, the association of VAT with non-fatal and fatal MACE was analyzed as a secondary outcome. Cox regression models were fitted and adjusted by confounders obtained at baseline to estimate adjusted hazard ratios (aHR).

RESULTS

The median age of the patients was 53 years, and 80% were male, with a median follow-up of 4.9 years. Overall, 10% of the patients had recurrent MACE (6.5% non-fatal and 3.6% fatal) with an incidence rate of 18.5 (95% CI: 18.0-19.0) events per 1,000 person-years. VAT was positively associated with MACE. Those in the upper tertile (VAT ≥ 194 cm²) had the highest risk for total (aHR: 2.71; 95% CI: 1.37-5.35; p=0.004) and non-fatal (aHR: 3.58; 95% CI: 1.49-8.61; p=0.004) MACE. Fatal MACE was not statistically associated (aHR: 2.13; 95% CI: 0.72-6.35; p=0.174).

CONCLUSION

Among patients with pCAD, VAT increased the risk of recurrent MACE despite adequate pharmacological treatment. These results suggest that VAT could be considered an emergent risk factor and a promising target for residual cardiovascular risk reduction.

Metabolic Dysfunction-Associated Steatotic Liver Disease: Pathogenetic Links to Cardiovascular Risk

Metabolic dysfunction-associated steatotic liver disease (MASLD) is correlated with an increased cardiovascular risk, independent of other traditional risk factors. The mechanisms underlying this pathogenic link are complex yet remain incompletely elucidated. Among these, the most significant are visceral adiposity, low-grade inflammation and oxidative stress, endothelial dysfunction, prothrombotic status, insulin resistance, dyslipidemia and postprandial hyperlipemia, gut dysbiosis, and genetic mutations. Cardiovascular diseases are the leading cause of death in patients with MASLD. These patients have an increased incidence of coronary artery disease, carotid artery disease, structural and functional cardiac abnormalities, and valvulopathies, as well as arrhythmias and cardiac conduction disorders. In this review, we present the latest data on the association between MASLD and cardiovascular risk, focusing on the pathogenic mechanisms that explain the correlation between these two pathologies. Given the high rates of cardiovascular morbidity and mortality among patients with MASLD, we consider it imperative to raise awareness of the risks associated with this condition within the general population. Further research is essential to clarify the mechanisms underlying the increased cardiovascular risk linked to MASLD. This understanding may facilitate the identification of new diagnostic and prognostic biomarkers for these patients, as well as novel therapeutic targets.

A Cameroon Western Regions high-fat diet (MACAPOS 2) induces visceral obesity in rat

The prevalence of obesity increases yearly in the world. The traditional local diet of the Western Regions of Cameroon was suspected to be the main contributor to the high prevalence of obesity in these Regions. This study aimed to evaluate the effects of a Cameroon-comparable fat diet on visceral obesity in rats. Two groups of male Wistar rats were fed for four months with respectively a normal diet (ND) (3400 kcal/kg of food) and a high-fat diet (HFD) containing maize, cassava, palm oil, and sugar (MACAPOS 2): 35 % carbohydrate, 55 % fat and 10 % proteins (4730 kcal/kg of food). Lee index, body weight, food intake, blood and hepatic lipids, body fat, insulin resistance, glucose tolerance, glycemia, serum insulin, leptin, and adiponectin were evaluated. HFD significantly (P < 0.01) increased body weight and decreased food intake. After four months of diet, 88.8 % of HFD rats were obese (Lee index >30 g/cm), and HFD significantly increased visceral and subcutaneous fats compared to ND. HFD increased triglyceride, total cholesterol, Low-density lipoprotein-cholesterol levels, and the atherogenic index, while the high-density lipoprotein-cholesterol level was decreased. The hepatic triglyceride and total cholesterol levels significantly (P < 0.01) increased in HFD, compared to ND. In HFD, the fasting blood glucose, serum insulin, and leptin levels significantly (P < 0.01) increased, meanwhile adiponectin decreased. HFD-induced glucose intolerance and insulin resistance in rats. Based on our findings, we can conclude that HFD MACAPOS 2 can induce central obesity. Therefore, it can be used as a model of diet-induced obesity.

Correlation between estimated glucose disposal rate, insulin resistance, and cardiovascular mortality among individuals with metabolic syndrome: a population-based analysis, evidence from NHANES 1999-2018

BACKGROUND

Estimated glucose disposal rate (eGDR), is an index of insulin resistance. It is intimately correlated with inflammation and endothelial dysfunction, both of which are contributory factors in the pathogenesis of cardiovascular disease (CVD) and premature mortality. This study aims to explore the correlation between eGDR and both all-cause and CVD-related mortality in adults with metabolic syndrome (MetS).

METHODS

A total of 8215 subjects with MetS screened from the National Health and Nutrition Examination Survey (NHANES) during the period from 1999 to 2018 were evaluated for the predictive value of eGDR for CVD and all-cause mortality.

RESULTS

Over a median follow-up for 8.3 years, a total of 1537 all-cause deaths (18.7%) and 467 CVD-related deaths (5.7%) were recorded. Logistic regression analyses revealed a significant inverse correlation between eGDR and the risk of having CVD (OR:0.845, 95%CI:0.807-0.884, p < 0.01). Multivariate Cox regression analysis and restricted cubic splines analysis demonstrated that eGDR is non-linearly correlated with both the mortality of CVD (HR: 0.906, 95% CI: 0.850-0.967, p = 0.003) and all-cause mortality (HR: 0.944, 95% CI: 0.912-0.977, p = 0.001), with an identified inflection point at 5.918. Further subgroup analyses indicated a more pronounced correlation between eGDR and all-cause mortality in individuals under 60 years old (HR: 0.893, 95%CI:0.823-0.970) or those with obesity (HR:0.891, 95%CI:0.839-0.946). Mediation analysis revealed that neutrophil to lymphocyte ratio mediated 8.9% of the correlation between eGDR and all-cause mortality.

CONCLUSION

This study demonstrates, for the first time, that a decrease in eGDR is associated with an increased risk of all-cause and CVD mortality in adults with MetS. The eGDR indices could serve as surrogate biomarkers for monitoring patients with MetS.

Visceral adipose tissue mediates the relationship between left ventricular global longitudinal strain and insulin resistance among adults living with type 2 diabetes

BACKGROUND

Adipose tissue distribution plays a crucial role in the development of cardiovascular complications. In particular, visceral adipose tissue (VAT) has been linked to insulin resistance (IR) and cardiovascular disease (CVD). However, the relationship between VAT, cardiac dysfunction and the meditation capacity of VAT related to IR has not been fully characterized.

METHODS

This cross-sectional study included adults living with type 2 diabetes (T2D). VAT was measured using electrical bioimpedance and also estimated with the Metabolic Score for Visceral Fat (METS-VF). LV function was assessed using left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography analysis. Spearman correlation coefficients, adjusted linear regression models guided by direct acyclic diagrams and causal mediation analysis were performed.

RESULTS

Among 195 adults living with T2D (median age: 57, IQR: 49-64, women: 63%), VAT showed a positive association with LV-GLS (β = 0.482, 95% CI: 0.060-0.904, p = 0.039) after adjusting for relevant confounders. The effect was strongly replicated using METS-VF as a surrogate for VAT. The mediation analysis revealed that VAT accounted for 60.9% (95% CI: 15.82-171) of the total effect between IR and LV-GLS.

CONCLUSION

This study demonstrated a positive association between VAT and LV-GLS. This relationship was consistently observed using the clinical surrogate METS-VF. Visceral adiposity was identified as a strong mediator in the relationship between IR and LV-GLS, underscoring its role in the pathophysiology of cardiovascular disease in patients with T2D.

Association of Visceral Adipose Tissue With Hypertension: Results From the NHANES 2011-2018 and Mendelian Randomization Analyses

The causal relationship between visceral adipose tissue (VAT) and hypertension remains unclear. We aimed to examine the potential association between them using observational and two-sample Mendelian randomization (MR) analyses. Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 were used, applying multivariable logistic regression analysis to investigate the association between VAT mass and hypertension risk. Independent genetic variants related to VAT mass were derived from genome-wide association studies (GWAS) in 325 153 UK Biobank participants. The primary analysis employed the random-effects inverse-variance weighted (IVW) method, with MR-Egger, weighted median, simple mode, and weighted mode as sensitivity analyses. A total of 7661 participants were included. After adjusting for confounding factors, increased VAT mass was associated with a higher risk of hypertension (quartile 4 vs. quartile 1: OR:1.85, 95% confidence intervals [CI]: 1.31-2.63). Furthermore, VAT mass exhibited greater accuracy than body mass index (BMI) in predicting hypertension (areas under the curve [AUC]: 0.701 vs. 0.676, p for comparison < 0.001). The MR analyses demonstrated a causal relationship between increased VAT mass and the risk of hypertension in primary analyses (odds ratio [OR]:1.768, 95% CI: 1.594-1.861). Consistent findings across various MR models substantiate the robustness and strength of this causal relationship. These analyses provide additional support for both the positive association and causal relationship between elevated VAT and the risk of developing hypertension, suggesting that targeted interventions for VAT may be beneficial in preventing hypertension.

Association between cardiometabolic index and all-cause and cause-specific mortality among the general population: NHANES 1999-2018

BACKGROUND

Cardiometabolic index (CMI) is a comprehensive clinical parameter which integrates overweight and abnormal lipid metabolism. However, its relationship with all-cause, cardiovascular disease (CVD), and cancer mortality is still obscure. Thus, a large-scale cohort study was conducted to illustrate the causal relation between CMI and CVD, cancer, and all-cause mortality among the common American population.

METHODS

Our research was performed on the basis of National Health and Nutrition Examination Survey (NHANES) database, involving 40,275 participants ranging from 1999 to 2018. The formula of CMI is [waist circumference (cm) / height (cm)] × [triglyceride (mg/dL) / high-density lipoprotein cholesterol (mg/dL)]. Outcome variables consisted of CVD, cancer, and all-cause mortality, which were identified by the International Classification of Diseases (ICD)-10. The correlation between CMI and mortality outcomes was analyzed utilizing the Kaplan-Meier survival modeling, univariate/multivariate Cox regression analysis, smooth curve fitting analysis, threshold effect analysis, and subgroup analysis. Stratification factors for subgroups included age, race/ethnicity, sex, smoking behavior, drinking behavior, BMI, hypertension, and diabetes.

RESULTS

The baseline characteristics table includes 4,569 all-cause-induced death cases, 1,113 CVD-induced death cases, and 1,066 cancer-induced death cases. Without adjustment for potential covariates, significantly positive causal correlation existed between CMI and all-cause mortality (HR = 1.03, 95% CI 1.02,1.04, P-value<0.05), CVD mortality (HR = 1.04, 95% CI 1.03, 1.05, P-value<0.05) and cancer mortality(HR = 1.03, 95% CI 1.02, 1.05, P-value<0.05); whereas, after confounding factors were completely adjusted, the relationship lost statistical significance in CMI subgroups (P for trend>0.05). Subgroup analysis found no specific subgroups. Under a fully adjusted model, a threshold effect analysis was performed combined with smooth curve fitting, and the findings suggested an L-shaped nonlinear association within CMI and all-cause mortality (the Inflection point was 0.98); in particular, when the baseline CMI was below 0.98, there existed a negative correlation with all-cause mortality with significance (HR 0.59, 95% CI 0.43, 0.82, P-value<0.05). A nonlinear relation was observed between CMI and CVD mortality. Whereas, the correlation between CMI and cancer mortality was linear.

CONCLUSIONS

Among the general American population, baseline CMI levels exhibited an L-shaped nonlinear relationship with all-cause mortality, and the threshold value was 0.98. What's more, CMI may become an effective indicator for CVD, cancer, and all-cause mortality prediction. Further investigation is essential to confirm our findings.

AbaComplex Enhances Mitochondrial Biogenesis and Adipose Tissue Browning: Implications for Obesity and Glucose Regulation

Adipose tissue, particularly white adipose tissue (WAT), plays a central role in energy storage and metabolic regulation. Excess WAT, especially visceral fat, is strongly linked to metabolic disorders such as obesity and type 2 diabetes. The browning of WAT, whereby white fat cells acquire characteristics of brown adipose tissue (BAT) with enhanced thermogenic capacity, represents a promising strategy to enhance metabolic health. In this study, we investigated the effects of chronic supplementation with an infusion based on lyophilized, thin nectarines rich in abscisic acid (ABA), named AbaComplex, on promoting browning of WAT and activating BAT in mice. Over 30 days, C57BL/6 mice were treated with the ABA-rich infusion, and various metabolic and molecular parameters were assessed. The results showed that the AbaComplex significantly increased the expression of browning markers, such as UCP1 and PGC1-α, in both visceral and subcutaneous WAT. Additionally, mitochondrial biogenesis and function were enhanced, evidenced by elevated mitochondrial DNA content and activity. The treatment also reduced the weight of WAT (both visceral and subcutaneous) and BAT and significantly improved glucose uptake in WAT via upregulation of GLUT4, suggesting enhanced insulin sensitivity. Overall, the pronounced browning effect in WAT underscores the potential of AbaComplex as a natural approach for combating obesity and improving metabolic health.

Incremental Cardiovascular Risk of Menopause in Women with Psoriasis, Psoriatic Arthritis or Spondyloarthritis?

PURPOSE OF THE REVIEW

This narrative review aims to discuss the most recent studies regarding the risk of cardiovascular disease (CVD) in women with psoriasis, psoriatic arthritis (PsA) and spondyloarthritis (SpA). In addition, the potential of menopause to modulate/increase CVD risk in women with these diseases will also be explored. It is of major interest to gain more understanding into this topic because it can have meaningful implications for screening and treatment of CVD risk in these women.

RECENT FINDINGS

Literature shows that psoriasis, PsA, SpA and menopause itself cause higher CVD risks and higher CVD prevalence. This is predominantly explained by the increase of chronic systemic inflammation. No existing literature conclusively demonstrates or studies specifically whether the menopause amplifies this effect caused by psoriasis, PsA, or SpA.

CONCLUSION

Differences in pathophysiology of psoriasis, SpA and PsA versus the menopausal transition could suggest that menopause may increase the risk of CVD. However, the hypothesis that menopause represents an additional CV risk factor in women with psoriasis, PsA and SpA still needs to be thoroughly investigated and more clinical studies are required for further understanding and conclusions.

The Cardioprotective Effects of Nutritional Ketosis: Mechanisms and Clinical Implications

Cardiovascular diseases (CVDs) persist as the primary cause of death worldwide, accounting for roughly 17.9 million fatalities each year. The prevalence of obesity, metabolic syndrome, and type 2 diabetes (key risk factors for CVD) continues to escalate at an alarming rate, necessitating novel therapeutic strategies to address this global health crisis. Nutritional ketosis, induced through ketogenic diets, modified fasting, intermittent fasting, and medium-chain triglyceride (MCT) oil consumption, has garnered attention for its potential cardioprotective effects. Ketosis is a metabolic state in which the body, due to a significantly reduced intake of carbohydrates, shifts its primary energy source from glucose to ketone bodies, i.e., beta-hydroxybutyrate (BHB), acetoacetate, and acetone, which are produced in the liver from fatty acids. This review examines the mechanisms by which ketone bodies, particularly BHB, mitigate cardiovascular risk. We focus mainly on the anti-inflammatory and antioxidative properties of BHB and summarize recent evidence to highlight the clinical relevance of ketosis in cardiometabolic health.

A long-term high-fat diet induces differential gene expression changes in spatially distinct adipose tissue of male mice

The accumulation of visceral adipose tissue (VAT) is strongly associated with cardiovascular disease and diabetes. In contrast, individuals with increased subcutaneous adipose tissue (SAT) without corresponding increases in VAT are associated with a metabolic healthy obese phenotype. These observations implicate dysfunctional VAT as a driver of disease processes, warranting investigation into obesity-induced alterations of distinct adipose depots. To determine the effects of obesity on adipose gene expression, male mice (n = 4) were fed a high-fat diet to induce obesity or a normal laboratory diet (lean controls) for 12-14 mo. Mesenteric VAT and inguinal SAT were isolated for bulk RNA sequencing. AT from lean controls served as a reference to obesity-induced changes. The long-term high-fat diet induced the expression of 169 and 814 unique genes in SAT and VAT, respectively. SAT from obese mice exhibited 308 differentially expressed genes (164 upregulated and 144 downregulated). VAT from obese mice exhibited 690 differentially expressed genes (262 genes upregulated and 428 downregulated). KEGG pathway and GO analyses revealed that metabolic pathways were upregulated in SAT versus downregulated in VAT while inflammatory signaling was upregulated in VAT. We next determined common genes that were differentially regulated between SAT and VAT in response to obesity and identified four genes that exhibited this profile: elovl6 and kcnj15 were upregulated in SAT/downregulated in VAT while trdn and hspb7 were downregulated in SAT/upregulated in VAT. We propose that these genes in particular should be further pursued to determine their roles in SAT versus VAT with respect to obesity.NEW & NOTEWORTHY A long-term high-fat diet induced the expression of more than 980 unique genes across subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). The high-fat diet also induced the differential expression of nearly 1,000 AT genes. We identified four genes that were oppositely expressed in SAT versus VAT in response to the high-fat diet and propose that these genes in particular may serve as promising targets aimed at resolving VAT dysfunction in obesity.

Association of metabolic score for visceral fat with all-cause mortality, cardiovascular mortality, and cancer mortality: A prospective cohort study

AIM

Our study aimed to evaluate the association between the metabolic score for visceral fat (METS-VF) and mortality.

METHODS

We conducted a cohort study comprising 11,120 participants. We employed weighted multivariable Cox regression analysis to assess the relationship between METS-VF and mortality. Restricted cubic spline analyses were used to investigate potential non-linear associations. Receiver operating characteristic curves were used to evaluate the predictive value of METS-VF and other obesity-related indicators for mortality. Subgroup analysis and sensitivity analysis were performed to confirm the robustness of the results. Mendelian randomization analysis was utilized to assess potential causality.

RESULTS

Over a median follow-up duration of 83 months, a total of 1014 all-cause deaths, 301 cardiovascular deaths, and 262 cancer deaths occurred. For every 0.2-unit increase in METS-VF, the hazard ratios(HRs) of all-cause mortality, cardiovascular mortality, and cancer mortality were 1.13 [95% confidence interval (CI): 1.06, 1.20], 1.18 (95% CI: 1.06, 1.31), and 1.13 (95% CI: 1.03, 1.25), respectively. In addition, restricted cubic spline analyses revealed no significant non-linear associations between METS-VF and all-cause mortality, cardiovascular mortality, and cancer mortality. In multivariate Cox regression models, hazard ratios of all-cause mortality, cardiovascular mortality and cancer mortality were higher in the highest METS-VF group compared to the reference group. Subgroup and sensitivity analyses confirmed that our results were robust. Receiver operating characteristic curves indicated that METS-VF predicted mortality better than other obesity-related indicators. Mendelian randomization analysis confirmed significant causal relationships.

CONCLUSIONS

METS-VF was positively associated with all-cause mortality, cardiovascular mortality, and cancer mortality. These findings suggest that METS-VF could serve as a straightforward, reliable, and cost-effective marker for identifying individuals at high risk of mortality.

The challenges of assessing adiposity in a clinical setting

To tackle the burden of obesity-induced cardiometabolic disease, the scientific community relies on accurate and reproducible adiposity measurements in the clinic. These measurements guide our understanding of underlying biological mechanisms and clinical outcomes of human trials. However, measuring adiposity and adipose tissue distribution in a clinical setting can be challenging, and different measurement methods pose important limitations. BMI is a simple and high-throughput measurement, but it is associated relatively poorly with clinical outcomes when compared with waist-to-hip and sagittal abdominal diameter measurements. Body composition measurements by dual energy X-ray absorptiometry or MRI scans would be ideal due to their high accuracy, but are not high-throughput. Another important consideration is that adiposity measurements vary between men and women, between adults and children, and between people of different ethnic backgrounds. In this Perspective article, we discuss how these critical challenges can affect our interpretation of research data in the field of obesity and the design and implementation of clinical guidelines.

Relationship between Body Adiposity Indices and Reversal of Metabolically Unhealthy Obesity 6 Months after Roux-en-Y Gastric Bypass

The factors determining the reversal of metabolically unhealthy obesity (MUO) to metabolically healthy obesity (MHO) after Roux-en-Y gastric bypass (RYGB) are not completely elucidated. The present study aims to evaluate body adiposity and distribution, through different indices, according to metabolic phenotypes before and 6 months after RYGB, and the relationship between these indices and transition from MUO to MHO. This study reports a prospective longitudinal study on adults with obesity who were evaluated before (T0) and 6 months (T1) after RYGB. Bodyweight, height, waist circumference (WC), BMI, waist-to-height ratio (WHR), total cholesterol (TC), HDL-c, LDL-c, triglycerides, insulin, glucose, HbA1c and HOMA-IR were evaluated. The visceral adiposity index (VAI), the conicity index (CI), the lipid accumulation product (LAP), CUN-BAE and body shape index (ABSI) were calculated. MUO was classified based on insulin resistance. MUO at T0 with transition to MHO at T1 formed the MHO-t group MHO and MUO at both T0 and T1 formed the MHO-m and MUO-m groups, respectively. At T0, 37.3% of the 62 individuals were classified as MHO and 62.7% as MUO. Individuals in the MUO-T0 group had higher blood glucose, HbA1c, HOMA-IR, insulin, TC and LDL-c compared to those in the MHO-T0 group. Both groups showed significant improvement in biochemical and body variables at T1. After RYGB, 89.2% of MUO-T0 became MHO (MHO-t). The MUO-m group presented higher HOMA-IR, insulin and VAI, compared to the MHO-m and MHO-t groups. CI and ABSI at T0 correlated with HOMA-IR at T1 in the MHO-t and MHO-m groups. CI and ABSI, indicators of visceral fat, are promising for predicting post-RYGB metabolic improvement. Additional studies are needed to confirm the sustainability of MUO reversion and its relationship with these indices.

A detailed analysis of body composition in relation to cardiopulmonary exercise test indices

A cardiopulmonary exercise test (CPET) is a test assessing an individual's physiological response during exercise. Results may be affected by body composition, which is best evaluated through imaging techniques like magnetic resonance imaging (MRI). The aim of this study was to assess relationships between body composition and indices obtained from CPET. A total of 234 participants (112 female), all aged 50 years, underwent CPETs and whole-body MRI scans (> 1 million voxels). Voxel-wise statistical analysis of tissue volume and fat content was carried out with a method called Imiomics and related to the CPET indices peak oxygen consumption (V̇O2peak), V̇O2peak scaled by body weight (V̇O2kg) and by total lean mass (V̇O2lean), ventilatory efficiency (V̇E/V̇CO2-slope), work efficiency (ΔV̇O2/ΔWR) and peak exercise respiratory exchange ratio (RERpeak). V̇O2peak showed the highest positive correlation with volume of skeletal muscle. V̇O2kg negatively correlated with tissue volume in subcutaneous fat, particularly gluteal fat. RERpeak negatively correlated with tissue volume in skeletal muscle, subcutaneous fat, visceral fat and liver. Some associations differed between sexes: in females ΔV̇O2/ΔWR correlated positively with tissue volume of subcutaneous fat and V̇E/V̇CO2-slope with tissue volume of visceral fat, and, in males, V̇O2peak correlated positively to lung volume. In conclusion, voxel-based Imiomics provided detailed insights into how CPET indices were related to the tissue volume and fat content of different body structures.

Impact of diet intervention on visceral adipose tissue and hepatic fat in patients with obesity or type 2 diabetes: a randomized trial

This study aimed to assess the effects of a diet intervention on visceral and hepatic fat in patients with obesity or type 2 diabetes (T2D). Participants with obesity or T2D were randomized to a diet intervention or their usual diet. The intervention comprised a "3G rice" regimen combined with a low-salt, high-fiber diet. The primary outcomes were changes in visceral adipose tissue (VAT) area and hepatic fat over 12 weeks assessed by magnetic resonance imaging. Eighty-six patients were randomized. Their mean age was 47.5 ± 11.0 years, and 82.3% were female. Eighty-one (94.2%) had obesity, and 16 (18.6%) had T2D. Baseline metrics were body weight 76.3 ± 16.1 kg, BMI 29.6 ± 4.6, VAT 12 629 ± 5819 mm2, and hepatic fat 7.9% ± 7.2%. At the 12-week follow-up, the diet group had greater VAT and hepatic fat reductions than controls (- 1468 ± 1468 vs. - 179 ± 1576 mm2, P = 0.001; and - 2.6% ± 3.4% vs. 0.4% ± 2.2%, P < 0.001). Adjusted differences remained significant for VAT (- 1093 mm2, P < 0.001) and hepatic fat (- 2.5%, P < 0.001). In conclusion, the 12-week diet intervention decreased VAT, hepatic fat, body weight, and BMI compared to a usual diet.

The association between parental cardiovascular health status and the risk of obesity in their offspring: Tehran Lipid and Glucose Study

BACKGROUND AND AIMS

Little is known about the association of parental cardiovascular risk factors with the risk of obesity in offspring. We aimed to investigate whether parental ideal cardiovascular health (ICVH) status was associated with the risk of general and central obesity in their young/adult offspring.

METHODS AND RESULTS

Of individuals who participated in the 2012-15 phase of the Tehran Lipid and Glucose Study, 2395 pairs of parent-unmarried offspring aged ≥6 years were selected in this cross-sectional study. General and central obesity were defined based on Iranian BMI percentile reference data for offspring aged ≤18 years. For subjects aged ≥19 years, central obesity was defined based on the introduced cut-off points for Iranian adults. We employed the American Heart Association's 2020 impact goal criteria of ICVH. The mean ± SD age of fathers and mothers were respectively 55.4 ± 9.79 and 48.4 ± 9.88. About 55% of offspring were older than 19 years. Higher adherence to ICVH score in mothers was associated with lower risk of overweight/obesity in female offspring (OR for Q1-Q4: 1, 0.56, 0.57, 0.37, P < 0.05 for all quartiles). Among ICVH components, only ideal BMI status in fathers was observed to be associated with a lower risk of overweight/obesity in their male offspring. The risk of abdominal obesity decreased in female offspring with increasing total ICVH score in mothers.

CONCLUSION

Higher adherence of parents to ICVH and its components was positively associated with a lower risk of general and abdominal obesity in their offspring. Our findings demonstrate that maternal-offspring relationship was stronger than paternal-offspring association.

Molecular Mechanisms behind Obesity and Their Potential Exploitation in Current and Future Therapy

Obesity is a chronic disease caused primarily by the imbalance between the amount of calories supplied to the body and energy expenditure. Not only does it deteriorate the quality of life, but most importantly it increases the risk of cardiovascular diseases and the development of type 2 diabetes mellitus, leading to reduced life expectancy. In this review, we would like to present the molecular pathomechanisms underlying obesity, which constitute the target points for the action of anti-obesity medications. These include the central nervous system, brain-gut-microbiome axis, gastrointestinal motility, and energy expenditure. A significant part of this article is dedicated to incretin-based drugs such as GLP-1 receptor agonists (e.g., liraglutide and semaglutide), as well as the brand new dual GLP-1 and GIP receptor agonist tirzepatide, all of which have become "block-buster" drugs due to their effectiveness in reducing body weight and beneficial effects on the patient's metabolic profile. Finally, this review article highlights newly designed molecules with the potential for future obesity management that are the subject of ongoing clinical trials.

The effect of incretin-based drugs on the riks of acute pancreatitis: a review

Objectives

In recent years, new hypoglycaemic drugs that affect the incretin system have become increasingly popular in the treatment of type 2 diabetes mellitus (T2DM): glucagon-like receptor 1 agonists (GLP1RAs), dipeptidyl peptidase 4 inhibitors (DPP4is) and the recently developed dual glucagon-like receptor 1 agonist and glucose-dependent insulinotropic polypeptide (tirzepatide). Their main role of these drugs is to normalise blood glucose levels. In addition, GLP1RAs are approved for the treatment of excessive body weight. The efficacy of drugs affecting the incretin system is well described in the literature, however, there are still only few reports about their safety. This review aims to summarize the results of current research and meta-analyses on risk of acute pancreatitis (AP) during incretin-affecting drugs treatment.

Methods

A narrative review was performed using present literature in an attempt to identify the relationship between AP and incretin-affecting drugs. The following keywords were used: acute pancreatitis, glucagon-like receptor 1 agonists, dipeptidyl peptidase 4 inhibitors and tirzepatide.

Results

It was demonstrated that the use of DPP4is is safe for the majority of patients with T2DM, whereas a risk of AP should be noted in case of GLP1RAs therapy. To date, most studies found no significant association between tirzepatide therapy and the increased risk of AP.

Conclusion

The majority of studies have shown that DPP4is, GLP1RAs and tirzepatide are effective and safe in most T2DM patients. However, the follow-up time for patients treated with tirzepatide is short, therefore more studies are required to confirm the safety of this drug.

Bioactive Compounds Formulated in Phytosomes Administered as Complementary Therapy for Metabolic Disorders

Metabolic disorders (MDs), including dyslipidemia, non-alcoholic fatty liver disease, diabetes mellitus, obesity and cardiovascular diseases are a significant threat to human health, despite the many therapies developed for their treatment. Different classes of bioactive compounds, such as polyphenols, flavonoids, alkaloids, and triterpenes have shown therapeutic potential in ameliorating various disorders. Most of these compounds present low bioavailability when administered orally, being rapidly metabolized in the digestive tract and liver which makes their metabolites less effective. Moreover, some of the bioactive compounds cannot fully exert their beneficial properties due to the low solubility and complex chemical structure which impede the passive diffusion through the intestinal cell membranes. To overcome these limitations, an innovative delivery system of phytosomes was developed. This review aims to highlight the scientific evidence proving the enhanced therapeutic benefits of the bioactive compounds formulated in phytosomes compared to the free compounds. The existing knowledge concerning the phytosomes' preparation, their characterization and bioavailability as well as the commercially available phytosomes with therapeutic potential to alleviate MDs are concisely depicted. This review brings arguments to encourage the use of phytosome formulation to diminish risk factors inducing MDs, or to treat the already installed diseases as complementary therapy to allopathic medication.

The pathophysiology of visceral adipose tissues in cardiometabolic diseases

Central pattern of fat distribution, especially fat accumulation within the intraabdominal cavity increases risks for cardiometabolic diseases. Portal hypothesis combined with a pathological remodeling in visceral fat is considered the major etiological factor explaining the independent contribution of visceral obesity to cardiometabolic diseases. Excessive remodeling in visceral fat during development of obesity leads to dysfunctions in the depot, characterized by hypertrophy and death of adipocytes, hypoxia, inflammation, and fibrosis. Dysfunctional visceral fat secretes elevated levels of fatty acids, glycerol, and proinflammatory and profibrotic cytokines into the portal vein directly impacting the liver, the central regulator of systemic metabolism. These metabolic and endocrine products induce ectopic fat accumulation, insulin resistance, inflammation, and fibrosis in the liver, which in turn causes or exacerbates systemic metabolic derangements. Elucidation of underlying mechanisms that lead to the pathological remodeling and higher degree of dysfunctions in visceral adipose tissue is therefore, critical for the development of therapeutics to prevent deleterious sequelae in obesity. We review depot differences in metabolic and endocrine properties and expendabilities as well as underlying mechanisms that contribute to the pathophysiological aspects of visceral adiposity in cardiometabolic diseases. We also discuss impacts of different weight loss interventions on visceral adiposity and cardiometabolic diseases.

Are we ready for an adipocentric approach in people living with type 2 diabetes and chronic kidney disease?

We are entering a new era in the management of adiposity-based chronic disease (ABCD) with type 2 diabetes (T2D) and related chronic kidney disease (CKD). ABCD, T2D and CKD can affect almost every major organ system and have a particularly strong impact on the incidence of cardiovascular disease (CVD) and heart failure. ABCD and the associated insulin resistance are at the root of many cardiovascular, renal and metabolic (CKM) disorders, thus an integrated therapeutic framework using weight loss (WL) as a disease-modifying intervention could simplify the therapeutic approach at different stages across the lifespan. The breakthrough of highly effective WL drugs makes achieving a WL of >10% possible, which is required for a potential T2D disease remission as well as for prevention of microvascular disease, CKD, CVD events and overall mortality. The aim of this review is to discuss the link between adiposity and CKM conditions as well as placing weight management at the centre of the holistic CKM syndrome approach with a focus on CKD. We propose the clinical translation of the available evidence into a transformative Dysfunctional Adipose Tissue Approach (DATA) for people living with ABCD, T2D and CKD. This model is based on the interplay of four essential elements (i.e. adipocentric approach and target organ protection, dysfunctional adiposity, glucose homeostasis, and lifestyle intervention and de-prescription) together with a multidisciplinary person-centred care. DATA could facilitate decision-making for all clinicians involved in the management of these individuals, and if we do this in a multidisciplinary way, we are prepared to meet the adipocentric challenge.

Relevance of obesity-related organ damage and metabolic syndrome classification in cardiovascular and renal risk stratification in patients with essential hypertension

Introduction

Hypertension is a relevant cardiovascular comorbidity. Adipose tissue represents a metabolically active tissue involved in the regulation of blood pressure and metabolic alterations. In recent decades, several classifications for the metabolic syndrome (MS) have been proposed. Recently, a new syndrome called the "Cardiovascular-kidney-metabolic" (CKM) syndrome was identified, to determine patients at high cardiovascular and metabolic risk. The aim of the study was to compare different classifications in a large population of hypertensive patients.

Materials and methods

Between September 2022 and August 2023, we consecutively enrolled 772 hypertensive patients (407 men; 365 women; mean age 52.2 ± 15.1 years), evaluating anthropometric, biochemical, and instrumental parameters (transthoracic echocardiogram, carotid echo-Doppler, 24-h ambulatory blood pressure monitoring, fundus oculi).

Results

Using different classifications we found MS prevalence: Adult Treatment Panel III (ATP-III) 28.8%, International Diabetes Federation (IDF) 31.5%, CKM 40.7%. CKM Classes 3 and 4 showed higher body mass index and waist circumference compared with other groups. Compared with ATP-III and IDF, CKM Class 4 showed higher 24-h systolic blood pressure, lower percentage of controlled hypertension, increased interventricular septum and posterior wall, reduced ejection fraction, and greater prevalence of hypertensive arterial retinal damage.

Discussion

Visceral obesity and MS are frequent conditions with healthy impact, becoming an important trigger for the development of cardiovascular and metabolic complications. The different MS classifications allow the early identification of patients at high risk of cardiometabolic complications. The new CKM syndrome proves useful to identify individuals at high risk for CKM morbidity and mortality.

The effect of stretching exercises on the mobility of the spine in the sagittal plane in people using digital devices – preliminary observations

Introduction. Digital devices and a sedentary lifestyle pose significant health risks in today’s society, further exacerbated by the regular adoption of incorrect posture. Prolonged adoption of an incorrect posture can result in pain and impaired spinal mobility. Aim of the study. The study aims to evaluate the impact of stretching exercises on improving cervical, thoracic and lumbar spine mobility in the sagittal plane. Furthermore, it sought to examine the potential correlation between the occurrence of pain and the duration of digital equipment usage. Study materials and methodology. The study was conducted on a sample group of 22 individuals aged 18 to 21 (20.11 ± 1.56) years. Linear measurements, including the Schober and Otto-Wurm tests, were used to examine spinal mobility in the sagittal plane. The subjects were given a 10-day programme comprising six stretching exercises to perform autonomously daily. After ten days, line measurements were retaken. Results. Significant statistical values were observed for spinal ranges of motion in the sagittal plane; no statistically significant value was obtained for the incidence of pain and the duration of use of digital devices. Conclusions. The subjects demonstrated improvement in cervical, thoracic, and lumbar spine mobility in the sagittal plane following the implementation of stretching exercises. Additionally, a decrease in spinal pain was observed.

Subclinical Hypothyroidism in Patients with Obesity and Metabolic Syndrome: A Narrative Review

The literature on the connection between obesity, metabolic syndrome, and subclinical hypothyroidism is critically analyzed in this narrative review. These conditions are frequently observed among adult populations and various studies and meta-analyses have assessed their association. The prevalence of subclinical hypothyroidism in obese individuals is higher than in non-obese subjects and this trend is more pronounced in unhealthy obesity phenotypes. However, the diagnosis and treatment of subclinical hypothyroidism can be difficult in obese patients. Exaggerated body fat is linked to thyroid hypoechogenicity as evident through ultrasonography and euthyroid obese people have greater TSH, FT3, and FT3/FT4 ratios than non-obese individuals in a euthyroid condition. Moreover, a reduced expression of the TSH receptor and altered function of deiodinases has been found in the adipose tissue of obese patients. Current data do not support the necessity of a pharmacological correction of the isolated hyperthyrotropinemia in euthyroid obese patients because treatment with thyroid hormone does not significantly improve weight loss and the increase in serum TSH can be reversible after hypocaloric diet or bariatric surgery. On the other hand, obesity is linked to elevated leptin levels. Inflammation can raise the risk of Hashimoto thyroiditis, which increases the likelihood that obese patients will experience overt or subclinical hypothyroidism. Both metabolic syndrome and subclinical hypothyroidism are associated with atherosclerosis, liver and kidney disease. Hence, the association of these two illnesses may potentiate the adverse effects noted in each of them. Subclinical hypothyroidism should be identified in patients with obesity and treated with appropriate doses of L-thyroxine according to the lean body mass and body weight. Randomized controlled trials are necessary to verify whether treatment of thyroid deficiency could counteract the expected risks.