Obesity and insulin resistance

FcRn-dependent IgG accumulation in adipose tissue unmasks obesity pathophysiology

Immunoglobulin G (IgG) is traditionally recognized as a plasma protein that neutralizes antigens for immune defense. However, our research demonstrates that IgG predominantly accumulates in adipose tissue during obesity development, triggering insulin resistance and macrophage infiltration. This accumulation is governed by neonatal Fc receptor (FcRn)-dependent recycling, orchestrated in adipose progenitor cells and macrophages during the early and late stages of diet-induced obesity (DIO), respectively. Targeting FcRn abolished IgG accumulation and rectified insulin resistance and metabolic degeneration in DIO. By integrating artificial intelligence (AI) modeling with in vivo and in vitro experimental models, we unexpectedly uncovered an interaction between IgG's Fc-CH3 domain and the insulin receptor's ectodomain. This interaction hinders insulin binding, consequently obstructing insulin signaling and adipocyte functions. These findings unveil adipose IgG accumulation as a driving force in obesity pathophysiology, providing a novel therapeutic strategy to tackle metabolic dysfunctions.

Comparison of triglyceride glucose index and modified triglyceride glucose indices in predicting cardiovascular diseases incidence among populations with cardiovascular-kidney-metabolic syndrome stages 0-3: a nationwide prospective cohort study

BACKGROUND

Cardiovascular-kidney-metabolic (CKM) syndrome has been recently proposed by American Heart Association recently. The triglyceride glucose (TyG) index and TyG-related indices combined with obesity indicators have proven to be associated with the incidence of cardiovascular diseases (CVD). However, there are few studies to explore whether these associations exist among people with CKM syndrome stages 0-3.

METHODS

A total of 7,364 participants from the China Health and Retirement Longitudinal Study were included. Cox hazard regression and restricted cubic spline regression were used to analyze the associations of these indices with CVD incidence. To compare predictive performance, time-dependent Harrell's C-indices, net reclassification index and integrated discrimination improvement were conducted.

RESULTS

The CVD incidence was 20.55% over nine years. The TyG single index and all the modified TyG indices were capable of predicting CVD incidence. RCS regression analyses showed that all indicators had linear relationships with CVD incidence and these linear relationships of TyG combined with waist circumference (TyG-WC) or waist-to-height ratio (TyG-WHtR) still existed in CKM stage 1, stage 2 and stage 3. TyG-WC (C-index: 0.621, p < 0.001) and TyG-WHtR (C-index: 0.621, p < 0.001) almost had the highest C-indices in predicting CVD incidence, compared to single TyG index (C-index: 0.611, p < 0.001) and TyG combined with body mass index (C-index: 0.616, p < 0.001).

CONCLUSION

The TyG index and all the modified TyG indices were independent predictors of CVD incidence among people with CKM syndrome stages 0-3. It was found that modified indices had better predictive performance, especially TyG combined with waist circumference or waist-to-height ratio.

Associations between religiosity/spirituality with insulin resistance and metabolic syndrome in the Midlife in the United States (MIDUS) study

Religiosity and spirituality (R/S) are central aspects to the lives of many people worldwide. Previous research suggests a potentially beneficial relationship between R/S, mostly understood as religious service attendance, and mortality. Though important, this research often fails to account for the complex and multidimensional nature of R/S. Also lacking is an adequate understanding of the physiological mechanisms that may link R/S with mortality and other health outcomes. Insulin resistance and metabolic syndrome, subclinical physiological processes that are influenced by the types of lifestyle factors and psychological factors that R/S addresses, serve as two possible biological mechanisms linking R/S and health outcomes. This study investigated the relations of R/S, defined as service attendance, support from one's religious community, and composite variables comprised of several diverse R/S indicators, in relation to insulin resistance and metabolic syndrome both cross-sectionally and in longitudinal analyses across 8-10 years in the Midlife in the United States (MIDUS) study. Results, controlling for important covariates (demographic factors, self-rated health, chronic conditions, depressive symptoms for all analyses; diabetes status and body mass index for insulin resistance analyses; antihyperlipidemic medications for metabolic syndrome), demonstrated nonsignificant relationships for all measures of R/S and both insulin resistance and metabolic syndrome in both cross-sectional and longitudinal analyses. Integrating these findings into the limited research on physiological mechanisms in the R/S and health relationship suggests that the area lacks consistent findings. Additional studies that use heterogenous, representative samples and further refine the operationalization of R/S are indicated.

Association between estimated glucose disposal rate and prediction of cardiovascular disease risk among individuals with cardiovascular-kidney-metabolic syndrome stage 0-3: a nationwide prospective cohort study

BACKGROUND

Insulin resistance is a crucial factor in the development of cardiovascular diseases (CVD), yet the relationship between the estimated glucose disposal rate (eGDR), an index reflecting insulin resistance, and the risk of new-onset CVD among individuals with cardiovascular-kidney-metabolic (CKM) syndrome stage 0-3 remains underexplored, and large-scale prospective cohort studies are needed to clarify this relationship.

METHODS

All data for this study were extracted from the China Health and Retirement Longitudinal Study (CHARLS). The primary outcome was the incidence of new-onset CVD (including heart diseases (HD) and stroke) during the follow-up period (from 2013 to 2020). Multivariable logistic regression models were applied to elucidate the relationship between the eGDR and the risk of developing CVD. The restricted cubic splines (RCS), mediation analysis, and stratified analyses were also employed.

RESULTS

This study included 6752 participants, of whom 1495 (22%) developed CVD. Odds ratios and 95% confidence intervals from lowest eGDR level (<7.37 mg/kg/min) to highest eGDR level (≥ 11.16 mg/kg/min) were 1.00 (reference), 0.81 (0.68, 0.96), 0.72 (0.58, 0.88), and 0.74 (0.58, 0.94) respectively, for the occurrence of CVD; 1.00 (reference), 0.81 (0.67,0.97), 0.72 (0.57,0.90), and 0.75 (0.58,0.97) respectively, for the occurrence of HD; 1.00 (reference), 0.91 (0.74,1.12), 0.80 (0.62,1.04), and 0.71 (0.52,0.97) respectively, for the occurrence of stroke after adjusting for all potential covariates. The RCS analysis discovered an approximately inverse "L" correlation between eGDR and the occurrence of CVD and HD across all individuals with CKM syndrome stages 0-3 (All P for overall < 0.001, All P for nonlinear = 0.005), while there was a negative linear correlation between eGDR and the risk of new-onset stroke (P for overall = 0.026, P for nonlinear = 0.098). Furthermore, the proportions mediated through BMI were 41.98%, 43.05%, and 43.23% for CVD, HD and stroke, respectively. No significant interactions were found.

CONCLUSIONS

The eGDR was a novel indicator of new-onset CVD in individuals with CKM syndrome stages 0-3, with BMI serving as a partial mediator in the association between eGDR and CVD risk. Addressing insulin resistance may represent a viable strategy for reducing the risk of CVD in this population.

MASH as an emerging cause of hepatocellular carcinoma: current knowledge and future perspectives

Hepatocellular carcinoma is one of the deadliest and fastest-growing cancers. Among HCC etiologies, metabolic dysfunction-associated fatty liver disease (MAFLD) has served as a major HCC driver due to its great potential for increasing cirrhosis. The obesogenic environment fosters a positive energy balance and results in a continuous rise of obesity and metabolic syndrome. However, it is difficult to understand how metabolic complications lead to the poor prognosis of liver diseases and which molecular mechanisms are underpinning MAFLD-driven HCC development. Thus, suitable preclinical models that recapitulate human etiologies are essentially required. Numerous preclinical models have been created but not many mimicked anthropometric measures and the course of disease progression shown in the patients. Here we review the literature on adipose tissues, liver-related HCC etiologies and recently discovered genetic mutation signatures found in MAFLD-driven HCC patients. We also critically review current rodent models suggested for MAFLD-driven HCC study.

Elevated uric acid levels as a risk factor for new-onset hypertension in newly enrolled Japanese university students (JSH46-0100)

This study aimed to determine the association between serum uric acid (UA) levels and new-onset hypertension (HTN) in newly enrolled students (aged 18 to 20 years) at a university in Gifu, Japan. We analyzed data collected over a 12-year period from April 2010 to March 2022. From this dataset, we selected individuals who were normotensive at admission and underwent a follow-up examination four years later, at the time of their progression to a master's course (n = 2859). Among these participants, 75 (2.6%) developed HTN by the second visit. Their serum UA levels (mg/dL) were significantly higher compared to those who remained HTN-free, both at baseline (6.02 ± 1.06 vs. 5.42 ± 1.17) and at the second visit (6.10 ± 1.20 vs 5.46 ± 1.22). Logistic regression analysis revealed that the odds of developing HTN were higher when considering the mean UA level across both visits (odds ratio: 1.63 per 1 mg/dL increase) compared to either the first or second visit alone. Further analysis of the relationship between elevated mean UA levels (above the cutoff value of 5.7 mg/dL) and the risk of new-onset HTN demonstrated a significant odds ratio of 3.39, which remained significant after adjusting for body mass index and sex. In summary, elevated UA levels are an independent risk factor for future HTN in young adults.

Impact of surrogates for insulin resistance on mortality and life expectancy in primary care: a nationwide cross-sectional study with registry linkage (LIPIDOGRAM2015)

Background

Insulin resistance (IR) is an important risk factor for multiple chronic diseases, increasing mortality and reducing life expectancy. The associations between emerging surrogates for IR, triglyceride-glucose index (TyG) and TyG-related indicators, with all-cause mortality and life expectancy in middle-aged and older patients in primary care are unclear.

Methods

This study originated from the Polish primary care cohort LIPIDOGRAM2015, including patients aged ≥45 years. Baseline fasting triglycerides and fasting glucose were used to derive TyG. Other TyG-related indicators included TyG-adjusted body mass index (TyG-BMI), TyG-adjusted waist circumference (TyG-WC), TyG-adjusted waist-to-hip, and TyG-adjusted waist-to-height. In this longitudinal analysis, we assessed associations between TyG-related indicators with total all-cause mortality, premature (age at death ≤75 years) all-cause mortality and years of life lost (YLL).

Findings

We included 10,688 patients (mean age 61.8 ± 9.3 years; 63.5% female). Cumulative total and premature all-cause mortality were 7.2% and 4.6%, respectively, during 5.7 years (IQR 5.6-5.7) of follow-up. Lowest (Q1) and highest quartile (Q4) of TyG-BMI and TyG-WC were associated with total all-cause mortality (second quartile [Q2]: reference; TyG-BMI: Q1: aHR 1.33, 95% CI 1.07-1.65, Q4: aHR 1.28, 95% CI 1.03-1.58; TyG-WC: Q1: aHR 1.44, 95% CI 1.14-1.82, Q4: aHR 1.29, 95% CI 1.04-1.59), similar results for premature all-cause mortality. Within age 45-80 years, compared with Q2 and third quartile, YLL were 4.49 and 5.46 years for TyG-BMI Q1 and Q4, respectively, 3.24 and 5.31 years for TyG-WC Q1 and Q4, respectively.

Interpretation

TyG-BMI and TyG-WC demonstrated a U-shaped association with total and premature all-cause mortality. Low and high levels of TyG-BMI and TyG-WC were associated with reduced life expectancy. Despite the relatively short follow-up period, significant associations were still observed, but longer follow-up studies are required to further explore these relationships.

Funding

Polish Lipid Association, College of Family Physician in Poland, Valeant in Poland.

Structure-based molecular docking and molecular dynamics simulations study for the identification of dipeptidyl peptidase 4 inhibitors in type 2 diabetes

Inhibition of dipeptidyl peptidase-4 (DPP4) activity has emerged as a promising therapeutic approach for the treatment of type 2 diabetes mellitus (T2DM). Bioinformatics-driven approaches have emerged as crucial tools in drug discovery. Molecular docking and molecular dynamics (MD) simulations are effective tools in drug discovery, as they reduce the time and cost associated with experimental screening. In this study, we employed structure-assisted in-silico methods, including molecular docking and MD simulations, to identify SRT2183, a small molecule that may potentially inhibit the activity of DPP4 enzyme. The interaction between the small molecule "SRT2183" and DPP4 exhibited a binding affinity of -9.9 Kcal/Mol, leading to the formation of hydrogen bonds with the amino acid residues MET348, SER376, and THR351 of DPP4. The MD simulations over a period of 100 ns indicated stable protein-ligand interactions, with no significant conformational rearrangements observed within the simulated timeframe. In conclusion, our results suggest that the small molecule SRT2183 may have the potential to inhibit the DPP4 enzyme and pave the way for the therapeutics of T2DM.Communicated by Ramaswamy H. Sarma.

Role of miR-125b-5p in modulating placental SIRT7 expression and its implications for lipid metabolism in gestational diabetes

Gestational diabetes is marked impaired glucose tolerance, poses various adverse outcomes including increased BMI and obesity. These outcomes results from excess lipid accumulation which is marked by elevated triglycerides. In GDM, placenta exhibits altered lipid metabolism, including reduced fatty acid oxidation and increased triglyceride accumulation. These elevated triglycerides can also contribute to oxidative stress in GDM. SIRT7 plays an important role in regulating lipid metabolism and triglycerides levels. This study aimed to investigate the potential of miRNA to regulate the placental SIRT7 in GDM. PCR analysis reveals that SIRT7 expression along with oxidative stress markers elevated in GDM placenta. These elevated SIRT7 levels were positively correlated with BMI and triglycerides levels in GDM subjects. miR-125b-5p was identified to regulate SIRT7 mRNA using in-silico approaches. Expression levels of miR-125b-5p were found to be downregulated in GDM placenta and found to be negatively correlated with SIRT7 mRNA expression. To confirm the hypothesis BeWo cells were transfected with anti-miR-125b and miR-125b-mimic. Anti-miR overexpressed the SIRT7 expression where mimic dysregulated it. Additionally, overexpressing miR-125b-5p controlled the elevated SIRT7 caused by the exposure of high glucose in BeWo cells. Collectively this study indicated that miR-125b-5p may regulate lipid metabolism via SIRT7 contributing to GDM. These findings highlights the warrant of further research to develop the therapeutic approaches that target miR-125b-5p to reduce lipid accumulation and obesity in GDM.

Using an Oral Sugar Test to Biologically Validate the Use of a Commercial Enzyme Immunoassay to Measure Salivary Insulin in Western Lowland Gorillas (Gorilla gorilla gorilla)

Noninvasive evaluations of hormones can contribute to the assessment of health and welfare of animals. Variations in insulin levels and sensitivity, for example, have been linked to health concerns in non-human and human primates including insulin resistance, diabetes, and heart disease, the leading cause of death in zoo-housed gorillas. Few published studies have assessed insulin concentrations in western lowland gorillas (Gorilla gorilla gorilla), and all did so using serum. Anesthesia is typically required to collect blood samples from zoo-housed gorillas, limiting sampling frequency and restricting samples to the fasted state. The ability to measure insulin levels in saliva would eliminate these constraints and provide a minimally invasive means for monitoring this hormone. The purpose of this study was to analytically and biologically validate the measurement of insulin in saliva of western lowland gorillas using a commercially available enzyme immunoassay. For validation, an oral sugar test was conducted on five adult gorillas residing at Cleveland Metroparks Zoo. Such assessments are common practice in both human and equine medicine to evaluate the body's insulin response to ingestion of sugars. The test involved measuring salivary insulin at timed intervals before and after gorillas consumed doses of sugar. Salivary insulin levels increased from 15 min post-sugar ingestion and peaked after 90 to 120 min. One female had a high response and peaked at 990.21 mU/L. The other four gorillas had peaks between 49.82 and 167.04 mU/L. The assessment provided a biological validation for the measurement of salivary insulin in western lowland gorillas.

The multi-omics signatures of telomere length in childhood

BACKGROUND

Telomere length is an important indicator of biological age and a complex multi-factor trait. To date, the telomere interactome for comprehending the high-dimensional biological aspects linked to telomere regulation during childhood remains unexplored. Here we describe the multi-omics signatures associated with childhood telomere length.

METHODS

This study included 1001 children aged 6 to 11 years from the Human Early-life Exposome (HELIX) project. Telomere length was quantified via qPCR in peripheral blood of the children. Blood DNA methylation, gene expression, miRNA expression, plasma proteins and serum and urinary metabolites were measured through microarrays or (semi-) targeted assays. The association between each individual omics feature and telomere length was assessed in omics-wide association analyses. In addition, a literature-guided, sparse supervised integration method was applied to multiple omics, and latent components were extracted as predictors of child telomere length. The association of these latent components with early-life aging risk factors (child lifestyle, body mass index (BMI), exposure to smoking, etc.), were interrogated.

RESULTS

After multiple-testing correction, only two CpGs (cg23686403 and cg16238918 at PARD6G gene) out of all the omics features were significantly associated with child telomere length. The supervised multi-omics integration approach revealed robust associations between latent components and child BMI, with metabolites and proteins emerging as the primary contributing features. In these latent components, the contributing molecular features were known as involved in metabolism and immune regulation-related pathways.

CONCLUSIONS

Findings of this multi-omics study suggested an intricate interplay between telomere length, metabolism and immune responses, providing valuable insights into the molecular underpinnings of the early-life biological aging.

Dysregulation of Metabolic Peptides Precedes Hyperinsulinemia and Inflammation Following Exposure to Rotenone in Rats

Rotenone, a naturally occurring compound derived from the roots of tropical plants, is used as a broad-spectrum insecticide, piscicide, and pesticide. It is a classical, high-affinity mitochondrial complex I inhibitor that causes not only oxidative stress, α-synuclein phosphorylation, DJ-1 (Parkinson's disease protein 7) modifications, and inhibition of the ubiquitin-proteasome system but it is also widely considered an environmental contributor to Parkinson's disease (PD). While prodromal symptoms, such as loss of smell, constipation, sleep disorder, anxiety/depression, and the loss of dopaminergic neurons in the substantia nigra of rotenone-treated animals, have been reported, alterations of metabolic hormones and hyperinsulinemia remain largely unknown and need to be investigated. Whether rotenone and its effect on metabolic peptides could be utilized as a biomarker for its toxic metabolic effects, which can cause long-term detrimental effects and ultimately lead to obesity, hyperinsulinemia, inflammation, and possibly gut-brain axis dysfunction, remains unclear. Here, we show that rotenone disrupts metabolic homeostasis, altering hormonal peptides and promoting infiltration of inflammatory T cells. Specifically, our results indicate a significant decrease in glucagon-like peptide-1 (GLP-1), C-peptide, and amylin. Interestingly, levels of several hormonal peptides related to hyperinsulinemia, such as insulin, leptin, pancreatic peptide (PP), peptide YY (PYY), and gastric inhibitory polypeptide (GIP), were significantly upregulated. Administration of rotenone to rats also increased body weight and activated macrophages and inflammatory T cells. These data strongly suggest that rotenone disrupts metabolic homeostasis, leading to obesity and hyperinsulinemia. The potential implications of these findings are vast, given that monitoring these markers in the blood could not only provide a crucial tool for assessing the extent of exposure and its relevance to obesity and inflammation but could also open new avenues for future research and potential therapeutic strategies.

Reduced PI3K(p110α) induces atrial myopathy, and PI3K-related lipids are dysregulated in athletes with atrial fibrillation

BACKGROUND

Elucidating mechanisms underlying atrial myopathy, which predisposes individuals to atrial fibrillation (AF), will be critical for preventing/treating AF. In a serendipitous discovery, we identified atrial enlargement, fibrosis, and thrombi in mice with reduced phosphoinositide 3-kinase (PI3K) in cardiomyocytes. PI3K(p110α) is elevated in the heart with exercise and is critical for exercise-induced ventricular enlargement and protection, but the role in the atria was unknown. Physical inactivity and extreme endurance exercise can increase AF risk. Therefore, our objective was to investigate whether too little and/or too much PI3K alone induces cardiac pathology.

METHODS

New cardiomyocyte-specific transgenic mice with increased or decreased PI3K(p110α) activity were generated. Multi-omics was conducted in mouse atrial tissue, and lipidomics in human plasma.

RESULTS

Elevated PI3K led to an increase in heart size with preserved/enhanced function. Reduced PI3K led to atrial dysfunction, fibrosis, arrhythmia, increased susceptibility to atrial enlargement and thrombi, and dysregulation of monosialodihexosylganglioside (GM3), a lipid that regulates insulin-like growth factor-1 (IGF1)-PI3K signaling. Proteomic profiling identified distinct signatures and signaling networks across atria with varying degrees of dysfunction, enlargement, and thrombi, including commonalities with the human AF proteome. PI3K-related lipids were dysregulated in plasma from athletes with AF.

CONCLUSION

PI3K(p110α) is a critical regulator of atrial biology and function in mice. This work provides a proteomic resource of candidates for further validation as potential new drug targets and biomarkers for atrial myopathy. Further investigation of PI3K-related lipids as markers for identifying individuals at risk of AF is warranted. Dysregulation of PI3K may contribute to the association between increased cardiac risk with physical inactivity and extreme endurance exercise.

First-trimester metabolic profiling of gestational diabetes mellitus: insights into early-onset and late-onset cases compared with healthy controls

Introduction

Gestational diabetes mellitus (GDM) is a global health concern with significant short and long-term complications for both mother and baby. Early prediction of GDM, particularly late-onset, is crucial for implementing timely interventions to mitigate adverse outcomes. In this study, we conducted a comprehensive metabolomic analysis to explore potential biomarkers for early GDM prediction.

Methods

Plasma samples were collected during the first trimester from 60 women: 20 with early-onset GDM, 20 with late-onset GDM, and 20 with normal glucose tolerance. Using advanced analytical techniques, including liquid chromatography-tandem mass spectrometry (LC-MS/MS) and gas chromatography-mass spectrometry (GC-MS), we profiled over 150 lipid species and central carbon metabolism intermediates.

Results

Significant metabolic alterations were observed in both early- and late-onset GDM groups compared to healthy controls, with a specific focus on glycerolipids, fatty acids, and glucose metabolism. Key findings revealed a 4.0-fold increase in TG(44:0), TG(46:0), TG(46:1) with p-values <0.001 and TG(46:2) with 4.7-fold increase and p-value <0.0001 as well as changes in several phospholipids as PC(38:3), PC(40:4) with 1.4-fold increase, p < 0.001 and PE(34:1), PE(34:2) and PE(36:2) with 1.5-fold change, p < 0.001 in late-onset GDM.

Discussion

Observed lipid changes highlight disruptions in energy metabolism and inflammatory pathways. It is suggested that lipid profiles with distinct fatty acid chain lengths and degrees of unsaturation can serve as early biomarkers of GDM risk. These findings underline the importance of integrating metabolomic insights with clinical data to develop predictive models for GDM. Such models could enable early risk stratification, allowing for timely dietary, lifestyle, or medical interventions aimed at optimizing glucose regulation and preventing complications such as preeclampsia, macrosomia, and neonatal metabolic disorders. By focusing on metabolic disruptions evident in the first trimester, this approach addresses a critical window for improving maternal and fetal outcomes. Our study demonstrates the value of metabolomics in understanding the metabolic perturbations associated with GDM. Future research is needed to validate these biomarkers in larger cohorts and assess their integration into clinical workflows for personalized pregnancy care.

Divergent roles of m6A in orchestrating brown and white adipocyte transcriptomes and systemic metabolism

N6-methyladenosine (m6A) is among the most abundant mRNA modifications, yet its cell-type-specific regulatory roles remain unclear. Here we show that m6A methyltransferase-like 14 (METTL14) differentially regulates transcriptome in brown versus white adipose tissue (BAT and WAT), leading to divergent metabolic outcomes. In humans and mice with insulin resistance, METTL14 expression differs significantly from BAT and WAT in the context of its correlation with insulin sensitivity. Mettl14-knockout in BAT promotes prostaglandin secretion, improving systemic insulin sensitivity. Conversely, Mettl14-knockout in WAT triggers adipocyte apoptosis and systemic insulin resistance. m6A-seq and RNA-seq integration revealed upregulated prostaglandin biosynthesis pathways in BAT and apoptotic pathways in WAT with Mettl14 deficiency. Stable METTL14-knockout hBAs/hWAs show METTL14-mediated m6A promotes mRNA decay of PTGES2 and CBR1 in hBAs and TRAIL and TNFR1 in hWAs. These data shed light on the ability of m6A to impact metabolism in a cell-type-specific manner with implications for influencing the pathophysiology of metabolic diseases.

Determinants of increased muscle insulin sensitivity of exercise-trained versus sedentary normal weight and overweight individuals

The athlete's paradox states that intramyocellular triglyceride accumulation associates with insulin resistance in sedentary but not in endurance-trained humans. Underlying mechanisms and the role of muscle lipid distribution and composition on glucose metabolism remain unclear. We compared highly trained athletes (ATHL) with sedentary normal weight (LEAN) and overweight-to-obese (OVWE) male and female individuals. This observational study found that ATHL show higher insulin sensitivity, muscle mitochondrial content, and capacity, but lower activation of novel protein kinase C (nPKC) isoforms, despite higher diacylglycerol concentrations. Notably, sedentary but insulin sensitive OVWE feature lower plasma membrane-to-mitochondria sn-1,2-diacylglycerol ratios. In ATHL, calpain-2, which cleaves nPKC, negatively associates with PKCε activation and positively with insulin sensitivity along with higher GLUT4 and hexokinase II content. These findings contribute to explaining the athletes' paradox by demonstrating lower nPKC activation, increased calpain, and mitochondrial partitioning of bioactive diacylglycerols, the latter further identifying an obesity subtype with increased insulin sensitivity (NCT03314714).

Vitamin D modulates the content of inflammatory microRNAs in extracellular vesicles from human adipocyte cells in inflammatory context

Inflammation of adipose tissue is a contributing factor to many chronic diseases associated with obesity. We previously showed that micronutrients such as vitamin D (VD) limited this metabolic inflammation by decreasing inflammatory markers expression including miR-155 (microRNA-155) or miR-146a in different in vitro and in vivo models. These miRNAs could be incorporated into extracellular vesicles (EVs) in order to modulate the activity of target cells. Nevertheless, the role of VD on the miRNAs contained in EVs from adipose tissue in inflammatory conditions remains unclear. In this study, we used a human model of SGBS (Simpson-Golabi-Behmel syndrome) adipocytes preincubated with 1,25(OH)2D (the active form of VD) before an inflammatory stress with tumor necrosis factor α (TNFα). First, we confirmed by quantitative PCR that the expression of classical inflammatory factors (TNFα and chemokine ligand 2 [CCL2/MCP1]), miR-146a, and miR-155 was increased significantly under inflammatory conditions in SGBS cells and that VD prevented this up-regulation. Secondly, transmission electron microscope imaging of EVs preparations in supernatant allowed visualization of small and large vesicles under these conditions. Then, EVs were obtained with isolation kit and the expression of miR-155 and miR-146a were measured. The expression of miR-155 under TNFα effect was increased in EVs while miR-146a was not detected. Moreover, we also showed that the TNFα-mediated expression of miR-155 in EVs was significantly reduced by a VD pre-incubation of cells. Using miRNA PCR array, we also identified 33 miRNAs, organized in 5 clusters that were differentially regulated by TNFα and VD. Bioinformatic analysis of biological pathways revealed that the different miRNAs targeting genes that are involved in important cell process such as the regulation of transcription or protein phosphorylation. In conclusion, these results support for the first time that VD modulated the expression of miRNAs in EVs from adipocytes, which could represent a new mechanism of regulation of inflammation by micronutrients.

Longitudinal Metabolomics Data Analysis Informed by Mechanistic Models

Background: Metabolomics measurements are noisy, often characterized by a small sample size and missing entries. While data-driven methods have shown promise in terms of analyzing metabolomics data, e.g., revealing biomarkers of various phenotypes, metabolomics data analysis can significantly benefit from incorporating prior information about metabolic mechanisms. This paper introduces a novel data analysis approach to incorporate mechanistic models in metabolomics data analysis. Methods: We arranged time-resolved metabolomics measurements of plasma samples collected during a meal challenge test from the COPSAC2000 cohort as a third-order tensor: subjects by metabolites by time samples. Simulated challenge test data generated using a human whole-body metabolic model were also arranged as a third-order tensor: virtual subjects by metabolites by time samples. Real and simulated data sets were coupled in the metabolites mode and jointly analyzed using coupled tensor factorizations to reveal the underlying patterns. Results: Our experiments demonstrated that the joint analysis of simulated and real data had better performance in terms of pattern discovery, achieving higher correlations with a BMI (body mass index)-related phenotype compared to the analysis of only real data in males, while in females, the performance was comparable. We also demonstrated the advantages of such a joint analysis approach in the presence of incomplete measurements and its limitations in the presence of wrong prior information. Conclusions: The joint analysis of real measurements and simulated data (generated using a mechanistic model) through coupled tensor factorizations guides real data analysis with prior information encapsulated in mechanistic models and reveals interpretable patterns.

Mediating role of triglyceride-glucose index and its derivatives in the relationship between central obesity and Hashimoto thyroiditis in type 2 diabetes

BACKGROUND

Obesity and insulin resistance (IR) may be risk factors for thyroid disease, but there is no clinical-based consensus on this topic. Therefore, this study aims to evaluate the associations between the triglyceride-glucose index (TyG) and its derivatives and Hashimoto thyroiditis (HT) in type 2 diabetes mellitus (T2DM) patients, and explore the relationships between the central obesity indicators and HT risk to provide a reliable basis for the early prevention of HT.

METHODS

A total of 1071 T2DM patients aged ≥ 20 years were selected from a tertiary hospital in Tianjin, all of them had normal thyroid function (including free triiodothyronine, free thyroxine, total triiodothyronine, total thyroxine, and thyroid-stimulating hormone). HT was assessed via thyroid-associated antibodies and thyroid colour Doppler ultrasound. TyG and its derivatives were measured via IR. Restricted cubic spline (RCS) models, multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis were used to explore the correlations and predict HT. Mediation analysis explored the mediating role of TyG and its derivatives in the associations between the central obesity indicators and HT.

RESULTS

RCS models revealed that increases in waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), TyG-WC, TyG-WHR, and TyG-WHtR were associated with increased HT risk. Logistic regression revealed that participants in the fourth quartile of TyG-WC, TyG-WHR, and TyG-WHtR had approximately 3.38 times greater HT risk (odds ratio range: 2.807 to 3.375). ROC analysis revealed that WC, WHtR, WHR, TyG-WC, TyG-WHtR and TyG-WHtR could distinguish the presence of HT. In females, the WHR had the highest predictive power, with an area under the ROC curve of 0.651 (95% confidence interval 0.611-0.691, P < 0.001). Mediation analysis revealed that high IR, as assessed by the TyG-body mass index (TyG-BMI), significantly mediated the effects of WC, WHtR, and WHR on the risk of HT. Among them, the TyG-BMI had the highest proportion of mediating effect of WC on HT risk, reaching 74.08%.

CONCLUSION

IR significantly mediates the increased risk of HT associated with central obesity. In clinical practice, WC, WHtR, WHR, TyG-WC, TyG-WHR, and TyG-WHtR serve as sensitive indicators for predicting HT risk in adult T2DM patients.

Exploring the prognostic impact of triglyceride-glucose index in critically ill patients with first-ever stroke: insights from traditional methods and machine learning-based mortality prediction

BACKGROUND

The incidence and mortality of first-ever strokes have risen sharply, especially in the intensive care unit (ICU). Emerging surrogate for insulin resistance, triglyceride-glucose index (TyG), has been linked to stroke prognosis. We aims to explore the relationships between TyG with ICU all-cause mortality and other prognosis, and to develop machine learning (ML) models in predicting ICU all-cause mortality in the first-ever strokes.

METHODS

We included first-ever stroke patients from the eICU Collaborative Research Database in 2014-2015 as the primary analysis cohort (then divided into training and internal validation cohorts) and from local hospital's ICUs as the external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the association between TyG and ICU/hospital all-cause mortality. Linear regression and correlation analyses were performed to examine the relationships between TyG with length of ICU/hospital stay and Glasgow Coma Score.

RESULTS

The primary analysis cohort included 3173 first-ever strokes (median age 68.0 [55.0-68.0] years; 63.0% male), while the external validation cohort included 201 first-ever strokes (median age 71.0 [63.0-77.0] years; 62.3% male). Multivariate Cox proportional hazards models revealed that the high TyG group (TyG ≥ 9.265) was associated with higher ICU (HR 1.92, 95% CI 1.38-2.66) and hospital (HR 1.69, 95% CI 1.32-2.16) all-cause mortality, compared with low TyG group (TyG < 9.265). TyG was also correlated with ICU length of stay (r = 0.077), hospital length of stay (r = 0.042), and Glasgow Coma Score (r = -0.132). TyG and other six features were used to construct ML models. The random forest model performed best in internal validation with AUC (0.900) and G-mean (0.443), and in external validation with AUC (0.776) and G-mean (0.399).

CONCLUSION

TyG (optimal cut-off: 9.265) was identified as an independent risk factor for ICU and hospital all-cause mortality in first-ever strokes. The ML model incorporating TyG demonstrated strong predictive performance. This emphasises the importance of insulin resistance (with TyG as a surrogate measure) in the prognostic assessment and early risk stratification of first-time stroke patients.

An improved in vitro 3T3-L1 adipocyte model of inflammation and insulin resistance

Tumor necrosis factor alpha (TNF-α)/hypoxia-treated 3T3-L1 adipocytes have been used to model inflamed and insulin-resistant adipose tissue: this study examines gaps in the model. We tested whether modulating TNF-α/hypoxia treatment time could reduce cell death while still inducing inflammation and insulin resistance. Adipocytes were treated with TNF-α (12 h or 24 h) and incubated in a hypoxic chamber for 24 h. To examine maintenance of the phenotype over time, glucose and FBS were added at 24 h post initiation of treatment, and the cells were maintained for an additional 48 h. Untreated adipocytes were used as a control. Viability, insulin resistance, and inflammation were assessed using Live/Dead staining, RT-qPCR, ELISA, and glucose uptake assays. Treatment for 12 h with TNF-α in the presence of hypoxia resulted in an increase in the percentage of live cells compared to 24 h treated cells. Importantly, insulin resistance and inflammation were still induced in the 12 h treated adipocytes: the expression of the insulin sensitive and inflammatory genes was decreased and increased, respectively. In 72 h treated adipocytes, no significant differences were found in the viability, glucose uptake or insulin-sensitive and inflammatory gene expression. This study provides a modified approach to in vitro odeling adipocyte inflammation and insulin resistance.        .

Macromolecules from mushrooms, venoms, microorganisms, and plants for diabetes treatment - Progress or setback?

Diabetes is a substantial public health issue, while its prevalence continues to rise worldwide, affecting millions of persons between the ages of 20 and 80, the development of new therapeutic classes improving glycemic control and consequently micro and macrovascular complications are needed. Today, diabetes treatment is daily for life, and should not be interrupted. However, insulin secretagogues medications, and exogenous self-administration of insulin provide efficient antidiabetic effects, but their misuse leads to hypoglycemic complications besides other risks, hence the need to look for other natural products not to use solely but in concert with others types of medications. In this review, we will highlight briefly the pathophysiology of diabetes and its complications, then we will report the main bioactive macromolecules derived from various sources of natural products providing anti-diabetic properties. However, further researches need to be carried out to face the limitations hampering the development of effective natural drugs for diabetes treatment.

Metabolic Status Modulates Global and Local Brain Age Estimates in Overweight and Obese Adults

BACKGROUND

As people live longer, maintaining brain health becomes essential for extending health span and preserving independence. Brain degeneration and cognitive decline are major contributors to disability. In this study, we investigated how metabolic health influences the brain age gap estimate (brainAGE), which measures the difference between neuroimaging-predicted brain age and chronological age.

METHODS

K-means clustering was applied to fasting metabolic markers including insulin, glucose, leptin, cortisol, triglycerides, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, steady-state plasma glucose, and body mass index of 114 physically and cognitively healthy adults. The homeostatic model assessment for insulin resistance served as a reference. T1-weighted brain magnetic resonance imaging was used to calculate voxel-level and global brainAGE. Longitudinal data were available for 53 participants over a 3-year interval.

RESULTS

K-means clustering divided the sample into 2 groups, those with favorable (n = 58) and those with suboptimal (n = 56) metabolic health. The suboptimal group showed signs of insulin resistance and dyslipidemia (false discovery rate-corrected p < .05) and had older global brainAGE and local brainAGE, with deviations most prominent in cerebellar, ventromedial prefrontal, and medial temporal regions (familywise error-corrected p < .05). Longitudinal analysis revealed group differences but no significant time or interaction effects on brainAGE measures.

CONCLUSIONS

Suboptimal metabolic status is linked to accelerated brain aging, particularly in brain regions rich in insulin receptors. These findings highlight the importance of metabolic health in maintaining brain function and suggest that promoting metabolic well-being may help extend health span.

The Gut Microbiome's Influence on Incretins and Impact on Blood Glucose Control

Obesity and type 2 diabetes mellitus (T2DM) have been increasing in prevalence, causing complications and strain on our healthcare systems. Notably, gut dysbiosis is implicated as a contributing factor in obesity, T2DM, and chronic inflammatory diseases. A pharmacology exists which modulates the incretin pathway to improve glucose control; this has proven to be beneficial in patients with obesity and T2DM. However, it is unclear how the gut microbiome may regulate insulin resistance, glucose control, and metabolic health. In this narrative review, we aim to discuss how the gut microbiome can modulate incretin pathways and related mechanisms to control glucose. To investigate this, Google Scholar and PubMed databases were searched using key terms and phrases related to the microbiome and its effects on insulin and glucose control. Emerging research has shown that several bacteria, such as Akkermansia and MN-Gup, have GLP-1-agonistic properties capable of reducing hyperglycemia. While more human research is needed to prove clinical benefit and identify long-term implications on health, the usage of pre-, pro-, and postbiotics has the potential to improve glucose control.

HM-Chromanone Alleviates Hyperglycemia by Activating AMPK and PI3K/AKT Pathways in Mice Fed a High-Fat Diet

OBJECTIVES

We investigated potential antihyperglycemic effects of HM-chromanone (HMC), a homoisoflavonoid isolated from Portulaca oleracea, in mice fed a high-fat diet (HFD).

METHODS

Five-week-old male C57BL/6J mice (n = 24) were divided into three groups: controls, mice fed an HFD (11 weeks), and HFD-fed mice receiving HMC supplementation (8 weeks). Various analyses assessed liver and skeletal muscle proteins, pancreatic β-cell histology, blood glucose and HbA1c levels, and homeostatic index of insulin resistance (HOMA-IR).

RESULTS

HMC supplementation significantly reduced fasting blood glucose and postprandial blood glucose levels in HFD-fed mice. HbA1c and serum insulin levels reduced significantly, and HOMA-IR improved. Compensatory β-cell hyperplasia was reduced, and pancreatic β-cell function improved. AMP-activated protein kinase (AMPK) was significantly activated in skeletal muscle and liver tissues. IRS-1tyr612 expression increased significantly. PI3K activation and Akt phosphorylation in skeletal muscles improved insulin signaling. Forkhead box protein O1 phosphorylation increased through hepatic AMPK activation. Phosphoenolpyruvate carboxykinase and glucose-6-phosphatase expression was inhibited. Glycogen synthase kinase 3β phosphorylation increased.

CONCLUSIONS

HMC supplementation alleviated hyperglycemia by activating the AMPK and PI3K/Akt pathways in skeletal muscles and the AMPK pathway in the liver of HFD-fed mice.

Triglyceride-glucose Index and Its combination with obesity indicators mediating the association between 2-hydroxyfluorene and the prevalence of cardiovascular disease: Evidence from the NHANES (2005-2018)

BACKGROUND

Polycyclic aromatic hydrocarbons (PAHs) were increasingly recognized as a group of environmental pollutants associated with various health issues. The rise in their prevalence in the environment was concerning. Yet, the effects of PAH exposure on cardiovascular diseases (CVDs) were still not well understood.

PURPOSE

This study investigated the impact of exposure to 2-hydroxyfluorene on CVDs prevalence, with a special focus on the mediating role of triglyceride-glucose (TyG) index and its combination with obesity indicators.

METHOD

Using National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018, this study assessed how 2-hydroxyfluorene affects CVDs prevalence through various statistical techniques. The investigation began with restricted cubic spline (RCS) analysis to explore the relationship between 2-hydroxyfluorene levels and CVDs prevalence. Logistic regression was then used to examine associations within PAH mixtures, alongside the Bayesian Kernel Machine Regression (BKMR) model. Furthermore, the Quantile G-Computation (QG-comp) model was used to evaluate the influence of weights and directions. A mediation analysis was also performed to assess the mediating role of TyG-related indicators on the relationship between 2-hydroxyfluorene and CVDs prevalence. Besides, the association between 2-hydroxyfluorene and the prevalence of each specific CVDs, congestive heart failure, myocardium infarction, angina pectoris and coronary heart disease, was also assessed and so was the mediated effect. Finally, the subgroup analysis was conducted to assess the association in each specific subgroup.

RESULT

The study, involving 3645 participants, found a significant positive association between 2-hydroxyfluorene exposure and CVD (OR (95 %CI) = 115.8013 (5.0521 ∼ 2654.3248), P=0.0029), with 2-hydroxyfluorene showing the positive contribution to CVDs prevalence within the phthalate mixture. The positive association also existed between 2-hydroxyfluorene and the prevalence of each specific CVDs. TyG and TyGWC (Triglyceride Glucose-Waist Circumference) were identified as mediators in the link between 2-hydroxyfluorene exposure and the prevalence of total CVD and each specific CVD, while TyGBMI (Triglyceride Glucose-Body Mass Index) can only mediate the association between 2-hydroxyfluorene and the prevalence of total CVD, congestive heart failure and angina pectoris CONCLUSION: The findings highlighted a significant association between 2-hydroxyfluorene exposure and CVDs prevalence, with TyG-related indicators acting as mediators.

Out-of-phase treatment with the synthetic glucocorticoid betamethasone disturbs glucose metabolism in mice

OBJECTIVE

Endogenous glucocorticoid levels display a strong circadian rhythm, which is often not considered when synthetic glucocorticoids are prescribed as anti-inflammatory drugs. In this study we evaluated the effect timing of glucocorticoid administration, i.e. in-phase (administered when endogenous glucocorticoid levels are high) versus out-of-phase (administered when endogenous glucocorticoid levels are low). We investigated the synthetic glucocorticoid betamethasone - which is extensively used in the clinic - and monitored the development of common metabolic side effects in mice upon prolonged treatment, with a particular focus on glucose metabolism.

METHODS

Male and female C57BL/6J mice were treated with the synthetic glucocorticoid betamethasone in-phase and out-of-phase, and the development of metabolic side effects was monitored.

RESULTS

We observed that, compared with in-phase treatment, out-of-phase treatment with betamethasone results in hyperinsulinemia in both male and female C57BL/6J mice. We additionally found that out-of-phase betamethasone treatment strongly reduced insulin sensitivity as compared to in-phase administration during morning measurements. Our study shows that the adverse effects of betamethasone are dependent on the time of treatment with generally less side effects on glucose metabolism with in-phase treatment.

CONCLUSIONS

This study highlights differences in glucocorticoid outcome based on the time of measurement, advocating that potential circadian variation should be taken into account when studying glucocorticoid biology.

Gestational diabetes mellitus (GDM): diagnosis using biochemical parameters and anthropometric measurements during the first trimester in the Indian population

OBJECTIVES

The objective of the study was to use anthropometric measurements (age, BMI, and subcutaneous fat) in conjunction with biochemical parameters (sex hormone-binding globulin (SHBG), homeostasis model assessment-insulin resistance (HOMA-IR), fasting glucose, serum insulin, and total cholesterol) to predict the probability of gestational diabetes mellitus (GDM) in the first trimester.

METHODS

The study enrolled 48 pregnant women with GDM and 64 high-risk pregnant women without GDM. During the first-trimester examination, maternal blood samples were collected to measure SHBG, fasting blood glucose, serum insulin, and total cholesterol levels. Regression model analysis was used to examine the variables that showed statistically significant differences between the groups and were independent predictors of GDM. Receiver operating characteristic (ROC) curve analysis was employed to determine the risk of developing GDM based on cut-off values.

RESULTS

The levels of SHBG, HOMA-IR, serum insulin, fasting glucose, and total cholesterol were identified as significant independent markers for predicting GDM. Meanwhile, age, body mass index, and subcutaneous fat values were found to be non-independent predictors of GDM. The areas under the ROC curve were calculated to determine the predictive accuracy of total cholesterol, HOMA-IR, SHBG, and subcutaneous fat for developing into GDM, and were 0.869, 0.977, 0.868, and 0.822 respectively. The sensitivities for a false positive rate of 5 % for predicting GDM were 68.7 , 91.67, 91.7, and 97.9 % for total cholesterol, HOMA-IR, SHBG, and subcutaneous fat, respectively.

CONCLUSIONS

The independent predictors for the subsequent development of GDM in high-risk pregnancies are HOMA-IR, SHBG, Total cholesterol, and subcutaneous fat (SC) levels. These parameters can be used to create a regression model to predict the occurrence of GDM.

Association of Body Composition Changes with the Development of Diabetes Mellitus: A Nation-Wide Population Study

BACKGRUOUND

We investigated the association between body composition changes and new-onset diabetes mellitus (DM) development according to the body mass index (BMI) in a longitudinal setting in the general Korean population.

METHODS

From 2010 to 2011 (1st) and 2012 to 2013 (2nd), we included 1,607,508 stratified random sample participants without DM from the National Health Insurance Service-Health Screening dataset of Korean. The predicted appendicular skeletal muscle mass index (pASMMI), body fat mass index (pBFMI), and lean body mass index (pLBMI) were calculated using pre-validated anthropometric prediction equations. A prediction equation was constructed by combining age, weight, height, waist circumference, serum creatinine levels, alcohol consumption status, physical activity, and smoking history as variables affecting body composition.

RESULTS

Decreased pASMMI (men: hazard ratio [HR], 0.866; 95% confidence interval [CI], 0.830 to 0.903; P<0.001; women: HR, 0.748; 95% CI, 0.635 to 0.881; P<0.001), decreased pLBMI (men: HR, 0.931; 95% CI, 0.912 to 0.952; P<0.001; women: HR, 0.906; 95% CI, 0.856 to 0.959; P=0.007), and increased pBFMI (men: HR, 1.073; 95% CI, 1.050 to 1.096; P<0.001; women: HR, 1.114; 95% CI, 1.047 to 1.186; P=0.007) correlated with the development of new-onset DM. Notably, only in the overweight and obese BMI categories, decreases in pASMMI and pLBMI and increases in pBFMI associated with new-onset DM, regardless of gender.

CONCLUSION

Decreased pASMMI and pLBMI, and increased pBFMI with excess fat accumulation may enhance the risk of newonset DM. Therefore, appropriate changes in body composition can help prevent new-onset DM.

Dietary modulation of microRNAs in insulin resistance and type 2 diabetes

The prevalence of type 2 diabetes is increasing worldwide. Various molecular mechanisms have been proposed to interfere with the insulin signaling pathway. Recent advances in proteomics and genomics indicate that one such mechanism involves the post-transcriptional regulation of insulin signaling by microRNA (miRNA). These noncoding RNAs typically induce messenger RNA (mRNA) degradation or translational repression by interacting with the 3' untranslated region (3'UTR) of target mRNA. Dietary components and patterns, which can either enhance or impair the insulin signaling pathway, have been found to regulate miRNA expression in both in vitro and in vivo studies. This review provides an overview of the current knowledge of how dietary components influence the expression of miRNAs related to the control of the insulin signaling pathway and discusses the potential application of these findings in precision nutrition.

Waist-to-hip ratio as a contributor associated with higher atherosclerotic cardiovascular disease risk assessment in patients with diabetes: a cross-sectional study

INTRODUCTION

This study aimed to identify the factors most strongly associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk score in patients with type 2 diabetes (T2D).

METHODS

This cross-sectional study included 4698 patients with T2D over an 11-year period (2010-2021). Patients were categorized into four groups based on their 10-year ASCVD risk score (< 5%, 5-7.5%, 7.5-20%, and > 20%). Multinominal regression analysis was used to evaluate the association between various modifiable and non-modifiable risk factors and the ASCVD risk score.

RESULTS

Of the patients, 35.9% had a 10-year ASCVD risk score below 5%, 12.6% had a score between 5% and 7.5%, 30.8% had a score between 7.5% and 20%, and 19.7% had a score above 20%. Higher ASCVD risk scores were significantly associated with elevated waist-to-hip ratio (WHR > 0.93), pulse pressure, uric acid, triglycerides, and decreased glomerular filtration rate (all p-values < 0.05). WHR demonstrated the strongest association with higher ASCVD risk scores (OR: 4.55, 95% CI: 2.94-7.03, p < 0.001) when comparing patients with ASCVD scores > 5% to those with scores < 5%.

CONCLUSION

WHR was independently associated with higher ASCVD risk scores in patients with T2D. Incorporating WHR, along with traditional risk factors, could improve ASCVD risk assessments in this population.

Gender-specific capacity of insulin resistance proxies to predict functional decline in older adults

OBJECTIVES

Insulin resistance determined by Homeostasis Model of Insulin Resistance (HOMA-IR) has been associated with functional decline in non-diabetic older subjects. However, insulin is not routinely assessed. The study evaluated the predictive value of non-insulin-dependent IR surrogates on functional decline in non-diabetic older men and women.

DESIGN AND PARTICIPANTS

Prospective cohort study over 5 years. The study included 615 older participants from the Toledo Study of Healthy Aging.

METHODS

Frailty was assessed by the Frailty Trait Scale-5 (FTS-5) at baseline and after 5 years follow-up. 193 subjects experienced functional decline (2.5-point reduction in the FTS-5 score). Multivariate regression models analysed the effect of five described IR surrogates on functional decline considering potential confounders.

RESULTS

Among evaluated IR proxies, triglyceride glucose-body mass index (TyG-BMI) and HOMA-IR were significantly associated with an increased risk of functional decline (odd ratio (95% confidence interval) TyG-BMI: 1.16 (1.05, 1.28), p = 0.0035 and HOMA-IR: 1.59 (1.15, 2.21), p = 0.0056) among all participants. When stratified by gender, HOMA-IR was related to functional decline in men [2.02 (1.13, 3.59), p = 0.0173] and TyG-BMI in women [1.19 (1.05, 1.35), p = 0.0057].

CONCLUSIONS

Only TyG-BMI index mimics the predictive capacity of insulin-based IR marker. The predictive ability of IR indexes is gender-specific, being TyG-BMI the only index able to predict functional decline in women and HOMA-IR in men.

Nicotinamide N-methyltransferase inhibition mitigates obesity-related metabolic dysfunction

AIM

To assess the effects of a small-molecule nicotinamide N-methyltransferase (NNMT) inhibitor, 5A1MQ, on body composition, metabolic variables, fatty liver pathologies, and circulating biomarkers in diet-induced obese (DIO) mice, and characterize its plasma pharmacokinetics (PK) and tissue distribution in vivo.

MATERIALS AND METHODS

DIO mice were administered vehicle or 5A1MQ once daily for 28 days. Longitudinal measures of body composition, blood glucose and plasma insulin levels, and terminal measures of liver histopathology and serum markers, were evaluated. Plasma and tissue PK were established in age- and strain-matched mice after intravenous, oral, and subcutaneous dosing of 5A1MQ.

RESULTS

5A1MQ treatment dose-dependently limited body weight and fat mass gains, improved oral glucose tolerance and insulin sensitivity, and suppressed hyperinsulinaemia in DIO mice. Liver histology from 5A1MQ-treated DIO mice showed attenuated hepatic steatosis and macrophage infiltration, and correspondingly reduced liver weight, size, and triglyceride levels. 5A1MQ treatment normalized circulating levels of alanine transaminase, aspartate transaminase, and ketone bodies, supporting an overall improvement in liver and metabolic functions. The pharmacodynamic effects of 5A1MQ were further corroborated by its high systemic exposure and effective distribution to metabolically active tissues, including adipose, muscle and liver, following subcutaneous dosing of mice.

CONCLUSIONS

This work validates NNMT inhibition as a viable pharmacological approach to ameliorate metabolic imbalances and improve liver pathologies that develop with obesity.

Lung cancer and obesity: A contentious relationship (Review)

The global obesity epidemic, attributed to sedentary lifestyles, unhealthy diets, genetics and environmental factors, has led to over 1.9 billion adults being classified as overweight and 650 million living with obesity. Despite advancements in early detection and treatment, lung cancer prognosis remains poor due to late diagnoses and limited therapies. The obesity paradox challenges conventional thinking by suggesting that individuals with obesity and certain diseases, including cancer, may have an improved prognosis compared with their counterparts of a normal weight. This observation has prompted investigations to understand protective mechanisms, including potentially favorable adipokine secretion and metabolic reserves that contribute to tolerating cancer treatments. However, understanding the association between obesity and lung cancer is complex. While smoking is the primary risk factor of lung cancer, obesity may independently impact lung cancer risk, particularly in non‑smokers. Adipose tissue dysfunction, including low‑grade chronic inflammation, and hormonal changes contribute to lung cancer development and progression. Obesity‑related factors may also influence treatment responses and survival outcomes in patients with lung cancer. The impact of obesity on treatment modalities such as chemotherapy, radiotherapy and surgery is still under investigation. Challenges in managing patients with obesity and cancer include increased surgical complexity, higher rates of postoperative complications and limited treatment options due to comorbidities. Targeted interventions aimed at reducing obesity prevalence and promoting healthy lifestyles are crucial for lung cancer prevention. The impact of obesity on lung cancer is multifaceted and requires further research to elucidate the underlying mechanisms and develop personalized interventions for prevention and treatment.

Tissue engineering strategies for ocular regeneration; from bench to the bedside

Millions globally suffer from visual impairment, complicating the management of eye diseases due to various ocular barriers. The eye's complex structure and the limitations of existing treatments have spurred interest in tissue engineering (TE) as a solution. This approach offers new functionalities and improves therapeutic outcomes over traditional drug delivery methods, creating opportunities for treating various eye disorders, from corneal injuries to retinal degeneration. In our review of recent articles concerning the use of scaffolds for eye repair, we categorized scaffolds employed in eye TE from recent studies into four types based on tissue characteristics: natural, synthetic, biohybrid, and decellularized tissue. Additionally, we gathered data on the cell types and animal models associated with each scaffold. This allowed us to gather valuable insights into the benefits and drawbacks of each material. Our research elucidates that, in comparison to conventional treatment modalities, scaffolds in TE emulate the extracellular matrix (ECM) of the eye and facilitate cell proliferation and tissue regeneration. These scaffolds can be precisely tailored to incorporate growth factors that augment the healing process while also providing considerable advantages such as bacterial inhibition, biocompatibility, and enhanced durability. However, they also have drawbacks, such as potential immune responses, poor tissue integration, complex and costly manufacturing, and inconsistent degradation rates that can affect their effectiveness. In this review, we provide an overview of the present condition of eye regenerative treatments, assess notable preclinical and clinical research endeavors, contemplate the obstacles encountered, and speculate on potential advancements in the upcoming decade.

Investigating the efficiency of novel indicators in predicting risk of metabolic syndrome in the Iranian adult population

BACKGROUND

Whether new anthropometric indicators are superior to conventional anthropometric indicators and whether they can better identify MetS in apparently healthy people needs further research. Thus, this study aimed to estimate the efficiency of novel indicators in predicting the risk of metabolic syndrome (MetS) in the Iranian adult population.

MATERIAL AND METHODS

In this cross-sectional study, 800 subjects were selected by clustered random sampling. The metabolic factors, traditional and novel anthropometric indices, the triglyceride and glucose index (TyG index) and modified TyG indices (TyG-BMI, TyG-WC, TyG-WHR, and TyG-WHtR), and metabolic score for insulin resistance (METS-IR) were evaluated. The MetS was calculated according to the IDF criteria. To investigate the risk of MetS, logistic regression was used along with modeling.

RESULTS

In all three models, all traditional anthropometric indices were associated with MetS (P < 0.001). Regarding novel anthropometric indices, all indices (except for ABSI) significantly predicted the risk of MetS in all participants before and after adjustment (P < 0.001). WTI index presented the highest Odds ratios for MetS (29.50, 95% CI: 15.53-56.03). A positive association was found in all models between TyG and modified TyG indices and METS-IR with MetS (P for all < 0.001). TyG-WHtR index presented the highest Odds ratios for MetS (70.07, 95% CI: 32.42-151.43).

CONCLUSION

A combination of the TyG index and WHtR (TyG-WHtR index) was better than the TyG index alone, with a higher odds ratio in predicting MetS. Due to the simplicity of these indices, cost-effectiveness, and facility at small-scale labs and being predictive of MetS risk it is suggested to include these markers in clinical practice.

Combined effect of triglyceride glucose-body mass index and hypertension on new-onset stroke: evidence from the China health and retirement longitudinal study

Objective

The aim of this study is to investigate the combined impact of the triglyceride glucose-body mass index (TyG-BMI) and hypertension on the risk of stroke among the middle-aged and older adult population in China.

Methods

This study included 6,922 participants aged 45 and above from the China Health and Retirement Longitudinal Study, utilizing a multivariate Cox proportional hazards regression model to explore the relationship between TyG-BMI, hypertension, and the incidence of new-onset stroke events, as well as conducting Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) analyses to evaluate the predictive utility of TyG-BMI.

Results

During a 7-year follow-up period, a total of 401 stroke events were recorded. Compared to patients with lower TyG-BMI (TyG-BMI < 199.74) levels and non-hypertension, those with elevated TyG-BMI levels and non-hypertension had an adjusted hazard ratio (HR) and 95% confidence intervals (95%CI) were 1.47 (1.05-2.05). The adjusted HR and 95%CI for the group with lower TyG-BMI levels and hypertension was 2.99 (2.17-4.12), and for those with elevated TyG-BMI levels and hypertension, the adjusted HR and 95%CI was 3.49 (2.63-4.62). In a multivariate Cox proportional hazards regression model, the combination of elevated TyG-BMI levels and hypertension, treated as routine variables, was still significantly associated with the risk of stroke. NRI and IDI analyses showed significant improvements in risk prediction with the inclusion of TyG-BMI. Furthermore, in all subgroup analyses conducted, individuals with elevated TyG-BMI levels and hypertension nearly exhibited the highest risk for incident stroke.

Conclusion

Our study reveals that the combined effect of TyG-BMI and hypertension may increase the risk of incident stroke in the middle-aged and older adult Chinese population. TyG-BMI correlates with comorbid conditions and enhances traditional risk assessment. Future research will require validation through larger sample sizes or diverse populations to further confirm this finding.

Alternative Perspectives on Obesity and Hypertension

It is known that obesity and hypertension have a relationship with one another. Often, obesity is thought to directly cause hypertension, with a list of mechanisms commonly cited. This, however, does not do the relationship justice. Not only can the directionality of the relationship be flipped, but the mechanisms may be misattributed confounders, themselves. Beyond this, some argue that the results of trials using glucagon-like-peptide-1 receptor agonist (GLP1R) medications suggest a causal relationship between obesity and hypertension, but this will be debunked. The relationship is far from linear, and mainstream literature often excludes key confounders that will be discussed in this article including food insecurity, mental health, socioeconomic status (SES), and weight stigma and discrimination. The factors used to measure the risk of hypertension as well as the measurements of hypertension, itself, need to be reexamined. For instance, there may be a high amount of "false positives" among the diagnosed. Finally, current research needs to be critically evaluated for forms of weight centrism and weight bias, deciphering improper assumptions from true, evidence-based science.

Metabolic surgery results in greater metabolic benefits in patients who achieve healthy weight

BACKGROUND

A percentage of total weight loss (%TWL) >20% as the expected weight loss target after metabolic surgery might be insufficient to produce adequate metabolic benefits.

OBJECTIVES

This study identified the optimal weight loss target to achieve substantial benefits from metabolic surgery.

SETTING

University-affiliated tertiary care center.

METHODS

In this retrospective study, participants were categorized into healthy weight (18.5 kg/m2 ≤ body mass index [BMI] < 24 kg/m2), overweight (24 kg/m2 ≤ BMI < 28 kg/m2), and obesity groups (BMI ≥28 kg/m2) according to their BMI 1 year after metabolic surgery. The weight loss and remission of obesity-related comorbidities were evaluated. Ordinal logistic regression analysis was used to identify predictors for achieving healthy weight 1 year postoperatively.

RESULTS

Overall, 125 patients (112 sleeve gastrectomies, 13 Roux-en-Y gastric bypasses) were recruited in this study. Forty-two participants achieved healthy weight, 38 were overweight, and 45 had obesity. Type 2 diabetes mellitus and obstructive sleep apnea were relieved in all groups. Individuals who achieved healthy weight showed more improvements in nonalcoholic fatty liver disease, hypertension, and hyperuricemia than those who did not. Preoperative BMI was an independent predictor for the BMI achieved postoperatively, and the optimal cut-off point for achieving healthy weight was 34.9 kg/m2.

CONCLUSIONS

Healthy weight was a more stringent target for patients who underwent metabolic surgery than the %TWL. Populations with a preoperative BMI of <34.9 kg/m2 were prone to realize the goal. Additional weight loss interventions could be considered for those with higher preoperative BMIs and enforced within 1 year postoperatively.

DIETARY REGULATION OF SILENT SYNAPSES IN THE DORSOLATERAL STRIATUM

Obesity and drugs of abuse share overlapping neural circuits and behaviors. Silent synapses are transient synapses that are important for remodeling brain circuits. They are prevalent during early development but largely disappear by adulthood. Drugs of abuse increase silent synapses during adulthood and may facilitate reorganizing brain circuits around drug-related experience, facilitating addiction and contributing to relapse during treatment and abstinence. Whether obesity causes alterations in the expression of silent synapses in a manner similar to drugs of abuse has not been examined. Using a dietary-induced obesity paradigm, mice that chronically consumed high fat diet (HFD) exhibited increased silent synapses in both direct and indirect pathway medium spiny neurons in the dorsolateral striatum. Both the time of onset of increased silent synapses and their normalization upon discontinuation of HFD occurs on an extended time scale compared to drugs of abuse. These data demonstrate that chronic consumption of HFD, like drugs of abuse, can alter mechanisms of circuit plasticity likely facilitating neural reorganization analogous to drugs of abuse.

Tissue-specific activation of insulin signaling as a potential target for obesity-related metabolic disorders

The incidence of obesity is rapidly increasing worldwide. Obesity-associated insulin resistance has long been established as a significant risk factor for obesity-related disorders such as type 2 diabetes and atherosclerosis. Insulin plays a key role in systemic glucose metabolism, with the liver, skeletal muscle, and adipose tissue as the major acting tissues. Insulin receptors and the downstream insulin signaling-related molecules are expressed in various tissues, including vascular endothelial cells, vascular smooth muscle cells, and monocytes/macrophages. In obesity, decreased insulin action is considered a driver for associated disorders. However, whether insulin action has a positive or negative effect on obesity-related disorders depends on the tissue in which it acts. While an enhancement of insulin signaling in the liver increases hepatic fat accumulation and exacerbates dyslipidemia, enhancement of insulin signaling in adipose tissue protects against obesity-related dysfunction of various organs by increasing the capacity for fat accumulation in the adipose tissue and inhibiting ectopic fat accumulation. Thus, this "healthy adipose tissue expansion" by enhancing insulin sensitivity in adipose tissue, but not in the liver, may be an effective therapeutic strategy for obesity-related disorders. To effectively address obesity-related metabolic disorders, the mechanisms of insulin resistance in various tissues of obese patients must be understood and drugs that enhance insulin action must be developed. In this article, we review the potential of interventions that enhance insulin signaling as a therapeutic strategy for obesity-related disorders, focusing on the molecular mechanisms of insulin action in each tissue.

Impact of diabetes mellitus on tuberculosis prevention, diagnosis, and treatment from an immunologic perspective

The coexistence of diabetes mellitus (DM) and tuberculosis (TB) presents a significant global burden, with DM being recognized as a major risk factor for TB. This review comprehensively analyzes the immunological aspects of DM-TB comorbidity, shedding light on the impact of DM on TB pathogenesis and immune responses. It reveals that high blood glucose levels in TB patients contribute to reduced innate immune cell count, compromised phagocytic function, and delayed antigen presentation. These factors ultimately impair the clearance of Mycobacterium tuberculosis (MTB) and delay adaptive immune responses. With the interaction between TB and DM, there is an increase in inflammation and elevated secretion of pro-inflammatory cytokines by immune cells. This exacerbates the inflammatory response and contributes to poor treatment outcomes in TB. Moreover, the review explores the effects of DM on TB prevention, diagnosis, and treatment. It highlights how poor glycemic control, insulin resistance (IR), DM complications, and genetic factors increase the risk of MTB infection in individuals with DM. Additionally, DM-related immune suppression adversely affects the sensitivity of traditional diagnostic tests for TB, potentially resulting in underdiagnosis and delayed intervention. To mitigate the burden of TB in DM patients, the review emphasizes the need for further research on the mechanisms underlying DM reactivation in latent TB infection (LTBI). It shows how important it is to find and treat LTBI in DM patients as soon as possible and suggests looking into biomarkers that are specific to DM to make diagnosis more accurate.

Association of visceral adiposity index and lipid accumulation products with prediabetes in US adults from NHANES 2007-2020: A cross-sectional study

BACKGROUND

The lipid accumulation product (LAP) and the visceral adiposity index (VAI) are suggested as dependable measures for assessing visceral fat levels. Prediabetes is recognized as a condition that precedes the potential onset of diabetes. The objective of this research is to investigate how VAI and LAP are related to prediabetes among the adult population in the United States.

METHODS

Information from the 2007-2020 National Health and Nutrition Examination Survey (NHANES) was scrutinized in a cross-sectional study. To evaluate the connection between VAI or LAP and the presence of prediabetes, both univariate analysis and multivariate logistic regression were utilized. Threshold effect analysis and fitted smoothing curves were used to delve into the non-linear association between VAI or LAP and prediabetes. Additional analyses were performed on specific subgroups, along with tests to explore potential interactions.

RESULTS

In general, 12,564 American adults were included. After full adjustment, prediabetes with VAI (OR: 1.128, 95% CI: 1.073-1.185) or LAP (OR: 1.006, 95% CI: 1.004-1.008) showed a positive correlation. Individuals in the 4th VAI quartile group faced a significant 61.9% elevated risk for prediabetes (OR: 1.619, 95% CI: 1.354-1.937) when contrasted to those in the 1st VAI quartile. Participants in the 4th LAP quartile group had a significant 116.4% elevated risk for prediabetes (OR: 2.164, 95% CI: 1.747-2.681) when contrasted to individuals of the 1st LAP quartile. Smooth curve fitting analysis revealed a nonlinear correlation of VAI or LAP and prediabetes, and threshold effect analysis was used to determine an inflection point of 4.090 for VAI and 68.168 for LAP.

CONCLUSIONS

The values of VAI and LAP are positively associated with the prevalence of prediabetes. The VAI and LAP indices may be used as predictors of prediabetes.

Is weight-adjusted waist index more strongly associated with diabetes than body mass index and waist circumference?: Results from the database large community sample study

BACKGROUND

The uncertainty regarding the correlation between the weight-adjusted waist index (WWI) and diabetes within the National Health and Nutrition Examination Survey (NHANES) necessitates further exploration. As indicators of obesity, the differences in the intensity of association between WWI, body mass index (BMI), and waist circumference (WC) with diabetes are worth exploring. This investigation is undertaken to elucidate the association between WWI and diabetes in the NHANES dataset and to compare the extent to which BMI, WC, and WWI were closely associated with diabetes. Then, choose an obesity index that is more strongly associated with diabetes.

METHODS

A comprehensive cross-sectional stratified survey of 7,973 participants from the 2017-2020 NHANES was conducted. WWI is an anthropometric measure based on WC and weight. The formula is WWI (cm/√kg) = WC/√weight. The association between WWI and diabetes was investigated using weighted multiple logistic regression, smooth curve fitting, stratified analysis, and interaction testing.

RESULTS

The participants' average age was 50.84±17.34 years, and 50.68% of them were female. The detection rate of diabetes was 15.11%. This positive association was particularly notable among non-diabetic patients. For each unit increase in BMI and WC as continuous variables, the likelihood of developing diabetes in the fully adjusted model increased by 5% (OR = 1.05; 95%CI, 1.03-1.07) and 3% (OR = 1.03; 95%CI, 1.02-1.04), respectively, but for each one-unit increase in WWI, the likelihood of developing diabetes increased by 111% (OR = 2.11; 95% CI, 1.68-2.65). Tests of interactions revealed that in various subgroups, the association between diabetes and WWI remained steady.

CONCLUSIONS

We analyzed 2017-2020 NHANES data to explore the link between WWI and diabetes, finding a consistent positive correlation. The correlation between WWI and diabetes was stronger than that between WC and BMI. WWI seems to offer better potential aid in disease prevention and diagnosis.

Hypericum perforatum-derived exosomes-like nanovesicles for adipose tissue photodynamic therapy

BACKGROUND

Recent investigations underscore the capacity of photodynamic therapy (PDT) to induce adipocyte apoptosis, thereby mitigating obesity. Nonetheless, extant synthetic photosensitizers manifest limitations that hinder their clinical viability.

PURPOSE

In the current study, we used Hypericum perforatum-derived exosomes-like nanovesicles (HPExos) as a novel photosensitizer, and investigated its PDT effects in adipose tissue during obesity.

METHOD

HPExos-were administered to high fat diet mice via intraperitoneal injection, followed by targeted irradiation with specialized LED lights. Mass spectrometric analysis was analyzed in adipose tissues. CCK8 assay and Oil Red O staining were used to investigate lipid accumulation in 3T3-L1 cells to clarify adipocyte differentiation. The expression levels of related markers associated with adipogenesis and lipogenesis were assessed by RT-PCR. Apoptosis analysis was performed by TUNEL staining of and western blotting.

RESULTS

HPExos combined with PDT accumulated in visceral white adipose tissues results in a reduced body weight and improved insulin sensitivity. HPExos combined with PDT induced apoptosis by driving high levels of ROS. In addition, HPExos combined with PDT significantly downregulated the expression of transcription factors, PPARγ, C/EBPα, and SREBP and lipogenesis protein FABP4 both in vitro and in vivo, associated with a decreased FFA levels.

CONCLUSION

These findings suggest that HPExos could act as an effective photosensitizer in regulating glucose hemostasis by inhibiting adipocyte differentiation and lipogenesis, offering a promising approach for obesity treatment.

Relation Between Obesity and Type 2 Diabetes: Evolutionary Insights, Perspectives and Controversies

PURPOSE OF REVIEW

Since the mid-twentieth century, obesity and its related comorbidities, notably insulin resistance (IR) and type 2 diabetes (T2D), have surged. Nevertheless, their underlying mechanisms remain elusive. Evolutionary medicine (EM) sheds light on these issues by examining how evolutionary processes shape traits and diseases, offering insights for medical practice. This review summarizes the pathogenesis and genetics of obesity-related IR and T2D. Subsequently, delving into their evolutionary connections. Addressing limitations and proposing future research directions aims to enhance our understanding of these conditions, paving the way for improved treatments and prevention strategies.

RECENT FINDINGS

Several evolutionary hypotheses have been proposed to unmask the origin of obesity-related IR and T2D, e.g., the "thrifty genotype" hypothesis suggests that certain "thrifty genes" that helped hunter-gatherer populations efficiently store energy as fat during feast-famine cycles are now maladaptive in our modern obesogenic environment. The "drifty genotype" theory suggests that if thrifty genes were advantageous, they would have spread widely, but proposes genetic drift instead. The "behavioral switch" and "carnivore connection" hypotheses propose insulin resistance as an adaptation for a brain-dependent, low-carbohydrate lifestyle. The thrifty phenotype theory suggests various metabolic outcomes shaped by genes and environment during development. However, the majority of these hypotheses lack experimental validation. Understanding why ancestral advantages now predispose us to diseases may aid in drug development and prevention of disease. EM helps us to understand the evolutionary relation between obesity-related IR and T2D. But still gaps and contradictions persist. Further interdisciplinary research is required to elucidate complete mechanisms.

Sex-Related Differences in the Associations between Adiponectin and Serum Lipoproteins in Healthy Subjects and Patients with Metabolic Syndrome

The strong associations between the serum levels of adiponectin and the lipoprotein subclasses observed in healthy subjects are much weaker in patients with metabolic syndrome (MS). However, the impact of sex on these associations remained unexplored. Therefore, in the present study, we examined associations between adiponectin and the lipoprotein subclasses, analyzed by nuclear magnetic resonance spectroscopy, separately in healthy females and males, as well as in females and males with MS. We observed negative correlations between adiponectin and VLDL, IDL, and small-dense LDL in healthy males, but neither in healthy females nor in females or males with MS. Additionally, adiponectin was positively correlated with some HDL subclasses in healthy males and females with MS, but not in healthy females or males with MS. Adjusting for age and either body mass index, waist circumference, C-reactive protein, or interleukin-6 weakened the associations between adiponectin and VLDL and IDL but not small-dense LDL. The adjustment weakened the associations between adiponectin and HDL in healthy males but not in females with MS. Based on our results, we conclude that sex and the presence of MS are strong determinants of the associations between adiponectin and serum lipoproteins and that the complex regulatory network comprising adiponectin and other molecular players involved in the regulation of lipoprotein metabolism is primarily operative in healthy males and females with MS.

Alteration of reactivity in isolated mesenteric artery from Zucker fatty diabetes mellitus rats

Obesity and diabetes are major risk factors for cardiovascular diseases. Zucker fatty diabetes mellitus (ZFDM) rats are novel animal model of obesity and type 2 diabetes. We have recently reported that blood pressure in ZFDM-Leprfa/fa (Homo) rats was normal, while blood adrenaline level and heart rate were lower than those in control ZFDM-Leprfa/+ (Hetero) rats. Here, we compared the reactivity in isolated mesenteric artery between Hetero and Homo rats. Contraction induced by phenylephrine was increased, while relaxation induced by isoprenaline was decreased in Homo rats at 21-23 weeks old compared with those in Hetero rats. The mRNA expression for α1A but not β2 adrenoreceptor in Homo rats was increased. Nitric oxide (NO)-mediated relaxation induced by acetylcholine was decreased, while the mRNA expression for endothelial NO synthase (eNOS) was rather increased in mesenteric artery from Homo rats. These findings for the first time revealed that in Homo rats with reduced plasma adrenaline, blood pressure could be maintained by enhancing vascular contractility induced by adrenaline through the increased α1 adrenoceptor expression and the attenuated β2 adrenoceptor signaling. Additionally, NO-mediated endothelium-dependent relaxation is impaired perhaps due to eNOS dysfunction, which might also contribute to maintain the blood pressure in Homo rats.

The Roles of Obesity and ASB4 in Preeclampsia Pathogenesis

Preeclampsia is a complex pregnancy-related hypertensive disorder which poses significant risks for both maternal and fetal health. Preeclampsia affects 5-8% of pregnancies in the United States, causing a significant public health and economic burden. Despite extensive research, the etiology and pathogenesis of preeclampsia remain elusive, but have been correlated with maternal conditions such as obesity. In recent decades, the incidence of preeclampsia increased along with the prevalence of obesity among women of reproductive age. Maternal obesity has been shown to negatively affect pregnancy in almost all aspects. However, the precise mechanisms by which obesity influences preeclampsia are unclear. Ankyrin repeat and SOCS Box Containing protein 4 (ASB4) is an E3 ubiquitin ligase that can promote the degradation of a wide range of target proteins. ASB4-null mice display a full spectrum of preeclampsia-like phenotypes during pregnancy including hypertension, proteinuria, and decreased litter size. Furthermore, maternal obesity induced by a high-fat diet aggravates preeclampsia-like phenotypes in pregnant mice lacking ASB4. Variants in the ASB4 gene have been associated with obesity in humans, and a functional connection between the ASB4 gene and obesity has been established in mice. This review discusses the connections between preeclampsia, obesity, and ASB4.

Exploring the diabesity characteristics and associated all-cause mortality at a population level: results from a small European island state

Aim

Diabesity, the co-occurrence of diabetes and obesity, presents a global health crisis. Understanding its prevalence, associated risk factors, and mortality outcomes is crucial for effective public health interventions. This study aims to investigate the prevalence of diabesity and diabetes, assess associated risk factors, and analyze mortality outcomes over a 7-year period in the diabetogenic country of Malta.

Subject and methods

A nationwide health examination survey (2014–16) was conducted involving 3947 adults aged 18–70 years. Sociodemographic data, anthropometric measurements, and blood samples were collected. Relationships between different adiposity indices were explored. Mortality data was obtained by cross-referencing with the national mortality register. Statistical analyses included chi-square tests, logistic regression, and Cox proportional hazard models.

Results

Prevalence of obesity was 34.08%, diabetes 10.31%, and diabesity 5.78%. Sociodemographic characteristics were similar across all three cohorts. Multivariable regression identified increasing age (OR 1.10 CI95% 1.07–1.12; p≤ 0.001), male gender (OR 0.53 CI95% 0.30–0.93; p = 0.03), and low educational level (OR 2.19 CI95% 1.39–3.45; p = 0.001) as significant predictors of diabesity. Only diabetes showed a significant increase in mortality risk (HR 3.15 CI95% 1.31–7.62; p = 0.02) after adjustment, with gender (HR 3.17 CI95% 1.20–8.37) and body adiposity index (HR 1.08 CI95% 1.01–1.16) also significant (p ≤ 0.05).

Conclusion

Diabesity represents a substantial public health challenge in Malta, with implications for mortality outcomes. Targeted interventions addressing sociodemographic disparities and promoting healthy lifestyles are essential to mitigate its impact. The findings underscore the need for comprehensive healthcare strategies and policy initiatives to combat diabesity and reduce associated mortality rates.