Expert Review of Endocrinology & Metabolism最新文献

Introduction: Diabetes disproportionately affects marginalized populations, leading to poorer glycemic control, higher complications, and reduced quality of life. Unequal access to care, mediated by multiple social determinants of health (SDoH), further exacerbates these risks. Addressing SDoH is crucial to mitigate health disparities and downstream impacts on the United States (U.S.) population and healthcare system.

Areas covered: This review explores SDoH that disproportionately affect marginalized communities, including socio-economic (SE), geographic, cultural and linguistic, health literacy-related, psychologic, and systemic barriers to equitable diabetes care. We also explore evidence-based care strategies such as telehealth, social media and internet-based education strategies, integration of community health workers (CHW), integrated care models and policy changes.

Expert opinion: While small-scale interventions have demonstrated success in overcoming challenges in diabetes care for marginalized populations, significant research gaps remain. Studies focusing on long-term outcomes and addressing the root causes of disparities tied to SDoH are urgently needed. Furthermore, rather than merely characterizing SDoH, researchers and clinicians must actively address them at the patient, provider, and system levels. Advancing diabetes care and reducing disparities requires equity-focused policies, inclusive research, and culturally tailored interventions. Without systemic reforms, however, these advancements risk perpetuating existing inequalities.

Introduction: Obesity is a chronic, progressive, and heterogeneous disease defined by excess adiposity that impairs health. While Body Mass Index (BMI) remains the most used diagnostic tool, it is increasingly regarded as an inadequate measure of obesity. BMI does not account for inter-individual, including inter-ethnic variation in fat distribution, body composition and metabolic health. These limitations highlight the need for a more nuanced and clinically robust diagnostic framework in obesity.

Areas covered: This article examines the shortcomings of BMI as a diagnostic tool and explores a range of alternative metrics, including anthropometric indices, clinical staging systems and direct assessments of adiposity and metabolic dysfunction, drawing on a narrative review of literature from 1950 to 2025 using PubMed. We also review recent international expert consensus statements and updated clinical guidelines from leading health organizations.

Expert opinion: Research progress in obesity diagnostics is expected to drive a shift away from BMI toward more clinically useful approaches. Future clinical practice could adopt more personalized management strategies, to guide prevention, diagnosis, and intervention in obesity care.

Introduction: Obesity is a global epidemic associated with significant health risks, including type 2 diabetes, cardiovascular diseases, and metabolic disorders. Bariatric surgery remains the gold standard for achieving significant and sustained weight loss. This narrative review was created using literature searches in PubMed, Web of Science, and Scopus.

Areas covered: Bariatric surgery induces shifts in gut microbiota composition, with changes in alpha and beta diversity and alters microbial phyla, such as Bacillota, Bacteroidota, Actinomycetota, Pseudomonadota, and Verrucomicrobiota. Genera and species belonging to these groups that have been associated with the pathophysiology of obesity are reported altered as well. These microbial changes, particularly after Roux-en-Y gastric bypass surgery, are generally linked to cardiometabolic improvements to gut hormone profiles and bile acid metabolism.

Expert opinion: This review focuses on the changes in gut microbiota following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), highlighting longitudinal human studies. Despite conflicting results, some genera, such as Veillonella, Streptococcus, and Akkermansia muciniphila, show consistent increases post-surgery and may serve as markers of metabolic improvements. The predominance of facultative anaerobes suggests a shift in the gut environment post-surgery. These findings are mainly associations and could be further developed into treatment with the use of next-generation probiotics.

Background: Anxiety and depression are significant mental health issues affecting adolescents globally. Moreover, Thyroid disorders frequently coexist with anxiety and depression, leading to overlapping symptoms that complicate diagnosis and treatment. The objective of this study is to determine the prevalence of anxiety and depression among adolescents and young adults with thyroid functional disorders and their associated factors.

Research design and method: A cross-sectional study was conducted at the Department of endocrinology, from (June to August) 2024. Variables included were patient demographics such as gender, age, occupation etc. For anxiety assessment: Beck Anxiety Inventory (BAI) was used. For depression assessment: Beck Depression Inventory (BDI) was used.

Result: In patients with hyperthyroidism, severe anxiety and depression are strongly associated with common symptoms like tremors, difficulty sleeping, and frequent bowel movements (p < 0.05). In hypothyroidism, severe anxiety and depression is also prevalent, especially with symptoms like constipation, forgetfulness, and muscle weakness.

Conclusion: Our study concluded that the mental health of adolescents and young adults is influenced by factors such as age, education, employment status, and thyroid function disorders - hypothyroidism and hyperthyroidism.

Introduction: In 2023, metabolic dysfunction-associated steatotic liver disease (MASLD) was introduced following metabolic dysfunction-associated fatty liver disease (MAFLD). Both aim to address the limitations of nonalcoholic fatty liver disease (NAFLD). This review analyzes the similarities and differences between MAFLD and MASLD, focusing on their impacts on epidemiology, diagnosis, stigma, and related liver diseases.

Areas covered: Current evidence suggests that MAFLD criteria effectively identify individuals at higher risk through a good balance of sensitivity and specificity. Moreover, MAFLD is a more generalizable term that is easily understood globally.

Expert opinion: The transition from NAFLD to MAFLD and MASLD marks a significant advance in understanding fatty liver disease within hepatology. MAFLD identifies a homogeneous cohort of patients with fatty liver due to metabolic dysfunction and provides a valuable framework for holistic, patient-centered management strategies that consider various contributing factors to improve health outcomes.

Introduction: Hypothyroidism is a relatively common condition, which generally cannot be reversed. Hypothyroid individuals are dependent on provision of exogenous thyroid hormone as a lifetime therapy. Levothyroxine therapy provides satisfactory treatment for most. However, a subset of patients are not restored to their baseline quality of life.

Areas covered: As discussed here, a number of solutions have been tried, including addressing accompanying conditions, rigorous titration of therapy, and combination therapy with levothyroxine and liothyronine. The latter has limited success with improving quality of life, but does appear to be associated with patient preference. The discrepancy between quality of life and patient preference may be important to understanding the nuances of successful hypothyroidism treatment.

Expert opinion: Future efforts to improve hypothyroidism therapy could tease out which are the specific subset of patients who benefit from combination therapy, such as those who have unresolved symptoms attributable to hypothyroidism at baseline and those with genetic polymorphisms that might impair thyroid hormone delivery to tissues. Better understanding of the drivers of patient preference for combination therapy should also be revealing. A future goal is to prevent autoimmune hypothyroidism from developing and to treat hypothyroidism completely by generating fully functioning thyroid follicles from stem cells.

Background: Epithelial-to-mesenchymal transition (EMT) may be involved in the pathogenesis of diabetic nephropathy (DN) among adults with type 2 diabetes. The current study aimed to evaluate the role of E-cadherin as a surrogate marker of EMT among children and adolescent with type 1 diabetes (T1D) and DN and its possible relation to carotid intima media thickness (CIMT).

Research design and methods: Sixty participants with T1D were divided equally into two groups based on urinary albumin creatinine ratio (UACR) and compared with 30 healthy controls. Hemoglobin A1c (HbA1c), kidney function tests, serum E-cadherin and CIMT were assessed.

Results: E-cadherin levels were significantly lower in patients with microalbuminuria (56.5 ± 15.8 ng/mL) compared with patients with normoalbuminuria (179.8 ± 45.1 ng/mL) and healthy controls (222.5 ± 39.9 ng/mL) (p < 0.001). E-cadherin correlated negatively with HbA1c (r = -0.42, p = 0.001), UACR (r = -0.89, p < 0.001) and CIMT (r = -0.716, p < 0.001). ROC curve analysis showed that the E-cadherin cutoff value 135 ng/mL could detect nephropathy with 96.67% sensitivity and 86.67% specificity. Logistic regression showed that E-cadherin was a significant independent factor for nephropathy.

Conclusions: E-cadherin is a potential biomarker reflecting EMT activity in both pathogenesis and progression of DN and subclinical atherosclerosis in pediatric patients with T1D.

Background: Considering the important role of obesity and related factors in different societies on increasing the burden of non-communicable diseases, in this review we will investigate the possible effects of Beinaglutide on these risk factors.

Research design and methods: In order to identify all randomized controlled trials that investigated the effects of Beinaglutide on cardiometabolic factors, a systematic search was conducted in the original databases using predefined keywords until July 2024. The pooled weighted mean difference (WMD) and 95% confidence intervals were computed using the random-effects model.

Results:    A quantitative meta-analysis results from seven studies with 872 participants showed that Beinaglutide has a significant lowering effect on weight (WMD: -3.74 kg; 95% CI: -5.03, -2.45), body mass index (BMI) (WMD:-1.64 kg/m2; 95% CI: -2.10, -1.17), waist circumference (WC) (WMD: -3.19 cm; 95% CI: -4.65 to -1.73), triglyceride (TG) levels (WMD: -0.14 mmol/l with; 95% CI: -0.25, -0.04), and systolic blood pressure (SBP) (WMD: -1.76 mm/Hg; 95% CI: -2.61, -0.91). In addition, body weight loss was greater in doses < 0.4 mg compared to doses ≥ 0.4 mg.

Conclusions: The results of this meta-analysis show that Beinaglutide is effective in reducing parameters related to obesity, TG as well as SBP.

Introduction: Mild autonomous cortisol secretion (MACS) is the most common hormonal alteration in patients with adrenal incidentalomas (AIs). Given its prevalence and associated adverse outcomes, reviewing its impact and interventions is essential.

Areas covered: In this article, we provide a comprehensive review on the diagnosis of MACS, the cardiometabolic burden associated with MACS and on its surgical and medical treatment. The diagnosis of MACS requires three criteria: hormonal evidence of hypercortisolism, the absence of typical Cushing's syndrome signs, and the presence of an AI. The most recommended test for MACS diagnosis is the 1 mg dexamethasone suppression test. There is plenty of evidence of the detrimental effect of MACS, including an increased risk of diabetes, hypertension, dyslipidemia and all-cause mortality. Surgery should be considered for patients with significant comorbidities and has been shown to significantly improve anthropometric variables, hyperglycemia and blood pressure. Medical therapy to lower cortisol offers an effective alternative, particularly for patients with bilateral AI, when surgery is contraindicated, or the patient declines surgery.

Expert opinion: Based on our expert opinion, steroid profiling has the potential to become the gold standard for MACS diagnosis, and further studies should identify which patients benefit most from specific treatment to guiding evidence-based recommendations.

Background: Chronic kidney disease (CKD) due to Type 2Diabetes Mellitus (T2DM) is an increasing health burden in South Asia. This study evaluates the burden, trends, and future projections of CKD from 1990-2021 using Global Burden of Disease (GBD) data and ARIMA modeling.

Research design and methods: We analyzed age-standardized rates (ASR) for prevalence, incidence, mortality, and DALYs of CKD due to T2DM in South Asia(India, Pakistan, Bangladesh, Bhutan, Nepal). Join point regression and ARIMAmodels were applied for trend analysis and projections.

Results: From 1990 to 2021, prevalence decreased slightly (e.g. India: 5.4% to 5.2%), while mortality increased (e.g.Pakistan: 33.7 to 42.1 per 100,000). Incidence increased across all countries, with Nepal (1.3% increase) and Bhutan (1.7% increase) showing the highest growth. Projections indicate a continued rise in CKD burden, especially inNepal and India.

Conclusion: CKD due to T2DM is increasing, emphasizing the need for targeted interventions.