Bariatric and metabolic surgeries have gained extensive popularity and trust due to their documented efficacy and safety in managing not only obesity but also associated comorbidities such as diabetes mellitus, hypertension, dyslipidemia, sleep apnea, and joint pain. Traditionally, bariatric surgeries have been categorized into hypoabsorptive, restrictive, or hybrid approaches. However, these classifications inadequately reflect the complex anatomical and physiological alterations associated with modern surgical methodologies. This paper explores the evolution of metabolic surgeries, emphasizing the integration of physiological concepts into classic procedures to provide more tailored and effective treatment options for obesity and its comorbidities. Finally, the proposal for a new classification based on current metabolic concepts will facilitate communication among patients, doctors, and healthcare professionals. Additionally, it will enable a more didactic and standardized approach to data collection for conducting studies and publications.
Paulo Reis Rizzo Esselin de MeloVictor Ramos Mussa DibCarlos Augusto Scussel MadalossoChetan ParmarOmar GhanemMiguel Ángel CarbajoRicardo ZorronAmador García Ruiz de GordejuelaCaio Gustavo Gaspar de AquinoLuiz Alfredo Vieira d’AlmeidaLuciano AntozziRui RibeiroHalit Eren TaskinJorge Bravo LópezChristine StierPatrick NoelJosé Sergio Verboonen SoteloLaurent Abram LayaniRamon Vilallonga PuyElinton Adami ChaimHelmuth BillyCarlos Eduardo DomenePaula VolpeNilton Tokio KawaharaAugusto Cláudio de Almeida TinocoAntelmo Sasso FinHiroji Okano JúniorNicholas Tavares KruelGiorgio Alfredo Pedroso BarettaDiogo Swain KfouriAnna Carolina HoffFernando Reis Esselin MeloThonya Cruz BragaClayton Alencar MoreiraLuis PoggiAlmino Cardoso RamosAntonio Torres
Natural medicines(NMs)demonstrate distinct advantages in the clinical management of chronic diseases.Recent years have seen growing recognition of the gut microbiota's role in the efficacy and synergy of NMs,providing new impetus for elucidating the material basis and mechanisms of NMs and their path toward modernization.A fundamental question that has emerged is how NM-microbiota interactions integrate into the multi-target holistic mechanisms of NMs,the answer to which may also illuminate new avenues for drug discovery.Metabolic regulation via small-molecule metabolites has been increasingly implicated in host-microbe interaction.This review presents an integral metabolic perspective on NMs-microbiota interaction in host health and disease.It highlights the emerging understanding of gut microbiota-related metabolic signals implicated in NM components'local and systemic actions.Additionally,it discusses key issues and prospects related to drug development and the translational study of NMs.
This article comments on the work by Soresi and Giannitrapani.The authors have stated that one of the most novel and promising treatments for metabolic dysfunction-associated steatotic liver disease(MASLD)is the use of glucagon-like peptide 1 receptor agonists,especially when used in combination therapy.However,despite their notable efficacy,these drugs were not initially designed to target MASLD directly.In a groundbreaking development,the Food and Drug Administration has recently approved resmetirom,the first treatment specifically aimed at reducing liver fibrosis in metabolic-associated steatohepatitis.Resmetirom,an orally administered,liver-directed thyroid hormone beta-selective agonist,acts directly on intrahepatic pathways,enhancing its therapeutic potential and marking the beginning of a new era in the treatment of MASLD.Furthermore,the integration of lifestyle modifications into liver disease management is an essential component that should be considered and reinforced.By incorporating dietary changes and regular physical exercise into treatment,patients may achieve improved outcomes,reducing the need for pharmacological interventions and/or improving treatment efficacy.As a complement to medical therapies,lifestyle factors should not be overlooked in the broader strategy for managing MASLD.
The growing global burden of metabolic dysfunction-associated steatohepatitis(MASH)demands a deeper understanding of its underlying mechanisms and risk factors.Recent studies,such as the large population-based case-control analysis by Abdel-Razeq et al,suggest a significant association between Helicobacter pylori(H.pylori)infection and an increased risk of developing MASH.This study provides compelling data supporting this association,even after adjusting for confounders such as obesity,diabetes,and hyperlipidemia.However,the complexity of this relationship remains unresolved,requiring further investigation into the biological,genetic,and environmental pathways that connect these two conditions.This article critically reviews the study’s findings and identifies its limitations,offering innovative research directions for the future.Key areas of focus include integrating genomic and microbiome analyses,exploring the impact of H.pylori eradication on MASH progression,studying molecular mechanisms at the intersection of infection and liver disease,and developing personalized therapeutic strategies.
Due to sedentary lifestyle and rising prevalence of obesity,patients with general population and those who are infected with chronic hepatitis B are found to have metabolic dysfunction associated steatotic liver disease(MASLD).Both chronic hepatitis B virus(HBV)infection and MASLD can damage hepatocytes in their own way,but concomitant HBV-MASLD has its own clinical implications.Cherry on top is the presence of diabetes mellitus,hypertension or obesity which added more chances of unfavorable outcomes in these patients.In this article,we co-mment on the article by Wang et al published in the recent issue.This article provides a comprehensive overview of the complex interaction between HBV-MASLD,HBV alone and MASLD alone patients.We discuss key findings from recent studies,including the promising outcomes observed in patients with concurrent HBV and MASLD,warrants further research.The insights presented here offer renewed understanding of this complex interaction.
BACKGROUND Insulin resistance,lipotoxicity,and mitochondrial dysfunction contribute to the pathogenesis of metabolic dysfunction-associated steatotic liver disease(MASLD).Mitochondrial dysfunction impairs oxidative phosphorylation and increases reactive oxygen species production,leading to steatohepatitis and hepatic fibrosis.Artificial intelligence(AI)is a potent tool for disease diagnosis and risk stratification.AIM To investigate mitochondrial DNA polymorphisms in susceptibility to MASLD and establish an AI model for MASLD screening.METHODS Multiplex polymerase chain reaction was performed to comprehensively genotype 82 mitochondrial DNA variants in the screening dataset(n=264).The significant mitochondrial single nucleotide polymorphism was validated in an independent cohort(n=1046)using the Taqman®allelic discrimination assay.Random forest,eXtreme gradient boosting,Naive Bayes,and logistic regression algorithms were employed to construct an AI model for MASLD.RESULTS In the screening dataset,only mt12361A>G was significantly associated with MASLD.mt12361A>G showed borderline significance in MASLD patients with 2-3 cardiometabolic traits compared with controls in the validation dataset(P=0.055).Multivariate regression analysis confirmed that mt12361A>G was an independent risk factor of MASLD[odds ratio(OR)=2.54,95%confidence interval(CI):1.19-5.43,P=0.016].The genetic effect of mt12361A>G was significant in the non-diabetic group but not in the diabetic group.mt12361G carriers had a 2.8-fold higher risk than A carriers in the non-diabetic group(OR=2.80,95%CI:1.22-6.41,P=0.015).By integrating clinical features and mt12361A>G,random forest outperformed other algorithms in detecting MASLD[training area under the receiver operating characteristic curve(AUROC)=1.000,validation AUROC=0.876].CONCLUSION The mt12361A>G variant increased the severity of MASLD in non-diabetic patients.AI supports the screening and management of MASLD in primary care settings.
Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.
