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Exploring Pathological Mechanisms in Obesity, Diabetes, and Metabolic Syndrome

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A special issue of Metabolites (ISSN 2218-1989). This special issue belongs to the section "Endocrinology and Clinical Metabolic Research".

Deadline for manuscript submissions: 30 September 2025 | Viewed by 13002

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Special Issue Editors

Prof. Dr. Tiemin Liu

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Guest Editor

Department of Physiology and Biophysics, the School of Life Science, Fudan University, Shanghai 200438, China
Interests: physiology and neuroscience; neuromodulation; pathogenesis of metabolic disorders and neuroendocrine homeostasis in mammals; muscle and exercise
Special Issues, Collections and Topics in MDPI journals

Dr. Hongmei Yan

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Guest Editor

Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Interests: obesity; non-alcoholic fatty liver disease; metabolic syndrome; sarcopenia
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Dr. Qiongyue Zhang

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Guest Editor

Department of Endocrinology, Huashan Hospital, Fudan University, Shanghai 200032, China
Interests: obesity; type 2 diabetes; standardized and individualized diagnosis and treatment of metabolic diseases; bariatric surgery, especially the preoperative evaluation and postoperative follow-up of differential diagnosis of obesity and perioperative blood glucose management
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the face of escalating global health challenges, the intricate web linking obesity, diabetes, and metabolic syndrome has emerged as a forefront concern for researchers, clinicians, and public health policymakers. This Special Issue of Metabolites aims to delve into the complexities of these interrelated conditions, with a specific focus on unraveling their pathogenesis. By casting a spotlight on the root causes and mechanisms underlying these diseases, we aspire to foster a deeper understanding that could eventually pave the way for innovative prevention and treatment strategies.

The epidemic proportions of obesity and its consequent cascade effect—propelling the rise in type 2 diabetes and metabolic syndrome instances worldwide—necessitate a multifaceted examination. This pursuit is not merely academic; it has the potential to significantly alter the course of countless lives through informed intervention strategies and therapeutic advancements.

We invite contributors to explore a broad spectrum of topics within this theme, including, but not limited to, the following:

Genetic predispositions and molecular biological insights into obesity, diabetes, and metabolic syndrome.
The impact of lifestyle factors (diet, physical activity, sleep, and stress) on the manifestation and progression of these diseases.
The role of the microbiome and environmental exposures in disease pathogenesis.
The potential of multi-omics in uncovering novel pathways and targets, such as metabolomics, lipidomics, proteomics, genomics, etc.
The role of inflammation and oxidative stress in these metabolic diseases.
Pathophysiological mechanisms about how obesity, diabetes, and metabolic syndrome interact and potentiate each other.

This Special Issue aims to be a crucible of innovation, gathering under its aegis the latest research findings, insightful reviews, and forward-thinking perspectives. Our goal is to inspire a cross-disciplinary dialogue that spans the spectrum from molecular biology to societal interventions, weaving together a comprehensive narrative on the pathogenesis of obesity, diabetes, and metabolic syndrome.

We welcome submissions in the form of original research articles, clinical trials, reviews, and perspectives that contribute meaningfully to our understanding of these conditions and offer glimpses into future directions for research and application. Contributions should aim not only to map the current landscape but also to identify gaps in our knowledge and propose pathways towards solutions.

Together, through this Special Issue, let us create a collaborative platform for sharing cutting-edge research and innovative ideas, igniting conversations that could lead to groundbreaking transformations in how these pervasive health issues are understood and addressed. Submissions are now open; we look forward to receiving contributions that enrich this critical discourse.

Prof. Dr. Tiemin Liu
Dr. Hongmei Yan
Dr. Qiongyue Zhang
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Metabolites is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

metabolic diseases: obesity, diabetes, NAFLD, MAFLD, NASH, metabolic syndrome, etc.
multi-omics: metabolomics, lipidomics, proteomics, etc.
pathogenesis: genetic predispositions, lifestyle factors, microbiome and environmental exposures, etc.

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Published Papers (7 papers)

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Research

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13 pages, 709 KiB

Open AccessArticle

Endothelial Markers in Type 2 Diabetic Patients with Acute Decompensated Heart Failure: A Pilot Study

by Martin Jozef Péč, Jakub Jurica, Tomáš Bolek, Ingrid Škorňová, Monika Péčová, Marek Cingel, Simona Horná, Lucia Stančiaková, Ján Staško, Štefan Tóth, Juraj Sokol, Peter Galajda, Marián Mokáň and Matej Samoš

Metabolites 2025, 15(2), 91; https://doi.org/10.3390/metabo15020091 - 3 Feb 2025

Viewed by 853

Abstract

Background: Impaired endothelial function has been associated with vascular complications in type 2 diabetes (T2D), but its role in T2D-related heart failure (HF) remains indeterminate. The aim of this study was to assess selected markers of endothelial function in T2D patients with acute decompensated HF. Methods: A pilot prospective study on patients with acute decompensated HF requiring in-hospital admission was carried out. The vascular endothelial growth factor (VEGF), intercellular adhesion molecule 1 (ICAM-1), and vascular cell adhesion molecule 1 (VCAM-1) were assessed at admission and after decongestion. Subsequently, differences in these markers between T2D and non-diabetic (ND) patients were studied. Results: In total, 39 patients (21 with T2D and 18 ND patients) were enrolled. Twenty-eight patients presented with preserved ejection fraction (EF), and 11 presented with reduced EF. Looking at the VEGF levels in T2D patients, on admission, a median of 233.0 pg/mL (1.7–598 pg/mL) was found compared to 106.0 pg/mL (1.7–888 pg/mL) in ND individuals; the differences reached statistical significance (p = 0.04). There were no significant differences in VEGF levels after decongestion, and in VCAM-1 (2237 ± 1195 vs. 2699 ± 1093 ng/mL, p = 0.37) and ICAM-1 (596 ± 268 vs. 638 ± 437 ng/mL, p = 0.79) levels between T2D and ND patients upon admission and after decongestion. The value of EF (preserved or reduced) affected the VEGF levels upon admission. Conclusions: This study identified significantly higher VEGF levels upon admission due to acute decompensated HF in T2D patients. Full article

(This article belongs to the Special Issue Exploring Pathological Mechanisms in Obesity, Diabetes, and Metabolic Syndrome)

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17 pages, 3919 KiB

Open AccessArticle

Long-Term Aerobic Exercise Enhances Hepatoprotection in MAFLD by Modulating Exosomal miR-324 via ROCK1

by Yang Zhang, Qiangman Wei, Xue Geng and Guoliang Fang

Metabolites 2024, 14(12), 692; https://doi.org/10.3390/metabo14120692 - 9 Dec 2024

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Abstract

Background: Insulin resistance (IR) is central to the progression of non-alcoholic fatty liver disease (MAFLD). While aerobic exercise reduces hepatic fat and enhances insulin sensitivity, the specific mechanisms—particularly those involving exosomal pathways—are not fully elucidated. Method: Exosomes were isolated from 15 MAFLD patients’ plasma following the final session of a 12-week aerobic exercise intervention. Liver fat content was measured using MRI-PDFF, and metabolic parameters were assessed via OGTT, HOMA-IR, QUICKI, and VO₂ max. Co-culture experiments evaluated the effects of exercise-derived exosomes on IR signaling pathways. miRNA microarray analysis identified miR-324, which was quantified in high-fat diet (HFD) mice with and without exercise and compared between athletes and sedentary controls. Functional assays assessed miR-324’s role in glucose and lipid metabolism, while luciferase reporter and Western blot assays confirmed ROCK1 as its direct target. Result: Aerobic exercise significantly reduced liver fat and improved insulin sensitivity in both MAFLD patients and HFD mice. Notably, exosomal miR-324 levels were lower in athletes than sedentary controls, indicating an inverse association with insulin sensitivity. Post-exercise, precursor and mature miR-324 increased in adipose tissue and decreased in muscle, suggesting its adipose origin and inverse regulation. Functional assays demonstrated that miR-324 modulates insulin resistance by targeting ROCK1. Conclusion: Exercise-induced exosomal miR-324 from adipose tissue targets ROCK1, revealing a novel mechanism by which aerobic exercise confers hepatoprotection against insulin resistance in MAFLD. These findings enhance our understanding of how exercise influences metabolic health and may inform future therapeutic strategies for managing MAFLD and related conditions. Full article

(This article belongs to the Special Issue Exploring Pathological Mechanisms in Obesity, Diabetes, and Metabolic Syndrome)

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13 pages, 628 KiB

Open AccessArticle

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

by Mariana Luna, Silvia Pereira, Carlos Saboya and Andrea Ramalho

Metabolites 2024, 14(9), 502; https://doi.org/10.3390/metabo14090502 - 18 Sep 2024

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Abstract

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

(This article belongs to the Special Issue Exploring Pathological Mechanisms in Obesity, Diabetes, and Metabolic Syndrome)

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13 pages, 4679 KiB

Open AccessArticle

Combination of Evidence from Bibliometrics and Bioinformatics Analysis Identifies miR-21 as a Potential Therapeutical Target for Diabetes

by Yiqing Chen, Xuan Ye, Xiao Zhang, Zilin Guo, Wei Chen, Zihan Pan, Zengjie Zhang, Bing Li, Hongyun Wang and Jianhua Yao

Metabolites 2024, 14(8), 403; https://doi.org/10.3390/metabo14080403 - 25 Jul 2024

Cited by 2 | Viewed by 1461

Abstract

Many microRNAs (miRNAs) have been identified as being involved in diabetes; however, the question of which ones may be the most promising therapeutical targets still needs more investigation. This study aims to understand the overall development tendency and identify a specific miRNA molecule to attenuate diabetes. We developed a combined analysis method based on bibliometrics and bioinformatics to visualize research institutions, authors, cited references, and keywords to identify a promising target for diabetes. Our data showed that diabetes-related miRNA is receiving continuously increasing attention, with a large number of publications, indicating that this is still a hot topic in diabetes research. Scientists from different institutions are collaborating closely in this field. miR-21, miR-146a, miR-155, and miR-34a are frequently mentioned as high-frequency keywords in the related references. Moreover, among all the above miRNAs, bioinformatics analysis further strengthens the argument that miR-21 is the top significantly upregulated molecule in diabetes patients and plays an important role in the pathogenesis of diabetes. Our study may provide a way to identify targets and promote the clinical translation of miRNA-related therapeutical strategies for diabetes, which could also indicate present and future directions for research in this area. Full article

(This article belongs to the Special Issue Exploring Pathological Mechanisms in Obesity, Diabetes, and Metabolic Syndrome)

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Review

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18 pages, 1749 KiB

Open AccessReview

Effects of Exercise on Arterial Stiffness: Mechanistic Insights into Peripheral, Central, and Systemic Vascular Health in Young Men

by Yongsheng Lan, Ruisi Wu, Yujuan Feng, Teng Keen Khong, Cunhan Wang, Ashril Yusof and Guangwei Che

Metabolites 2025, 15(3), 166; https://doi.org/10.3390/metabo15030166 - 1 Mar 2025

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Abstract

Background/Objectives: Arterial stiffness, a critical predictor of cardiovascular events, varies regionally across peripheral, central, and systemic arteries, necessitating targeted exercise interventions for young men. However, research on the effects of exercise on arterial stiffness in these regions among young men remains limited. This review aims to (i) examine the effects of exercise on arterial stiffness in young men across these regions, and (ii) investigate the underlying mechanisms involved. Methods: Database searches on PubMed, ScienceDirect, Web of Science, and Scopus were conducted up to July 2024. The keywords were: exercise, men/male, and arterial stiffness. Inclusion criteria were studies involving young men, supervised exercise, and arterial stiffness measures. Thirty-five papers were categorized into groups based on peripheral, central and systemic arterial stiffness. Results: Peripheral arterial stiffness: continuous aerobic cycling (light to high intensity), interval aerobic cycling (moderate to high intensity), and 30-s stretching exercises demonstrated positive effects, likely due to short-term changes in sympathetic nervous system activity, nitric oxide availability, and vascular tone. Central arterial stiffness: chronic high-intensity continuous and interval aerobic cycling exercises promoted vascular remodeling, including elastin preservation and collagen regulation. For systemic arterial stiffness, continuous and interval aerobic cycling and light-intensity squats with whole-body vibration exercises improve endothelial function, smooth muscle relaxation, and vascular remodeling. Conclusions: Tailored exercise intervention can effectively reduce arterial stiffness across peripheral, central and systemic regions in young men. Improvements in peripheral stiffness are linked to short-term metabolic shifts, central stiffness responds to long-term remodeling, while systemic arterial stiffness involves both short- and long-term metabolic adaptations. Full article

(This article belongs to the Special Issue Exploring Pathological Mechanisms in Obesity, Diabetes, and Metabolic Syndrome)

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21 pages, 1539 KiB

Open AccessReview

Exercise as a Therapeutic Strategy for Obesity: Central and Peripheral Mechanisms

by Yiyin Zhang, Ruwen Wang, Tiemin Liu and Ru Wang

Metabolites 2024, 14(11), 589; https://doi.org/10.3390/metabo14110589 - 30 Oct 2024

Viewed by 3321

Abstract

Obesity is a complex, multifactorial condition involving excessive fat accumulation due to an imbalance between energy intake and expenditure, with its global prevalence steadily rising. This condition significantly increases the risk of chronic diseases, including sarcopenia, type 2 diabetes, and cardiovascular diseases, highlighting the need for effective interventions. Exercise has emerged as a potent non-pharmacological approach to combat obesity, targeting both central and peripheral mechanisms that regulate metabolism, energy expenditure, and neurological functions. In the central nervous system, exercise influences appetite, mood, and cognitive functions by modulating the reward system and regulating appetite-controlling hormones to manage energy intake. Concurrently, exercise promotes thermogenesis in adipose tissue and regulates endocrine path-ways and key metabolic organs, such as skeletal muscle and the liver, to enhance fat oxidation and support energy balance. Despite advances in understanding exercise’s role in obesity, the precise interaction between the neurobiological and peripheral metabolic pathways remains underexplored, particularly in public health strategies. A better understanding of these interactions could inform more comprehensive obesity management approaches by addressing both central nervous system influences on behavior and peripheral metabolic regulation. This review synthesizes recent insights into these roles, highlighting potential therapeutic strategies targeting both systems for more effective obesity interventions. Full article

(This article belongs to the Special Issue Exploring Pathological Mechanisms in Obesity, Diabetes, and Metabolic Syndrome)

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17 pages, 2112 KiB

Open AccessReview

The Role of Exerkines in Obesity-Induced Disruption of Mitochondrial Homeostasis in Thermogenic Fat

by Hui Shao, Huijie Zhang and Dandan Jia

Metabolites 2024, 14(5), 287; https://doi.org/10.3390/metabo14050287 - 17 May 2024

Viewed by 2731

Abstract

There is a notable correlation between mitochondrial homeostasis and metabolic disruption. In this review, we report that obesity-induced disruption of mitochondrial homeostasis adversely affects lipid metabolism, adipocyte differentiation, oxidative capacity, inflammation, insulin sensitivity, and thermogenesis in thermogenic fat. Elevating mitochondrial homeostasis in thermogenic fat emerges as a promising avenue for developing treatments for metabolic diseases, including enhanced mitochondrial function, mitophagy, mitochondrial uncoupling, and mitochondrial biogenesis. The exerkines (e.g., myokines, adipokines, batokines) released during exercise have the potential to ameliorate mitochondrial homeostasis, improve glucose and lipid metabolism, and stimulate fat browning and thermogenesis as a defense against obesity-associated metabolic diseases. This comprehensive review focuses on the manifold benefits of exercise-induced exerkines, particularly emphasizing their influence on mitochondrial homeostasis and fat thermogenesis in the context of metabolic disorders associated with obesity. Full article

(This article belongs to the Special Issue Exploring Pathological Mechanisms in Obesity, Diabetes, and Metabolic Syndrome)

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