Search Results (7,819)

Background/Objectives: People with HIV (PWH) remain at high risk for cardiovascular and metabolic complications despite effective antiretroviral therapy (ART). Diet quality is an important modifiable factor that may influence these complications. Diets high in ultra-processed foods (UPF) have been linked to adverse metabolic and inflammatory profiles in the general population, but their impact on PWH remains poorly understood. The NOVA 4 classification categorizes foods by degree of processing, from unprocessed/minimally processed (NOVA 1) to UPF (NOVA 4). Methods: We conducted a cross-sectional study of adults with virologically suppressed HIV on stable ART. Assessments included dietary intake consisting of 24 h recalls analyzed with Nutrition Data System for Research software (NDSR) and classified into NOVA categories by a registered dietitian and the following characteristics: body composition (total and regional fat by DEXA and CT scan abdomen), cardiometabolic variables (glucose, HbA1C, HOMA-IR, lipids, blood pressure), and biomarkers of inflammation, immune activation, and gut integrity quantified by ELISA. Patients were stratified into NOVA 4 groups based on the median and quartile proportions of total energy intake from NOVA 4 foods. Associations between dietary NOVA and outcomes were analyzed using generalized additive models (GAMs) adjusted for age, sex, race, and CD4 count. Results: Among 222 PWH (mean age 45.4 ± 14.2 years; 31% female; 66% non-white; BMI 30.61 ± 7.91 kg/m²), median NOVA 4 intake was 45.6% of total energy intake. Participants with higher vs. lower NOVA 4 intake showed differences in diet quality, but in GAMs, higher NOVA 4 intake was not associated with higher levels of inflammatory, cardiometabolic, gut integrity, and body composition variables. Conclusions: In PWH, UPF consumption was high but not associated with markers of cardiometabolic health, systemic inflammation, or gut integrity. This may reflect the multifactorial nature of the heightened inflammation in PWH, potentially obscuring the effect of diet. Full article

Background: Normal-weight obesity (NWO) is a nutritional status in which individuals have a normal body mass index (BMI) with a high percentage of body fat (%BF). However, the impact of elevated %BF on cardiometabolic risk remains unclear. This study aimed to evaluate whether NWO is associated with worse cardiometabolic risk markers and scores. Methods: We conducted a cross-sectional study using a convenience sample of employees from a public hospital. Participants aged ≥18 years with a BMI between 18.5–24.9 kg/m² were included in the study. %BF was categorized according to sex and age (InBody720). Normal weight and normal %BF (NWNB) and NWO were defined using cutoff points. Body composition, serum biochemical and inflammatory markers, hemodynamics, and autonomic function were considered cardiometabolic risk markers. The visceral fat area (VFA), atherogenic coefficient (AC), atherogenic index of plasma (AIP), body shape index (ABSI), and Framingham Risk (FR) score were considered cardiometabolic risk scores. Statistical significance was set at p < 0.05. Results: Of the 228 eligible participants, 52 met the inclusion criteria (NWNB, N = 29 and NWO, N = 23). Participants with NWO presented worse values of lipid profiles, anthropometric measurements, hemodynamic parameters, and autonomic function indices. After adjustment for age and sex, NWO remained associated with selected cardiometabolic markers, particularly LDL-c, triglycerides, and autonomic indices, whereas body composition findings should be interpreted as confirmatory of the phenotype. Conclusions: In this cross-sectional secondary analysis, NWO was associated with worse cardiometabolic markers and selected risk scores compared with NWNB. These findings support an unfavorable cardiometabolic profile in individuals with NWO, but do not allow inferences about future cardiometabolic events or causal relationships. Longitudinal studies are needed to clarify its prognostic significance. Full article

Background/Objectives: This study aimed to compare hematological and inflammatory markers among patients with dry and wet age-related macular degeneration (AMD) and healthy controls, and to evaluate the influence of geographic atrophy (GA) in dry AMD and treatment response (TR) in wet AMD on these markers. Methods: The study included patients with dry AMD (n = 54), wet AMD (n = 53), and age- and sex-matched controls (n = 55). Hematological parameters, serum albumin, and systemic inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune–inflammation index (SII), systemic inflammation response index (SIRI), pan-immune–inflammation value (PIV), and hemoglobin, albumin, lymphocyte, and platelet index (HALP), were compared among the groups. Results: Age and sex distributions did not differ significantly between groups. Compared to controls, the wet AMD group had significantly higher neutrophil counts (p = 0.013), red cell distribution width (RDW) (p = 0.033), and inflammatory indices, including NLR, PLR, SII, SIRI, and PIV (all p < 0.01). HALP levels were significantly lower in wet AMD (p < 0.001). Dry AMD patients also had higher PLR (p = 0.045) and RDW (p = 0.005) than controls. When comparing wet and dry AMD groups directly, SIRI (p = 0.041) and PIV (p = 0.029) were significantly elevated in wet AMD, indicating stronger systemic inflammatory burden. In the dry AMD subgroup, patients with GA had significantly lower hemoglobin (p = 0.002) and erythrocyte counts (p = 0.039) than those without GA. No significant differences were observed between TR-positive and TR-negative wet AMD patients. Conclusions: Patients with wet AMD exhibit a more pronounced systemic inflammatory profile than both dry AMD patients and healthy controls. These findings support the hypothesis that systemic inflammation may contribute to AMD pathogenesis. Geographic atrophy in dry AMD may also be associated with additional hematologic alterations, whereas treatment response in wet AMD is not reflected in systemic markers. Full article

Background: Cardiovascular disease remains a leading cause of morbidity and mortality after kidney transplantation. The relative contribution of metabolic abnormalities and inflammatory burden to cardiac remodeling and subsequent clinical outcomes in kidney transplant recipients (KTRs) remains incompletely understood. Methods: In this retrospective cohort study, 152 KTRs underwent comprehensive cardiovascular evaluation at a stable post-transplant time point (12 ± 4 months after transplantation). Metabolic phenotype was assessed using metabolic syndrome and indices of insulin resistance and atherogenic dyslipidemia (TyG index, TG/HDL ratio, and atherogenic index of plasma [AIP]). Inflammatory status was evaluated using hs-CRP and complete blood count-derived indices. Echocardiographic damage composite (EDC) was defined as the presence of left ventricular hypertrophy, diastolic dysfunction, or left atrial enlargement. Patients were followed for major adverse clinical outcome (MACO), defined as cardiovascular event, graft failure, or death, and major adverse cardiovascular and cerebrovascular events (MACCE). Results: At baseline, 78 patients (51.3%) met criteria for EDC. EDC was strongly associated with higher TyG, AIP, TG/HDL, LDL/HDL ratio, and metabolic syndrome, whereas inflammatory markers showed no association. In multivariable logistic regression adjusted for age, sex, eGFR, and proteinuria, TyG remained independently associated with EDC (OR 1.13 per 0.1 increase, 95% CI 1.05–1.21; p = 0.001), independent of hs-CRP. Similar results were observed when AIP was evaluated in place of TyG (OR 10.39, 95% CI 2.22–48.71; p = 0.003). During follow-up, 78 patients developed MACO and 49 developed MACCE. In Cox regression analysis, graft dysfunction and inflammatory markers independently predicted MACO, whereas TyG was no longer significant. In contrast, TyG remained an independent predictor of MACCE after adjustment for confounders and inflammatory markers (HR 1.10 per 0.1 increase, 95% CI 1.04–1.16; p < 0.001). Similar results were observed when AIP was tested in place of TyG (HR 10.8, 95% CI 3.06–38.11; p < 0.001). Echocardiographic damage did not independently predict outcomes after adjustment. Conclusions: In KTRs, metabolic abnormalities reflecting insulin resistance and atherogenic dyslipidemia are closely associated with cardiac remodeling one year after transplantation and remain specifically linked to subsequent cardiovascular events. In contrast, systemic inflammation and graft dysfunction are the primary determinants of overall adverse clinical outcomes. Simple metabolic indices such as TyG and AIP may provide practical tools for cardiovascular risk stratification in this population. In Cox proportional hazards models, TyG (HR 1.102, 95% CI 1.043–1.164, p = 0.001) and AIP (HR 10.8, 95% CI 3.06–38.11, p < 0.001) were independently associated with cardiovascular events during follow-up, underscoring the role of atherogenic dyslipidemia in cardiovascular risk. Full article

Background: Older adults are particularly vulnerable to heat related illness due to impaired thermoregulatory responses. Heat acclimation (HA) strategies can mitigate the negative impacts of high environmental temperatures on physiological and perceptual responses. Whilst active HA strategies may prove problematic for older adults, passive approaches such as hot water immersion (HWI) may be more feasible. Methods: This study investigated the effects of four consecutive days of HWI on physiological and perceptual markers in individuals aged over 65 years during moderate exercise. Nine healthy, recreationally active participants (76 ± 5 years) completed two 30 min cycling bouts at 75–80% age predicted HR_max pre- and post-four days of HWI at 40 °C. Measures of average HR, gastrointestinal temperature, skin temperature, thermal sensation, thermal comfort, rate of perceived exertion, power output, and distance covered were recorded during both exercise bouts. Results: Results showed a significant increase in exercise capacity as measured by power output (p < 0.05, 7.45 W) post-intervention, despite no change in ratings of perceived exertion, and reductions in average heart rate (112 ± 3 vs. 109 ± 4 bpm). There were no alterations in gastrointestinal or skin temperature, and ratings of thermal comfort and sensation remained unchanged post-intervention. Conclusions: These preliminary findings provide important new evidence that four days of passive HWI may be a practical and effective method of inducing physiological adaptations in older individuals, which may be of use in interventions to mitigate the negative impact of high environmental temperatures in this population. Full article

Objective: Village Health Volunteers (VHVs) are vital to Thailand’s primary healthcare, yet many face high risks for non-communicable diseases (NCDs). This preliminary study aimed to implement health empowerment theory-based personalized health promotion for individuals in the NCD-risk group. Methods: The preliminary mixed-methods study implemented a 6-month empowerment-based health promotion program for 21 VHV leaders (mean age 62.43 ± 7.28 years) at risk for NCDs. The intervention integrated laboratory data, behavioral and qualitative focus-group insights, and quantitative anthropometric data obtained via bioelectrical impedance analysis (BIA). Results: Participants’ exercise adequacy significantly improved after the intervention, increasing from 8.3% to 61.9% (p = 0.03). BIA revealed a physiological shift toward improved energy homeostasis, including decreased body weight, reduced visceral fat area, and increased muscle hydration. While biochemical markers did not reach statistical significance, clinically favorable downward trends were observed in median HbA1c (8.0% to 7.3%) and LDL cholesterol (141.8 to 119.0 mg/dL), alongside stable renal and liver function. Qualitative thematic analysis identified four primary domains of impact: sustainability and systemic advocacy, personal transformation, broad competence acquisition, and enhanced social capital. Participants reported a marked increase in self-efficacy, transitioning from inactive beneficiaries to active health advocates. This change was largely driven by mastery experiences, such as visible improvements in body composition and functional health literacy. Conclusions: The empowerment program significantly improved physical activity and body composition while fostering the social capital and health literacy necessary for community leadership, suggesting that personal health mastery is a critical precursor to effective systemic advocacy and long-term sustainability in community-led health programs. Full article

Background/Objectives: Pediatric malnutrition is associated with loss of muscle mass and impaired physical function. While anthropometric measurements are widely used for diagnosis, functional indicators that reflect early changes in nutritional status are limited in children. Handgrip strength has been proposed as a simple and objective marker of muscle function; however, pediatric data remain scarce. Methods: In this prospective controlled study, 55 children aged 3–17 years diagnosed with malnutrition and 50 age- and sex-matched healthy controls were evaluated. Anthropometric measurements and muscle strength assessments, including handgrip and pinch grip strength, were performed in both groups. Muscle strength values were additionally converted to age- and sex-adjusted standard deviation scores (SDS). In the malnutrition group, measurements were repeated at 2 and 8 weeks following individualized nutritional therapy to assess treatment response. Results: Children with malnutrition had significantly lower body weight, body mass index, mid-upper arm circumference, triceps skinfold thickness, and lean body mass compared with controls (p < 0.05 for all). Both dominant and non-dominant handgrip strength values were also significantly reduced in the malnutrition group. When adjusted for age and sex, handgrip strength SDS values remained significantly lower in children with malnutrition, whereas pinch grip strength SDS values did not differ significantly between groups. During follow-up, nutritional therapy was associated with significant improvements in anthropometric parameters and absolute muscle strength measurements. However, SDS-based analyses demonstrated that these changes were not uniform across all parameters, suggesting that observed improvements may only partly exceed expected physiological growth. Conclusions: Handgrip strength appears to reflect nutritional status in children, and its association with malnutrition persists after adjustment for growth-related factors. These findings support its potential role as a complementary functional marker. However, longitudinal changes in standardized scores indicate that recovery is variable, and interpretation should consider the influence of normal growth and development. Further large-scale, age-standardized studies are needed to better define their role in clinical practice. Full article

European pork production pursues traceability and authenticity to ensure animal welfare, food safety, and support products with geographical indications. This study reports a European survey integrating stable isotope ratios (δ¹³C, δ¹⁵N, δ³⁴S, δ¹⁸O, δ²H) and multi-element profiling using IRMS and ICP-MS, on 612 samples collected across Denmark, Poland, Italy, and Spain, with diverse production systems, breeds, feeding, and slaughter ages. Geographical and climatic gradients influenced δ²H and δ¹⁸O, which ranged from −111‰ to −89‰ in samples from Denmark and Spain and from 13.3‰ to 16.0‰ in samples from Italy and Spain, respectively. In selected farms, δ¹³C ranged from −22.7‰ to −17.0‰ depending on diet composition based on C₃ and C₄ plants. The wide variability in pig management practices suggested that δ¹⁵N (2.50 ÷ 4.96‰) increased with slaughter age and was positively correlated with Fe (3.38 ÷ 8.39 mg/kg) and Zn (9.39 ÷ 23.6 mg/kg). Most mineral components were mainly driven by feed formulation and supplementation. Principal component analysis (PCA) showed that samples were grouped based on their origin and husbandry system, confirming the key role of isotopic and elemental markers for the development of a database supporting the pork supply chains across Europe. Full article

Objective: The fetal-to-neonatal transition is marked by profound cardio-respiratory changes. Infections emerging within the first 48 h after birth may influence early cardiovascular adaptation. We aimed to evaluate the association between early infection/inflammation markers and vital parameters in neonates during the first 15 min after birth. Methods: This is a secondary outcome parameter post-hoc analysis of data derived from a prospective observation study. Preterm and term neonates with cerebral oxygen saturation (crSO2) monitoring (INVOS 5100C) during the first 15 min after birth and available inflammatory markers (C-reactive protein [CRP], leukocytes, immature-to-total neutrophils ratio [IT ratio]) within 48 h after birth were included. Heart rate (HR) and arterial oxygen saturation (SpO₂) were continuously recorded during the first 15 min. Inflammatory markers obtained at 16–24 and 24–48 h after birth were correlated with crSO₂, SpO₂, and HR at minute 5, 10 and 15. Results: Sixty-eight neonates were included (median (IQR) gestational age 34.0 (32.0; 35.9) weeks, birth weight 1900 (1488; 2542) grams). CRP within the first 24 h correlated negatively with crSO₂ (r = −0.314; p = 0.011) and with SpO₂ (r = −0.393; p = 0.001) at minute 15. IT ratio within 24 h correlated negatively with crSO₂ at minute 5 (r = −0.367; p = 0.005), 10 (r = −0.273; p = 0.035), and 15 (r = −0.306; p = 0.013), and with SpO₂ at minute 5 (r = −0.327; p = 0.008). IT ratio at 24–48 h correlated negatively with crSO₂ at minute 15 (r = −0.384, p = 0.012). No significant correlations were observed with HR. Leukocytes within the first 24 h after birth correlated negatively with crSO2 at minute 5 (r = −0.265; p = 0.046). Conclusions: Early inflammatory markers, particularly CRP and the IT ratio, are associated with cerebral and systemic oxygenation during immediate postnatal transition. These findings suggest a potential association between early inflammatory activation and oxygenation dynamics; however, given the observational design and modest correlation strength, the results should be interpreted cautiously and do not allow conclusions regarding causality or underlying mechanisms. Full article

Objective: The purpose of this study was to determine the biological association between host-derived HSP47 and fungal-derived HSP90 in the context of vulvovaginal candidiasis (VVC) and to examine their relationships with clinical, inflammatory, and metabolic phenotypes in infected and healthy women. Methods: This study followed a six-month case–control design (February–July 2025) and was conducted at the University of Tabuk Hospital in Tabuk, Saudi Arabia. A total of 84 women aged 18–45 years were recruited, of which 42 were VVC-infected, and 42 were healthy controls. ELISA kits were used to test vaginal swabs for HSP47 and HSP90. Clinical, hematological, cytokine, and metabolic markers were also evaluated. Mann–Whitney U, Spearman correlation, and multiple linear regression tests were performed to analyze the data. Results: The levels of HSP47 and HSP90 were significantly higher among infected patients (2.29 ng/mL and 3341 ng/mL, respectively) when compared with controls (0.58 ng/mL and 1025.7 ng/mL; p < 0.001). Women who were infected were older (p = 0.02), but there were no significant differences in terms of BMI (p = 0.29). The levels of vitamin D and adiponectin were significantly decreased (p < 0.001), while pro-inflammatory cytokines (IL-6, TNF-α, IFN-γ, TGF-β, and IL-8) and WBC counts were higher compared to the control group. The hematology results were characterized by inflammation-related anemia and disturbed protein metabolism. The ROC analysis demonstrated good diagnostic performance, with an AUC of 1.0 in the case of HSP47 and 0.905 in the case of HSP90. In the case of the infected patients, the regression models were found to be weak (HSP90 R² = 0.154; HSP47 R² = 0.273), although HSP47 retained significant connections with IL-8 (p = 0.005) and IFN-γ (p = 0.028). Conclusions: High levels of HSP47 and HSP90 are observed in VVC, reflecting an epithelial stress response and fungal persistence. These HSPs have high diagnostic accuracy, which justifies their potential as biomarkers for the timely detection of VVC; they also have further implications as early biomarkers for prognostic and treatment monitoring support, despite the poor predictive models. This study has some limitations that must be addressed; in particular, the regression analyses failed to provide statistically significant predictive models, likely due to the limited sample size. In addition, the specificity of HSP90 and HSP47 for VVC in comparison with other vaginal infections was not evaluated. Full article

Background: Polygenic risk scores for Alzheimer’s disease (AD), organized by gene networks shared between the blood and brain, may provide insights into underlying disease mechanisms common to both tissues. Methods: We derived a blood–brain network-based polygenic risk score (nbPRS) from AD-associated genetic variants for three blood-brain networks, selected by the preservation of blood and brain gene co-expression networks, and AD association. Participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI, n = 1109), Framingham Heart Study (FHS, n = 8310), the Religious Orders Study Memory Aging Project (ROSMAP, n = 1215), and Mount Sinai Brain Bank (MSBB, n = 323) were stratified into low- and high-nbPRS subgroups, then profiled using longitudinal and cross-sectional data. We compared the conversion from normal cognition to AD between nbPRS subgroups. Genes differentially expressed among low- and high-nbPRS individuals were profiled with classical neuropathological markers and we investigated potential biologically relevant pathways for the genes significantly expressed in high-risk individuals. Results: Individuals with high nbPRS in three AD-associated networks (M2, M6, M14) demonstrated significant impairment in executive function and memory performance, whereas high-risk individuals in networks M2 and M14 had significantly reduced hippocampal volume. We observed high-risk individuals in M2 and M14 developed AD at twice the rate of low-risk individuals in these networks. HLA genes were differentially expressed with transcriptome-wide significance among low- and high-nbPRS individuals in M14 and associated with neuroinflammatory and tau pathology. Conclusions: Polygenic risk scores derived from blood and brain networks can differentiate individuals with a high risk of AD conversion. Full article

This Data Descriptor presents an anonymized, shuffled dataset of creatinine-normalized urinary metabolite measurements from 73 Bulgarian children with autism spectrum disorder (ASD), released to support reuse in secondary analyses and cross-cohort comparisons. The public release represents a pathway-oriented 24-marker subset from a broader urinary diagnostic panel, assembled as a self-contained resource for investigators working in these metabolic domains. Spot urine results are provided as individual-level values after creatinine normalization; for trimethylamine, values below the limit of quantification (LOQ) were replaced with LOQ/2. The deposit contains measurements for 24 urinary markers grouped into three functional classes (neurotransmitters and aromatic amino acid precursors; one-carbon/methylation and vitamin-related metabolites; and energy metabolism/organic acids with microbiome-related amines). The underlying cohort comprised children aged 3–13 years, and no contemporaneous neurotypical control group was enrolled. Second-morning, midstream, acid-stabilized spot urine samples were collected within the provider’s workflow; metabolites were measured by LC–MS/MS, and spot urinary creatinine was measured enzymatically for normalization. The release includes the results table in both XLSX and CSV formats, a reference limits and units file for contextual interpretation, a data dictionary, a README, a changelog, and SHA-256 checksums for integrity verification. The public files contain de-identified analytical variables only and omit individual-level demographics, dates, standalone urinary creatinine, and richer clinical metadata to preserve anonymity. Full article

Background: Left ventricular global longitudinal strain (GLS) measured by speckle-tracking echocardiography (STE) has become a key marker of myocardial systolic function, yet normal reference values remain heterogeneous, and the magnitude of physiological sex differences is not fully defined. We performed a systematic review and meta-analysis to establish pooled GLS reference estimates in healthy individuals, quantify sex-related differences, and contextualize deformation findings relative to conventional systolic function. Methods: A systematic search of PubMed, Scopus, and EMBASE identified observational studies reporting GLS in healthy adults assessed by two-dimensional or three-dimensional STE. Random-effects meta-analysis using standardized mean differences (SMD) compared GLS between women and men. Descriptive pooled reference values were derived using weighted median and interquartile range (IQR) reconstruction from study-level distributions. Meta-regression analyses explored demographic, clinical, and methodological sources of heterogeneity. A complementary analysis evaluated sex-related differences in left ventricular ejection fraction (LVEF) within the same populations. Results: Thirty-two studies, including 19,157 healthy individuals, were analyzed. The pooled population had a weighted median age of 47.5 years and 53% female participants. Overall, GLS demonstrated a weighted median of 20.3% (IQR 17.8–22.5). Women showed higher GLS values than men (20.8% [18.4–23.1] vs. 19.4% [17.0–21.6]). Meta-analysis of 28 studies confirmed significantly greater GLS in females (SMD 0.487, 95% CI 0.409–0.565; p < 0.001), with consistent findings across imaging modalities and no subgroup interaction. Between-study heterogeneity was substantial (I² = 82.7%), although effect direction was uniform. Meta-regression analyses identified no significant moderators, and sensitivity analyses confirmed stable estimates without publication bias. Segmental analysis demonstrated a physiological base-to-apex strain gradient. In contrast, LVEF was largely comparable between sexes, with no clinically meaningful difference (SMD 0.257, 95% CI 0.186–0.327; p < 0.001), indicating preserved global systolic performance despite differences in myocardial deformation. Conclusions: GLS demonstrates a consistent physiological range in healthy populations, with women exhibiting higher longitudinal deformation than men, independent of the imaging modality. These findings support the adoption of sex-specific GLS reference values and highlight the complementary roles of deformation and volumetric indices in improving the interpretation of myocardial function and reducing misclassification in clinical practice. Full article

Background/Objectives: Non-alcoholic fatty liver disease (NAFLD) is a prevalent metabolic disorder for which there are limited pharmacotherapies. Sodium rutin (NaR), a soluble flavonoid derivative, has shown beneficial metabolic effects, but its role in NAFLD remains unclear. This study investigates whether NaR ameliorates high-fat diet (HFD)-induced NAFLD and insulin resistance through promoting hepatic lipophagy. Methods: Male mice aged 8 weeks old were fed a HFD for 12 weeks with/without NaR supplementation. Body weight was measured every week. After 12 weeks of treatment, GTT and ITT were performed to assess insulin resistance. Then, the tissues were collected and hepatic histology, serum biochemistry, and markers of autophagy and senescence were assessed. Results: NaR treatment significantly attenuated HFD-induced weight gain, reduced visceral fat and liver weights, and ameliorated hepatic steatosis and vacuolization. NaR improved serum lipid profiles; lowered alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase levels; and reduced hepatic cellular senescence. NaR enhanced hepatic autophagy, evidenced by decreased p62 levels, increased LC3-II/LC3-I ratio, and enhanced colocalization of lipid droplets with LC3 and LAMP1 in vivo and in vitro. These changes were accompanied by improved glucose tolerance and insulin sensitivity. Conclusions: NaR effectively alleviates HFD-induced NAFLD and insulin resistance by activating hepatic lipophagy. These findings support NaR as a promising multi-targeted therapeutic candidate for NAFLD. Full article