Search Results (838)

Background: Low-glycemic index (GI) carbohydrates like isomaltulose (ISO) are known to enhance incretin release and to improve postprandial glucose control at the following meal (an effect known as second meal effect, or SME), which is particularly beneficial for individuals with metabolic syndrome (MetS). This study aimed to assess the most effective preprandial interval of ISO- or saccharose (SUC) snacks (1 h vs. 3 h preload) to enhance prandial incretin responses to a subsequent meal. Methods: In a randomized crossover design, 15 participants with MetS completed four experimental conditions on four non-consecutive days, combining two preload types (ISO or SUC) and two preload timings (Intervention A: 3 h preload; Intervention B: 1 h preload). Specifically, the four conditions were (1) ISO + Intervention A, (2) SUC + Intervention A, (3) ISO + Intervention B, and (4) SUC + Intervention B. The order of conditions was randomized and separated by a 3–7-day washout period to minimize carryover effects. On each study day, participants consumed two mixed meal tests (MMT-1 and MMT-2) with a standardized preload (50 g ISO or SUC) administered either 3 h or 1 h prior to MMT-2. Blood samples were collected over 9 h at 15 predefined time points for analysis of glucose, insulin, C-peptide, and incretin hormones (GLP-1, GIP, and PYY). Results: The unique digestion profile of ISO resulted in a blunted glucose ascent rate (ΔG/Δt: 0.28 vs. 0.53 mmol/L/min for SUC, p < 0.01), paralleled by synonyms PYY elevation over 540 min monitoring, compared with SUC. ISO also led to higher and more sustained GLP-1 and PYY levels, while SUC induced a stronger GIP response. Notably, the timing of ISO consumption significantly influenced PYY secretion, with the 3 h preload showing enhanced PYY responses and a more favorable SME compared to the 1 h preload. Conclusions: ISO, particularly when consumed 3 h before a meal (vs. 1 h), offers significant advantages over SUC by elevating PYY levels, blunting the glucose ascent rate, and sustaining GLP-1 release. This synergy enhances the second meal effect, suggesting ISO’s potential for managing postprandial glycemic excursions in MetS. Full article

Low glycemic index (GI) cookie bars were prepared with soft wheat flour substituted with 10–50% soybean flour and 10–50% resistant starch. The effects of increased levels of soybean flour and resistant starch on the quality of low glycemic index cookie bars were investigated (i.e., moisture, cookie spread, texture (breaking force), surface color, and in vitro starch digestibility). It was found that increasing soybean flour substitution increased the breaking force, moisture, protein content, and yellowish color of the low GI cookie bars but decreased the cookie bar spread and the lightness of the cookie bars (p < 0.05). The addition of soybean flour and resistant starch by up to 50% did not significantly change the in vitro starch digestibility of the cookie bars. The overall acceptability of the cookie bars was lower when the soybean flour blend went beyond 10%. When soft wheat flour in the cookie bar formulation was replaced at the following levels (10%, 30%, and 50%) by resistant starch, the cookie spread and lightness of the cookie bars increased but the breaking force was decreased along with the yellowish color (p < 0.05). When resistant starch was combined with soft wheat flour at levels of up to 50%, this significantly increased the content of total dietary fiber and spread ratio of cookie bars. Sensorial analysis showed that resistant starch presence had an acceptable impact on overall acceptability of the low GI cookie bars. Resistant starch represents a viable dietary fiber source when substituted for 50% of soft wheat flour in formulations. While this substitution may result in increased spread ratio and decreased crispness in cookie bars, the addition of 10% soybean flour can mitigate these textural changes. Full article

Sourdough fermentation, driven by the biochemical activity of lactic acid bacteria (LAB), presents a scientifically promising approach to addressing nutritional limitations in cereal-based staples. This review critically examines both the underlying mechanisms by which LAB enhance the nutritional profile of sourdough and the translational challenges in realizing these benefits. Key improvements explored include enhanced mineral bioavailability (e.g., up to 90% phytate reduction), improved protein digestibility, an attenuated glycemic response (GI ≈ 54 vs. ≈75 for conventional bread), and the generation of bioactive compounds. While in vitro and animal studies extensively demonstrate LAB’s potential to reshape nutrient profiles (e.g., phytate hydrolysis improving iron absorption, proteolysis releasing bioactive peptides), translating these effects into consistent human health outcomes proves complex. Significant challenges hinder this transition from laboratory to diet, including the limited bioavailability of LAB-derived metabolites, high strain variability, and sensitivity to fermentation conditions. Furthermore, interactions with the food matrix and host-specific factors, such as gut microbiota composition, contribute to inconsistent findings. This review highlights methodological gaps, particularly reliance on in vitro or animal models, and the lack of long-term, effective human trials. Although LAB hold significant promise for nutritional improvements in sourdough, translating these findings to validated human benefits necessitates continued efforts in mechanism-driven strain optimization, the standardization of fermentation processes, and rigorous human studies. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver condition globally, strongly linked to obesity, insulin resistance, and type 2 diabetes (T2D). Tirzepatide (TZP), a dual GIP/GLP-1 receptor agonist, improves glycemic control and reduces body weight and the liver fat content in patients with obesity and T2D. However, its effect on liver-specific outcomes such as steatosis and fibrosis remains incompletely characterized. Low-energy ketogenic therapy (LEKT), a nutritional strategy characterized by carbohydrate restriction and nutritional ketosis, may enhance hepatic β-oxidation and reduce hepatic lipogenesis. To date, however, the combination of TZP and LEKT has not been studied in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to compare the hepatic and metabolic effects of TZP combined with either LEKT or a conventional low-calorie diet (LCD) over a 12-week period. Methods: Sixty adult patients with MASLD undergoing TZP therapy were prospectively assigned to either an LEKT or a conventional LCD, with 30 participants per group. As primary endpoints, the controlled attenuation parameter (CAP, an index of hepatic steatosis) and liver stiffness measurement (LSM, an index of liver fibrosis) were assessed at the baseline and after 12 weeks using FibroScan^®. Secondary outcomes included changes in body mass index (BMI), glycated hemoglobin (HbA1c), and liver enzymes. Adherence to both diet and pharmacological treatment, as well as tolerability, were systematically monitored throughout the intervention period. Results: Both groups showed significant reductions in body weight (TZP + LEKT, p = 0.0289; TZP + LCD, p = 0.0278), with no significant intergroup difference (p = 0.665). CAP and LSM improved significantly in both groups, but reductions were greater in the TZP + LEKT group (CAP −12.5%, p < 0.001; LSM −22.7%, p < 0.001) versus LCD (CAP −6.7%, p = 0.014; LSM −9.2%, p = 0.022). Between-group differences were statistically significant for both CAP (p = 0.01) and LSM (p = 0.03). Conclusions: Based on these preliminary findings, we support the hypothesis that the combination of TZP and LEKT may be superior to TZP with an LCD in reducing hepatic steatosis and stiffness in individuals with obesity. Full article

Traditional taco preparation methods, such as oil immersion and steaming, can significantly affect the nutritional and metabolic characteristics of the final product. This study evaluated tacos made with five commercial nixtamalized maize flours and four common fillings (chicharron, beef skirt, potato, and refried beans), processed using three different methods: Plain, Full-Fat, and Patted-Dry. We assessed their chemical composition, starch digestibility, and thermal properties, and measured satiety-related hormone responses in mice. Fillings had a stronger influence on protein, fat, and moisture content than tortilla type. Full-fat tacos exhibited increased amylose–lipid complex formation and a lower gelatinization enthalpy, whereas plain tacos retained more retrograded starch and a crystalline structure. In vitro digestion revealed that Plain tacos, especially those with plant-based fillings, had the highest resistant starch content and the lowest predicted glycemic index. Hierarchical clustering showed that resistant starch, moisture, and gelatinization onset temperature were closely linked in the Plain samples, whereas lipid-driven variables dominated in the Full-Fat tacos. In mice, tacos with a higher resistant starch content led to greater GLP-1 levels, lower ghrelin levels, and reduced insulin responses, suggesting improved satiety and glycemic control. Patted-Dry tacos showed intermediate hormonal effects, supporting their potential as a balanced, health-conscious alternative. These findings demonstrate how traditional preparation techniques can be leveraged to enhance the nutritional profile of culturally relevant foods, such as tacos. Full article

Background/Objectives: The consumption of refined carbohydrates has increased globally. It is associated with inflammation and oxidative stress, both recognized as risk factors for cardiovascular disease. This study investigated the effects of a refined carbohydrate-rich diet on the vascular reactivity of rat aorta. Methods: We acclimatized adult male Wistar rats for two weeks and then randomly assigned them to two experimental groups: a control (CT) group and a high-carbohydrate diet (HCD) group. The CT group received standard laboratory chow for 15 days, while the HCD group received a diet composed of 45% sweetened condensed milk, 10% refined sugar, and 45% standard chow. After the dietary exposure period, we evaluated the vascular reactivity of aortic rings, gene expression related to inflammation, superoxide dismutase activity, and biochemical parameters, including cholesterol, triglycerides, fasting glucose, and glucose and insulin tolerance. Results: The results demonstrate a reduction in vascular reactivity caused by endothelial alterations, including increased NO production, which was observed as higher vasoconstriction in the presence of L-NAME and aminoguanidine and upregulation of iNOS gene expression. In addition, increased production of free radicals, such as O₂^-, was observed, as well as immune markers like MCP-1 and CD86 in the HCD group. Additionally, the HCD group showed an increase in the TyG index, suggesting early metabolic impairment. GTT and ITT results revealed higher glycemic levels, indicating early signs of insulin resistance. Conclusions: These findings indicate that short-term consumption of a refined carbohydrate-rich diet may trigger oxidative stress and endothelial dysfunction, thereby increasing the risk of cardiovascular complications. Full article

The high glycemic index (GI) of polished white rice (WR) presents challenges for blood glucose control in diabetes. This study investigated the in vitro digestibility of a whole grain blend (WGB, composed of black, red, and brown rice) and its effects on the gut microbiota in elderly diabetic individuals. WGB exhibited lower starch digestibility (69.76 ± 5.71% vs. 73.02 ± 6.16%) and a reduced estimated glycemic index (eGI, 73.43 ± 4.49 vs. 77.55 ± 2.64) than WR, likely due to its higher amylose content. WGB fermentation increased Bifidobacterium and Lactobacillaceae, reduced pro-inflammatory Bacteroides fragilis and Enterocloster bolteae, and released more arabinose and xylose. Additionally, WGB yielded higher isobutyrate, while WR contained more glucose and fructose in its structure, leading to increased acetate production and a more acidic environment. Functional analysis revealed that WGB upregulated pathways related to fatty acid elongation and fiber fermentation. These findings suggest WGB as a viable staple food alternative for diabetic patients, offering dual benefits in glycemic control and gut microbiota. Full article

Background/Objectives: To assess the association between early pregnancy carbohydrate quality, as measured by the Carbohydrate Quality Index (CQI), and the risk of delivering a large-for-gestational-age (LGA) infant in a Mediterranean pregnant cohort of northern Greece. Methods: We analyzed singleton pregnancies from the BORN 2020 prospective cohort in Greece. Dietary intake was assessed via a validated food frequency questionnaire, and CQI was computed from glycemic index, fiber density, whole-to-refined grain ratio, and solid-to-liquid carbohydrate ratio. Multivariable logistic regression was used to estimate the association between CQI (in tertiles) and LGA risk, defined as birthweight >90th percentile. Results: Among the 797 participants, 152 (19.1%) delivered LGA infants, and 117 (14.7%) were diagnosed with GDM. Of those with GDM, 23 (19.7%) delivered LGA infants. In the total population, higher maternal weight (p < 0.001), height (p = 0.006), and pre-pregnancy BMI (p = 0.004) were significantly associated with LGA. A greater proportion of women with LGA had a BMI > 25 (p = 0.007). In the GDM subgroup, maternal height remained significantly higher in those who delivered LGA infants (p = 0.017). In multivariable models, moderate CQI was consistently associated with increased odds of LGA across all models (Model 1: aOR = 1.60 (95% CI: 1.03–2.50), p = 0.037, Model 2: aOR = 1.57 (95% CI: 1.01–2.46), p = 0.046, Model 3: aOR = 1.58 (95% CI: 1.01–2.47), p = 0.044, Model 4 aOR: 1.70; 95% CI: 1.08–2.72; p = 0.023), whereas high CQI was not. In the GDM subgroup, a significant association between high CQI and increased LGA risk was observed in less adjusted models (Model 1 aOR: 6.74; 95% CI: 1.32–56.66; p = 0.039, Model 2 aOR: 6.64; 95% CI: 1.27–57.48; p = 0.044), but this was attenuated and became non-significant in the fully adjusted model (aOR: 3.05; 95% CI: 0.47–30.22; p = 0.28). When examining CQI components individually, no consistent associations were observed. Notably, a higher intake of low-quality carbohydrates (≥50% of energy intake) was significantly associated with increased LGA risk in the total population (aOR: 4.25; 95% CI: 1.53–11.67; p = 0.005). Conclusions: Higher early pregnancy intake of low-quality carbohydrates was associated with an elevated risk of LGA in the general population. However, CQI itself showed a non-linear and inconsistent relationship with LGA, with moderate, but not high, CQI linked to increased risk, particularly in GDM pregnancies, where associations were lost after adjustment. Both carbohydrate quality and quantity evaluations are essential, particularly in high-risk groups, to inform dietary guidance in pregnancy. Full article

Background: Gestational diabetes mellitus (GDM) affects 7–9% of pregnancies worldwide and is associated with adverse maternal and neonatal outcomes. Nutritional therapy is a key component of GDM management. However, inconsistencies exist across international and national guidelines regarding macronutrient distribution, glycemic targets, and micronutrient supplementation. This systematic review aims to compare updated nutritional recommendations for GDM across major health organizations and identify areas of consensus, divergence, and evidence gaps. Methods: This systematic review was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251026194). A comprehensive literature search was performed in PubMed, Scopus, and Google Scholar (concluding March 2025), along with manual searches of official websites of professional health organizations (e.g., ADA, WHO, NICE, IDF). Guidelines published within the last 10 years (or the most relevant national guideline if slightly older), available in English or with access to translation, and including explicit nutritional recommendations for GDM were included. Data were extracted on macronutrient composition, glycemic targets, and micronutrient supplementation, with evaluation of the supporting evidence and regional context, incorporating findings from recent key guideline updates. Results: In total, 12 guidelines met the inclusion criteria. While all guidelines emphasized carbohydrate moderation and adequate fiber intake, significant discrepancies were found in carbohydrate quality recommendations (e.g., low-glycemic index focus vs. total carbohydrate restriction), postprandial glucose targets (e.g., 1-h vs. 2-h measurements and varying thresholds like <120 vs. <140 mg/dL), and the use of non-routine micronutrients such as chromium, selenium, and omega-3 fatty acids (generally lacking endorsement). Recent updates from key bodies like ADA, Diabetes Canada, and KDA largely maintain these core stances but show increasing emphasis on dietary patterns and acknowledgement of CGM technology, without resolving key discrepancies. Cultural adaptability and behavioral counselling strategies were minimally addressed across most guidelines. Conclusions: Despite general agreement on the principal recommendations of nutritional management in GDM, substantial variation persists in specific recommendations, even considering recent updates. Consistent, evidence-based, and culturally adaptable guidelines incorporating implementation strategies are needed to optimize care and reduce disparities in GDM management across regions. Full article

Westernization of traditional diets has been implicated in the rising burden of overweight/obesity and type 2 diabetes, especially in developing countries. In recent times, diet therapy is increasingly being recognized as an essential component of diabetes care. This study assessed the effect of diet therapy on body composition, antioxidant nutrient intake, and glycemic status in individuals living with type 2 diabetes (ILWT2D). In this prospective observational cohort study, 45 ILWT2D who were receiving diet therapy (personalized dietary counseling) in addition to standard medical treatment (intervention group) were compared with 45 ILWT2D receiving only standard medical treatment (comparator group). Antioxidant micronutrient intake was assessed using a 24-h dietary recall. Body composition indices, including body mass index (BMI), percentage body fat (%BF), and visceral fat (VF), were assessed. Participants’ fasting blood glucose (FBG), glycated hemoglobin (HbA1C) levels, and blood pressure (BP) were measured. All measurements were performed before and after a three-month period. There were significant improvements in BMI (27.8 ± 6.0 kg/m² vs. 26.9 ± 5.5 kg/m², p = 0.003), %BF (37.8 ± 11.9% vs. 35.5 ± 10.5%, p < 0.001), visceral fat (9.8 ± 3.4 vs. 9.1 ± 3.2, p < 0.001), systolic BP (136.9 ± 19.9 mmHg vs. 124.6 ± 13.0 mmHg, p < 0.001), FBG (8.8 ± 2.8 mmol/L vs. 6.7 ± 1.5 mmol/L, p < 0.001), and HbA1c (7.3 ± 1.0% vs. 6.4 ± 0.8%, p < 0.001) in the intervention group from baseline to endline, but not in the comparator group. In contrast, %BF increased within the comparator group (39.9 ± 7.8 vs. 40.7 ± 7.4; p = 0.029). Vitamin A intake increased significantly (227.5 ± 184.3 µg vs. 318.8 ± 274.7 µg, p = 0.038) within the intervention group but not in the comparator group (174.9 ± 154.3 µg, 193.7 ± 101.4 µg, p = 0.54). There were no significant changes in zinc, copper, selenium, and vitamin C intakes (p > 0.05) in the intervention group from the baseline to endline, unlike those in the comparator group who showed a significant increase in the intake of these nutrients. There was a significant increase in vitamin A intake among the ILWT2D who received dietary counseling as an intervention compared to those who did not. Additionally, the ILWT2D who received dietary counseling had significant improvements in their body composition (BMI, body fat, and visceral fat) and systolic blood pressure, compared to those who did not. The ILWT2D who received the intervention had significantly better glycemic control (FBG and HbA1c) than their counterparts who did not. Thus, this study suggests the potential of diet therapy as a viable non-pharmacological treatment approach for individuals living with type 2 diabetes. Full article

In this study, the effects of enzymolysis on physicochemical properties, digestive characteristics, and flora regulation of the meal replacement powder (MRP) were investigated on the basis of the previously obtained compound MRP. The results showed that the color, water absorption index, and water solubility index of the MRP were obviously improved after enzymatic hydrolysis. The swelling power (1.43 ± 0.11 g/g, 25 °C) and water-holding capacity (4.66 ± 0.09 g/g) of the MRP (CE_1) were decreased, while the oil holding capacity (2.14 ± 0.13 g/g) was increased. In the microcosmic aspect, the samples treated by enzymolysis had different degree of degradation, the particle size decreased (D50 = 57.71 μm), and the specific surface area (679.2 cm²/g) increased. The MRP samples treated by enzymolysis had better antioxidant capacity and cholate adsorption capacity. All MRP samples belong to low glycemic index (GI) foods, and can improve gut microbiota (Megamonas, Bacteroides, Rocheella, Parasatre, Koalabacterium, and Prasus) and promote the production of short chain fatty acids such as acetic acid, propionic acid and butyric acid. Therefore, this study not only further expands the comprehensive utilization of Aronia melanocarpa, but also provides a reference for the diversification of low GI related products. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) is frequently associated with depressive disorder (DD), which negatively impacts glycemic control and overall metabolic outcomes. Recent evidence suggests that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may exert neuroprotective effects and modulate mood. Likewise, it is unknown whether the presence of a DD, due to increased brain inflammation, could lead to a poorer response to GLP-1 RAs in terms of weight loss. This study evaluates the impact of DD on metabolic outcomes in individuals treated with GLP-1 RAs. Methods: We conducted a retrospective longitudinal study including 115 patients with T2DM treated with GLP-1 RAs for at least six months. DD was identified based on a documented clinical diagnosis, chronic antidepressant use, or a Beck Depression Inventory (BDI) score ≥16. Metabolic parameters, including glycated hemoglobin (HbA1c), fasting glucose, the body mass index (BMI), the waist circumference, and triglycerides, were compared between patients with and without DD. Results: Patients with DD had significantly higher baseline HbA1c (7.5% vs. 6.9%, p = 0.01), fasting glucose, and triglyceride levels. The waist circumference was also higher in the DD group (p = 0.001). However, no significant differences were observed in weight loss or BMI reductions following the GLP-1 RA treatment. Final HbA1c levels remained higher in the DD group (7.2% vs. 7.0%, p = 0.01). Conclusions: While DD is associated with a poorer baseline metabolic control in T2DM, it does not appear to impair the weight loss efficacy with GLP-1 RAs. However, patients with DD maintain higher post-treatment HbA1c levels, underscoring the need for integrated metabolic and psychiatric care in diabetes management. Full article

Honey quality and authenticity are influenced by floral origin, processing, and storage, with implications for composition and sensory appeal. This study offers a comparative assessment of eight monofloral honey samples, representing five botanical varieties: acacia, linden, rapeseed, lavender, and thyme. For acacia, linden, and rapeseed, both producer-sourced and commercial honeys were analyzed, while lavender and thyme samples were available only from local beekeepers. The botanical origin of each sample was confirmed using morphological markers of pollen grains. Physicochemical characterization included acidity, pH, moisture content, refractive index, hydroxymethyl furfural (HMF), proline concentration, and carbohydrate profiling by HPLC-RID. Acacia honey exhibited the lowest acidity and HMF levels, alongside the highest fructose/glucose (F/G) ratios, indicating superior freshness, lower crystallization risk, and a sweeter flavor profile. In contrast, rapeseed honey showed elevated glucose levels and the lowest F/G ratio, confirming its tendency to crystallize rapidly. All samples recorded proline concentrations well above the quality threshold (180 mg/kg), supporting their authenticity and proper maturation. The estimated glycemic index (eGI) varied between 43.91 and 62.68 and was strongly inversely correlated with the F/G ratio (r = −0.98, p < 0.001). Sensory evaluation highlighted acacia honey from producers as the most appreciated across visual, tactile, and flavor attributes. Correlation analyses further revealed consistent links between sugar composition and both physical and sensory properties. Overall, the findings reinforce the value of integrated analytical and sensory profiling in assessing honey quality and authenticity. Full article

The production of food with a naturally enriched protein content is a strategic response to the growing global demand for sustainable protein sources. Wood distillate (WD), a by-product of the pyrolysis of woody biomass, has previously been shown to increase the protein concentration and bioavailability in chickpea seeds. Here, we evaluated the effect of 0.5% (v/v) WD soil drenching on chickpea productivity, nutritional profile, and proteomic pattern. WD treatment significantly improved the yield by increasing plant biomass (+144%), number of pods and seeds (+148% and +147%), and seed size (diameter: +6%; weight: +25%). Nutritional analyses revealed elevated levels of soluble proteins (+15%), starch (+11%), fructose (+135%), and polyphenols (+14%) and a greater antioxidant capacity (25%), alongside a reduction in glucose content, albeit not statistically significant, suggesting an unchanged or even lowered glycemic index. Although their concentration decreased, Ca (−31%), K (−12%), P (−5%), and Zn (−14%) in WD-treated plants remained within normal ranges. To preliminary assess the quality and safety of the protein enrichment, a differential proteomic analysis was performed on coarse flours from individual seeds. Despite the higher protein content, the overall protein profiles of the WD-treated seeds showed limited variation, with only a few storage proteins, identified as legumin and vicilin-like isoforms, being differentially abundant. These findings indicate a general protein concentration increase without a major alteration in the proteoform composition or differential protein synthesis. Overall, WD emerged as a promising and sustainable biostimulant for chickpea cultivation, capable of enhancing both yield and nutritional value, while maintaining the proteomic integrity and, bona fide, food safety. Full article

Background: Type 2 diabetes (T2D patients) have a 74% increased risk of heart failure (HF), but traditional HF biomarkers lack sensitivity in early disease detection. Increased epicardial adipose tissue volume (EATv) is associated with cardiovascular risk in T2D, and novel biomarkers such as growth differentiation factor 15 (GDF15), Galectin-3, and soluble suppression of tumorigenicity 2 (sST2) are inflammation biomarkers linked to HF. Methods: We investigated associations between EATv, inflammation biomarkers, and the effect of metabolic control in 14 healthy controls (HCs) and 36 newly diagnosed T2D patients both before (poor glycemic control, PGC) and after 12 months of glycemic optimization (good glycemic control, GGC). EATv indexed to body surface area (iEATv) was quantified by multidetector computed tomography, and biomarker levels were measured by immunoassays. Results: PGC patients had higher iEATv (59.53 ± 21.67 vs. 36.84 ± 16.57 cm³/m², p = 0.0017) and elevated GDF15, Galectin-3, and sST2 levels (all p < 0.05) than HC subjects. The glycemic optimization reduced iEATv (p = 0.0232) and sST2 (p = 0.048), while GDF15 and Galectin-3 remained unchanged. Multivariable analysis confirmed independent associations between iEATv, GDF15 (β = 0.27, p = 0.027) and sST2 (β = 0.29, p = 0.02). Conclusions: These results support the link between systemic inflammation, EAT expansion, and cardiac dysfunction, and they point to the role of epicardial fat in early HF risk of T2D patients. Full article