Obesity is a global epidemic that has rapidly increased in prevalence in East Asian countries. Complications of obesity, such as metabolic dysfunction-associated steatohepatitis (MASH), have increased in parallel with the recent rise in obesity. Rapidly aging populations, increasingly Westernized lifestyles, and a likelihood of developing higher-risk fat types (e.g., visceral adipose tissue) all play a role in the rising influence of obesity and MASH in East Asian populations. Additionally, East Asian patients are at high risk for developing lean MASH at lower body mass indexes than are common in Western populations. Tools to specifically detect and diagnose MASH in East Asia are lacking. Non-invasive tests (NITs) used globally to detect MASH have inadequate evidence of efficacy in East Asian populations. Current treatment strategies are also inadequate, with East Asian patients largely underrepresented in obesity and MASH clinical trials. Given large, diverse healthcare systems and a lack of awareness and infrastructure to support prevention and long-term management, obesity and MASH are rapidly becoming serious public health concerns in these countries. Therefore, both patients and physicians need better awareness of obesity and MASH, improved access to NITs to diagnose MASH, and more effective treatment options than they currently have. Educational methods should be developed to improve awareness, and more clinical studies of NITs and treatments in East Asian populations are needed.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve glycemic control and confer cardiovascular and renal benefits in individuals with type 2 diabetes mellitus (T2DM) partly by promoting urinary glucose excretion and modulating energy metabolism. However, the clinical relevance of ketogenesis induced by SGLT2 inhibitors remains unclear. This retrospective cohort study was conducted at the Seoul National University Bundang Hospital, South Korea. In total, 151 adults with T2DM who were newly treated with SGLT2 inhibitors (empagliflozin or dapagliflozin) between November 2021 and June 2024 were enrolled. Glycemic parameters (glycosylated hemoglobin [HbA1c], body mass index [BMI], and fasting plasma glucose [FPG]) as well as metabolic profiles (lipid profile, renal function, and hepatic function) were assessed at baseline and after 6 months of treatment. The participants were stratified into tertiles based on the relative increase in serum ketone levels. SGLT2 inhibitor treatment significantly improved HbA1c, FPG, BMI, insulin sensitivity, and the lipid profile. Mean serum ketone levels increased from 93±69 to 174±173 μmol/L (P<0.001), although with substantial inter-individual variability. Although ketone elevation did not independently predict HbA1c reduction, participants with elevated ketone responses exhibited enhanced FPG reduction, higher urinary glucose excretion, and favorable triglyceride reduction, suggesting metabolic benefits. A moderate decline in kidney function was also observed in these participants. Ketogenesis did not independently predict HbA1c reduction; however, elevated ketone levels following SGLT2 inhibitor treatment were associated with favorable metabolic adaptations, suggesting potential extra-glycemic benefits.

Amylin is a pancreatic peptide hormone that regulates blood glucose levels and appetite. This review outlines the physiological role of amylin and highlights recent clinical studies exploring its therapeutic potential in diabetes and obesity. Amylin lowers postprandial glucose levels by delaying gastric emptying and suppressing glucagon secretion, while promoting satiety via central nervous system pathways. Preclinical research has driven the development of long-acting amylin analogs with enhanced pharmacokinetics and reduced aggregation, resulting in significant weight loss and metabolic benefits in animal models. Clinically, the synthetic analog pramlintide has been shown to modestly improve glycemic control and induce weight loss in patients with diabetes. More recently, cagrilintide, a long-acting analog, has produced substantial weight reduction in individuals with obesity. Combination therapy with glucagon like peptide-1 receptor agonists has achieved synergistic effects, with weight loss exceeding 15%, positioning amylin analogs as a promising approach for treatment of diabesity—the co-existence of diabetes and obesity. This review summarizes recent advancements and discusses their implications for future therapeutic applications in diabesity management.

BackgroundThis study was conducted to examine the association of body mass index (BMI)-adjusted body cell mass (BCM; BCMbmi) and lean body mass (LBM; LBMbmi) with metabolic markers, metabolic syndrome (MetS), and insulin resistance (IR) in middle-aged and older Korean adults.MethodsThis cross-sectional study included 9,522 adults (4,456 males and 5,066 females) without a history of myocardial infarction, stroke, or cancer from the Ansan-Ansung Study of the Korean Genome and Epidemiology Study. Multivariable linear regression was conducted to evaluate the association of BCMbmi and LBMbmi with metabolic markers. Logistic regression analyses were conducted to evaluate the association of BCMbmi and LBMbmi with metabolic abnormalities, including MetS and IR. MetS diagnosis followed National Cholesterol Education Program Adult Treatment Panel III criteria, and IR was assessed using the homeostatic model assessment index of insulin resistance (HOMA-IR).ResultsBCMbmi and LBMbmi were negatively associated with fasting glucose, fasting insulin, HOMA-IR, triglycerides, alanine/aspartate aminotransferase, uric acid, and high-sensitivity C-reactive protein, while they were positively associated with high-density lipoprotein cholesterol. The magnitudes of regression coefficients were generally greater for BCMbmi than for LBMbmi. A total of 3,590 (37.7%) and 3,490 (36.7%) participants were categorized as having MetS and IR. Compared to the lowest tertile of BCMbmi, the highest tertiles were associated with lower odds ratio of MetS (males: 0.36 [95% confidence interval, CI, 0.30 to 0.42], females: 0.23 [95% CI, 0.20 to 0.27]) and IR (males: 0.34 [95% CI, 0.30 to 0.40], females: 0.33 [95% CI, 0.28 to 0.38]), all with significant trends (P for trend <0.001).ConclusionThe results suggest that BCMbmi is independently associated with metabolic markers and demonstrate comparable predictive power to LBMbmi for MetS and IR, particularly in males.

Obesity promotes carcinogenesis through interlocking metabolic, inflammatory, immune, and hormonal pathways. We narratively synthesize recent meta-analyses and selected cohort studies that examine adiposity—principally body mass index (BMI) and waist circumference—in relation to cancer incidence. Across the 13 cancers designated by the U.S. National Cancer Institute as obesity-associated, risk elevations are generally consistent, though magnitudes vary by histology (e.g., esophageal adenocarcinoma vs. squamous cell carcinoma), anatomic subsite (gastric cardia vs. non-cardia), sex or menopausal status, and adiposity metric, with central adiposity often revealing additional risk beyond BMI. Evidence is mixed for several sites (e.g., pancreas and thyroid), and emerging but less established signals are noted for oral cavity, melanoma, bladder, non-Hodgkin lymphoma, and leukemia. We also review prevention data: observational studies and select trials suggest that intentional weight loss—via lifestyle interventions, pharmacotherapy (including glucagon-like peptide-1 receptor agonists), or bariatric surgery—can reduce overall or site-specific cancer incidence, although estimates are heterogeneous and causal certainty is limited. Taken together, biologic plausibility and convergent epidemiology support obesity as a modifiable cancer risk factor. Future studies are warranted using standardized exposure definitions, consistent stratification, and rigorous control of confounding to improve comparability. Adequately powered, long-term randomized or quasi-experimental studies may further refine effect sizes and inform precision prevention for obesity-related cancers.

Bariatric surgery (BS) is an effective intervention for morbid obesity; however, it is often accompanied by undesirable muscle mass loss, which can negatively affect metabolic function and physical performance. Probiotics and resistance training have been studied discretely to address this complication. The present randomized controlled trial investigated the independent and combined effects of probiotic-enriched yogurt and resistance training on muscle preservation and related health outcomes in post-BS patients. In this parallel, randomized controlled trial, 52 participants who had recently undergone BS and met the eligibility criteria were randomly assigned to one of four groups: group A (probiotic-enriched yogurt plus resistance training [FY+RT]), group B (probiotic-enriched yogurt [FY]), group C (resistance training [RT]), and group D (control), with 13 participants in each group. Anthropometric indices, body composition, functional performance, inflammatory and oxidative stress markers, lipid profile, and liver enzymes were measured at baseline and after a 12-week intervention. All participants completed the intervention. The FY+RT group showed the greatest preservation of muscle mass, with the smallest reductions in fat-free mass percentage (-2.32%, P=0.001) and skeletal muscle mass (-1.34 kg, P<0.001). This group also exhibited significant improvements in muscle strength, as measured by hand grip strength (P=0.038) and 30-second chair stand test repetitions (P<0.001). The combination of probiotic-enriched yogurt and resistance training was the most effective strategy for preserving muscle mass and improving strength following BS. Further research is warranted to elucidate the underlying mechanisms and validate these findings.

Current evidence concerning a link between metabolic phenotypes and their dynamic changes over time and the risk of cancer is limited. The present study aimed to assess the association between different metabolic health statuses and the risk of cancer occurrence among adult individuals. This prospective cohort study enrolled 11,445 adults aged ≥18 years from the Tehran Lipid and Glucose Study and followed them for 18 years. We identified metabolic phenotypes based on the Joint Interim Statement. Accordingly, participants were divided into four groups: metabolically healthy normal weight/overweight (MHNW/OW), metabolically unhealthy normal weight (MUNW)/OW, metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUO). Cox proportional hazards modeling was performed to assess the association between metabolic phenotype and the risk of cancer occurrence. The multivariable adjusted hazard ratio (HR) (95% confidence interval [CI]) for cancer risk in participants with the MUNW/OW phenotype was 1.37 (95% CI, 1.04 to 1.82) and that in those with the MUO phenotype was 1.84 (95% CI, 1.21 to 2.79) when compared to those with the MHNW/OW phenotype, respectively. More particularly, the risk of breast cancer was higher in women with the MHO phenotype (HR, 3.60; 95% CI, 1.34 to 9.60) as well as those with the MUO phenotype (HR, 4.69; 95% CI, 1.96 to 11.20) relative to those with the MHNW/OW phenotype. Ultimately, however, we found no relationship between phenotype transition and the risk of cancer occurrence. Based on our findings, metabolically unhealthy phenotypes may be associated with a higher overall incidence of cancer. In addition, obesity, independent of metabolic status, was linked to an increased risk of breast cancer incidence. No association between the transition from a metabolically healthy to unhealthy phenotype and cancer risk was established.

Reduced handgrip strength (HGS) is associated with adverse cardiometabolic outcomes. This study aimed to determine reference values for HGS among Korean youth and young adults and to evaluate their relationships with metabolic syndrome (MS). We analyzed data from 9,024 individuals aged 10 to 29 years in the Korean National Health and Nutrition Examination Survey (2014-2019). The adjusted combined handgrip strength (aCHGS; the average of maximum values from the two hands divided by body weight) was used as the primary outcome variable. Percentile curves for aCHGS were generated using the LMS method and locally estimated scatterplot smoothing regression analysis, excluding outliers. Associations between aCHGS z-scores and MS were assessed. Percentile curves for aCHGS plateaued after 20 years in both sexes. At age 10 years, aCHGS was comparable between males and females. Males showed a marked rise in aCHGS after mid-adolescence, maintaining higher levels thereafter. The adjusted odds ratio for MS was 0.313 (95% confidence interval [CI], 0.276 to 0.354) using International Diabetes Federation (IDF) criteria and 0.348 (95% CI, 0.310 to 0.390) using modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. aCHGS z-scores demonstrated strong predictive power for MS (area under the curve, 0.802 for IDF and 0.776 for modified NCEP-ATP III criteria). The optimal aCHGS z-score cutoff values for predicting MS were -0.508 (IDF) and -0.519 (modified NCEP-ATP III). We established age- and sex-specific aCHGS reference values among Korean youth and young adults, demonstrating effectiveness in predicting MS risk. These standards may serve as a practical clinical tool to identify individuals at increased risk of MS early in development.