Chronic Energy Research Articles

Analysis of maternal factors and food security with the incidence of stunting in children 0-59 months of age in Sungai Penuh City

The high incidence of stunting is the leading cause of death in children under five in the world. One of the urban areas in Indonesia that has experienced an increase in the prevalence of stunting is Sungai Penuh City. Stunting is caused by a long-term nutritional deficiency in the mother due to inadequate food supply due to low household food security, besides that stunting can also occur due to the reproductive condition of the mother who is not ready to conceive. This cross-sectional study aims to analyze maternal factors and food security that have the most influence on the incidence of stunting in toddlers aged 0-59 months in Sungai Penuh City using data from the 2022 Indonesian Nutrition Status Survey conducted in August-September 2022. The sample was 308 toddlers living in urban areas. The data were analyzed using descriptive non-parametric statistical tests with the Chi-square test and the Logistic Regression test. The results of this study prove that short maternal stature has a significant relationship with the incidence of stunting in toddlers (p<0.05), while chronic energy deficiency mothers, maternal age, and food security do not have a significant relationship with the incidence of stunting in toddlers in urban areas (p>0.05). Maternal short stature is an indicator of past chronic malnutrition and a major predictor of stunting in children under five.

Diet and Nutritional Status of Women of Reproductive Age (15-49 Years) in Indigenous Communities of Attappady, Kerala, India.

The dietary patterns and quality of diets of women of reproductive age (WRA) significantly affect their health and that of their children. The suboptimal diet among women can lead to issues such as intrauterine growth retardation, low birth weight, premature birth, and malnutrition. To examine the dietary patterns and nutrient intake of WRA in the indigenous communities of the Attappady tribal block in Kerala, we conducted a cross-sectional study in 20 randomly selected villages in 2022. The study involved 24 h dietary recall surveys, anthropometric measurements, and estimation of hemoglobin concentration to assess nutrient intake and nutritional status. A total of 446 women aged 15-49 from 423 households participated, with 92 households included in the diet survey. The findings indicated that the diet was primarily based on cereals and root-based starchy staples, with low consumption of dairy products, fruits, and vegetables. The estimated intakes of major nutrients, except for protein, were lower than the recommended dietary allowance (RDA). Nearly 50% of the WRA were malnourished. About 32% of non-pregnant and non-lactating (NPNL) women and 40% of lactating mothers suffered from chronic energy deficiency (BMI < 18.5 kg/m2). Conversely, 13.4% of NPNL women and 15% of lactating mothers were overweight or obese (BMI ≥ 25 kg/m2). A total of 12.5% of adolescent girls aged 15-19 were thin (BAZ < -2 SD), and 10.5% were overweight or obese (BAZ > +1 SD). Since the co-existence of micronutrient deficiencies and undernutrition is rooted in the socio-cultural aspects of indigenous tribes, a culturally sensitive nutrition intervention model would be appropriate for the better health and wellbeing of women in the community.

Improving the Nutritional Status of Pregnant Women Who Experience Chronic Energy Deficiency with Spirulina Platensis

The highest prevalence of chronic energy deficiency (CED) in pregnancy occurs in the third trimester of pregnancy. The impacts that occur are abortion, premature birth, premature rupture of membranes, histitis, postpartum hemorrhage, and low birth weight (LBW). To prevent negative impacts, giving Spirulina Platensis is believed to improve nutritional status. This study aimed to analyze the effect of spirulina platensis extract on improving nutritional status in pregnant women. Using a Quasi-Experiment with a pretest and posttest control group design with a sample of 60 participants consisting of an intervention group of n=30 participants and a control group of n=30 participants. The intervention group received treatment, namely being given Spirulina Platensis extract, 1 capsule containing 300 mg, taken once for 30 days and standard care, while the control group received standard care only. The sampling technique used was simple side random. Chi-Square test results in the intervention group mean pretest nutritional status (m=22.04, SD=1.170) and posttest (m=23.33, SD=0.922) p-value=0.000, while the control group showed pretest nutritional status (m=22.16, SD=1.104) and posttest (m=22.39, SD=1.016) p-value=0.150. The difference between the mean posttest nutritional status in the experimental and control groups shows (m=23.33, SD=0.922) vs (m=22.39, SD=1.016) p-value=0.000. There is an increase in the administration of Spirulina Platensis extract on the nutritional status of pregnant women. As input for health workers, especially midwives, to provide non-pharmacological therapy to pregnant women who experience chronic energy deficiency (CED) by administering Spirulina Platensis.

Upaya Edukasi Ibu Hamil Dalam Mengenali Kurang Energi Kronis (KEK) Melalui Faktor Risiko

Chronic Energy Deficiency is a condition of a person's nutritional status which is caused because the source of intake they receive does not meet their daily and sustainable needs. The nutritional needs of pregnant women have increased and if this is not met in the short and long term it can result in chronic energy deficiency. The aim of this research is to determine the mother's level of knowledge in detecting CED. Based on the results of the Chi Square test, it was found that the value of p = 0.000 &lt; α (0.05) for the variables of pregnancy distance and income showed that there was a significant relationship that influenced the incidence of chronic energy deficiency (CED) in pregnant women, while the variables of parity, education and employment showed that there was none. significant relationship that influences the incidence of chronic energy deficiency (CED) in pregnant women. The results of the activity showed that the activity to increase knowledge of pregnant women in detecting chronic energy deficiency (KEK) through risk factors in the Saigon City Health Center area, Pontianak City, ran smoothly. There was an increase in knowledge of pregnant women between before and after being given counseling by 20 points.

Longitudinal proteomics of leptin treatment in humans with acute and chronic energy deficiency-induced hypoleptinemia reveal novel, mainly immune-related, pleiotropic effects

BackgroundLeptin is known for its metabolic, immunomodulatory and neuroendocrine properties, but the full spectrum of molecules downstream of leptin and relevant underlying mechanisms remain to be fully clarified. Our objective was to identify proteins and pathways influenced by leptin through untargeted proteomics in two clinical trials involving leptin administration in lean individuals. MethodsWe performed untargeted liquid chromatography-tandem mass spectrometry serum proteomics across two studies a) Short-term randomized controlled crossover study of lean male and female humans undergoing a 72-h fast with concurrent administration of either placebo or high-dose leptin; b) Long-term (36-week) randomized controlled trial of leptin replacement therapy in human females with acquired relative energy deficiency and hypoleptinemia. We explored longitudinal proteomic changes and run adjusted mixed models followed by post-hoc tests. We further attempted to identify ontological pathways modulated during each experimental condition and/or comparison, through integrated qualitative pathway and enrichment analyses. We also explored dynamic longitudinal relationships between the circulating proteome with clinical and hormonal outcomes. Results289 and 357 unique proteins were identified per each respective study. Short-term leptin administration during fasting markedly upregulated several proinflammatory molecules, notably C-reactive protein (CRP) and cluster of differentiation (CD) 14, and downregulated lecithin cholesterol acyltransferase and several immunoglobulin variable chains, in contrast with placebo, which produced minimal changes. Quantitative pathway enrichment further indicated an upregulation of the acute phase response and downregulation of immunoglobulin- and B cell-mediated immunity by leptin. These changes were independent of participants' biological sex. In the long term study, leptin likewise robustly and persistently upregulated proteins of the acute phase response, and downregulated immunoglobulin-mediated immunity. Leptin also significantly and differentially affected a wide array of proteins related to immune function, defense response, coagulation, and inflammation compared with placebo. These changes were more notable at the 24-week visit, coinciding with the highest measured levels of serum leptin. We further identified distinct co-regulated clusters of proteins and clinical features during leptin administration indicating robust longitudinal correlations between the regulation of immunoglobulins, immune-related molecules, serpins (including cortisol and thyroxine-binding globulins), lipid transport molecules and growth factors, in contrast with placebo, which did not produce similar associations. ConclusionsThese high-throughput longitudinal results provide unique functional insights into leptin physiology, and pave the way for affinity-based proteomic analyses measuring several thousands of molecules, that will confirm these data and may fully delineate underlying mechanisms.

Sodium butyrate improves renal injury in diabetic nephropathy through AMPK/SIRT1/PGC-1α signaling pathway

Diabetic nephropathy (DN) is a prototypical chronic energy metabolism imbalance disease. The AMPK/Sirt1/PGC-1α signaling pathway plays a pivotal role in regulating energy metabolism throughout the body. Gut microbiota ferment indigestible carbohydrates to produce a variety of metabolites, particularly short-chain fatty acids (SCFAs), which exert positive effects on energy metabolism. However, the potential for SCFAs to ameliorate DN-associated renal injury via the AMPK/Sirt1/PGC-1α pathway remains a matter of debate. In this study, we investigated the effects of sodium butyrate (NaB), a SCFA, on energy metabolism in mice with spontaneous DN at two different doses. Body weight, blood glucose and lipid levels, urinary protein excretion, liver and kidney function, interleukin-6 (IL-6) levels, and the expressions of AMPK, phosphorylated AMPK (p-AMPK), mitofusin 2 (MFN2), optic atrophy 1 (OPA1), and glucagon-like peptide-1 receptor (GLP-1R) were monitored in mice. Additionally, butyrate levels, gut microbiota composition, and diversity in colonic stool were also assessed. Our findings demonstrate that exogenous NaB supplementation can improve hyperglycemia and albuminuria, reduce renal tissue inflammation, inhibit extracellular matrix accumulation and glomerular hypertrophy, and could alter the gut microbiota composition in DN. Furthermore, NaB was found to upregulate the expressions of MFN2, OPA1, p-AMPK, and GLP-1R in DN renal tissue. These results suggest that NaB could improve the composition of gut microbiota in DN, activate the AMPK/Sirt1/PGC-1α signaling pathway, and enhance mitochondrial function to regulate energy metabolism throughout the body. Collectively, our findings indicate that NaB may be a novel therapeutic agent for the treatment of DN.

The Relationship Of Chronic Energy Deficiency (Ced) In Pregnant Women With The Incident Of Low Birth Weight

The Relationship Of Chronic Energy Deficiency (Ced) In Pregnant Women With The Incident Of Low Birth Weight

Analisis Kandungan Gizi dan Daya Terima Cookies Substitusi Tepung Ikan Gabus dan Tepung Kacang Hijau

Chronic Energy Deficiency (CED) is a state of malnutrition caused by a lack of food intake for a long time impact to health problems, especially in pregnant women. Malnutrition for a long time in pregnant women impact on inhibiting the growth and development of the fetus. One of the supplementary feeding for pregnant women is cookies. This study aims to determine the nutritional content and acceptability of cookies substituting snakehead fish flour and mung bean flour as an alternative PMT for pregnant women with CED. This study used True Experimental with Completely Randomized Design (CRD), 4 levels of treatment and 6 times of replication. The treatment applied was the ratio of wheat flour : snakehead fish flour : mung bean flour at each P0 (100:0:0), P1 (80:10:10), P2 (70:15:15), P3 (60 :20:20). The results showed that there was an effect of increasing levels of protein, fat, ash, water, Fe, and decreasing levels of carbohydrates. There was a significant effect on the organoleptic quality as shown by the Kruskall-Wallis test (p &lt;0.005) and continued with the Mann-Whitney follow-up test which showed that there were differences in all treatments. The conclusion of this study is that cookies substituted for snakehead fish flour and mung bean flour have an effect on nutritional value and organoleptic quality.

Presentasi Bokong dan Kek

The Maternal Mortality Rate (MMR) in Tegal Regency in 2022 reached a high number, namely 27 cases, 13 of which occurred during the postpartum period, 10 cases during pregnancy, 4 cases during childbirth. Based on data obtained from the Lebaksiu Community Health Center from September to October 2023, there were no maternal and infant deaths. The number of pregnant women at high risk was 115 cases. These include pregnant women with breech presentation, Chronic Energy Deficiency (CED), age &lt; 20 years, age &gt; 35 years, child spacing &lt; 2, history of CS, TB &lt; 145 cm, HBSAg (+), HIV (+), anemia, history asthma, grand multipara, history of abortion, history of PEB and syphilis (+). The aim of this study was to examine obstetric cases with breech presentation and CED. This research uses a case study approach. The research subject was pregnant mother Mrs. S is 24 years old with breech presentation and CED. Data was taken from September to November 2023. Data was taken using interviews, observation and documentation, the results during the subject's pregnancy were successful in making the pregnancy normal. However, during labor, fetal hypoxia was experienced, so collaboration was carried out with the doctor, after management was carried out according to the doctor's advice, the fetal condition was normal and a SC delivery was carried out. During the postpartum period and the newborn is in normal and healthy condition. Suggestion: it is hoped that if a similar case is found there needs to be collaboration with doctors during pregnancy until postpartum, apart from that it is necessary to involve the family during pregnancy until postpartum.

Factors affecting stunting in children aged 6-23 months in South Sumatra Province, Indonesia

Introduction: South Sumatra Province in Indonesia has a relatively high prevalence of stunting and there is limited research about this phenomenon in this area. The study aimed to identify what factors affected stunting in children aged 6-23 months in the province. Methods: Using a comparative cross-sectional design involving 139 mothers with children aged 6-23 months, the study collected data from September to December 2022 via anthropometric measurements and interviews using a questionnaire. Data on parental, child, socioeconomic, and environmental factors were analysed using chi-square test and logistic regression analysis. Results: Overall, there were significant relationships among the following variables: child’s age (p=0.031), birth length (p=0.017), and weight-for-age (WAZ) status (p&lt;0.001) with stunting. Children in the underweight and severely underweight categories were 28.7 times at risk of stunting compared to those in the normal category of WAZ status; children aged 12-23 months had a 2.8 times risk of stunting compared to children aged 6-11 months, while stunted birth length showed a 4.6 times risk of stunting compared to that of normal birth length. Conclusion: This research found that child age, birth length, and WAZ status were significant factors affecting stunting in the South Sumatra Province. Given these results, this study offers recommendations for the provincial government to focus on intervention programmes that provide additional food for pregnant women with chronic energy deficiency, monitor the growth of toddlers, and manage toddlers with nutritional problems in this province.

Formative research to understand food beliefs and practices relating to pregnancy on Kei Besar Island, Eastern Indonesia

BackgroundFood-related beliefs and practices during pregnancy may contribute to the high prevalence of chronic energy deficiencies (CED) in Eastern Indonesia, particularly in Southeast Maluku regency, where 21.33% of pregnant women experience CED. Currently, little information on these issues is available. This study investigates food beliefs and practices related to pregnancy on Kei Besar Island in the Maluku province of Eastern Indonesia.MethodsA qualitative study was conducted utilizing in-depth interviews, free lists, and pile sort exercises. Data collection was conducted in January 2023 and involved married pregnant women aged 18 and above (n = 12), community health volunteers (n = 2), and traditional healers (n = 3) from 9 villages in Kei Besar District. All participants must be natives of Kei Besar Island, with community health volunteers and traditional healers being respective figures recommended by the local villagers.ResultsThe need to avoid or minimize consumption of certain foods during pregnancy, such as some kinds of fish, chili and spicy food, soda, pineapples, octopus, squid, and ice was reported by more than one-third of all participants. Consumption of prescribed foods, such as cassava leaves, papaya, coconut water, rice during early pregnancies, moringa leaves, bananas, and katok leaves was reported by five or more participants. These food proscriptions and prescriptions were due to concerns about the risks of miscarriage, adverse effects on the fetus and mother, and complications during labor. Participants also reported other practices, such as eating for two during early pregnancy and reducing food intake in late pregnancy. We found that food beliefs have shaped the dietary patterns of most participants. However, they still consumed food recommended by community health volunteers and midwives.ConclusionsFood beliefs are present and practiced in the Kei Besar community and may impact the nutritional status of women and their infants. Interventions should target training healthcare providers and community health volunteers to provide culturally appropriate health education that incorporates prescribed local ingredients and provides nutritionally adequate substitutes for the proscribed food items.Trial RegistrationNot applicable.

Risk Factor Analysis of Stunting in Children Aged 6-23 Months in Tanralili District, Maros Regency, Indonesia

Background: The high rate of stunting is still a nutritional problem in children in Indonesia which has an impact on the quality of future generations. The study aims to determine the risk factors for stunting in children aged 6-23 months in Tanralili District, Maros Regency. Methodology: This study used a case control study design. The sampling technique uses the side exhaustive method with a ratio of 1: 1, as many as 260 samples consisting of 130 cases and 130 controls. Stata program version 17 is used for data analysis. Results: Risk factors associated with stunting were maternal age &lt;20 or 35 years (OR=1.953), lower-middle family income (OR=1.947), antenatal care &lt;4 visits (OR=1,820), anemia (OR=2.252), chronic energy deficiency (OR=2.261), low birth weight (OR=2,595), exclusive breastfeeding (OR=2.448), poor home sanitation (OR=2.226;). Working mothers are a protective factor against stunting (OR=0.819). Multivariate analysis shows that exclusive breastfeeding is the dominant risk factor for stunting. Conclusion: Risk factors for stunting come from mother, child, as well as environmental and family economic factors. The need for integrated and multisectoral programs to increase family income, access to proper home sanitation, maternal education on pregnancy and nutrition and exclusive breastfeeding to reduce the incidence of stunting.

Implementation of Specific Nutrition Interventions to Prevent Stunting in Pregnant Women in the Oesapa Community Health Center Area East Nusa Tenggara

Policies related to stunting prevention have been in place since 2013. However, the prevalence of stunting in East Nusa Tenggara Province is still the highest in Indonesia from 2013 to 2022. One of the areas in the province where the prevalence decreased from 2021 to 2022 is Kupang City. Oesapa Community Health Centre was appointed by the Indonesian Ministry of Health as a pilot health centre representing Kupang City. The purpose of this study is to describe the implementation of specific nutritional interventions for handling stunting based on the variables of communication, bureaucratic structure, resources, and disposition in the target group of pregnant women which will be associated with the target achievement of specific nutritional interventions based on Presidential Regulation No 72 of 2021. The research used qualitative methods with triangulation of informants totalling 5 people, data triangulation, and triangulation of methods, namely in-depth interviews and observations. The results showed that interventions in the form of providing additional food to pregnant women with chronic energy deficiency conditions and pregnant women who consume blood supplement tablets at least 90 tablets during pregnancy have successfully reached the target. Other Community Health Centres can make the Oesapa Community Health Centre a barometer in providing health services, especially in specific nutrition interventions aimed at target groups of pregnant women so that they work together in accelerating the reduction in stunting prevalence.

The Effect of the Implementation of the Supplementary Feeding Consumption Compliance Card on the Compliance Level Among Pregnant Women at the North Ponorogo Health Center

Background: Chronic Energy Deficiency (CED) is the cause of non-obstetric medical complications in pregnancy that occurs over a long period of time. The Providing Additional Food (PAF) program for vulnerable pregnant women is a supplementation strategy in overcoming nutritional problems, but the program has not been able to run well, based on observations made and also interviews with officers, it is known that some pregnant women have not been regular in consuming PAF biscuits. Researchers want to know the effect of implementing the PAF consumption compliance card on the level of compliance of CED pregnant women at the North Ponorogo Community Health Center. Methods: This study uses an experimental research method. The research design with a pre-experimental approach is in the form of a one-group pretest-posttest design. The sample was taken using the total population sampling technique. The independent variable in this study was the implementation of the PAF consumption compliance card while the dependent variable was the level of compliance of CED pregnant women consuming PAF. Data collection uses interviews and obedient cards as instruments. Data analysis was carried out by normality test and the result of a p value of &gt; 0.05 could be carried out, then the Paired Sample t-Test could be carried out to find out if there was a difference. Results: The results of the Paired samples t-test showed that there was a difference in the compliance of CED pregnant women before and after being given an obedience card, which can be seen at the value of p = 0.0001473. Conclusions: It can be concluded that compliance cards have proven effective in increasing the compliance of CED pregnant women in consuming PAF. Therefore, it is recommended to implement compliance cards as a reminder and monitor for pregnant women regarding PAF consumption.

Efforts to Prevent Chronic Energy Deficiency Through Leaflet-Giving Education to Teenagers

Efforts to Prevent Chronic Energy Deficiency Through Leaflet-Giving Education to Teenagers

Prevalence of Association of Dietary Habits with Chronic Energy Deficiency in Ethnic Adult Punjabi Population

Background: Food is a basic thing without which, life is impossible. Without proper food, body will not thrive to its optimum potential and Chronic Energy Deficiency (CED) is the state, where there is a lack of food intake over a prolonged period of time. Aims &amp; Objectives: To find the association of dietary habits with CED in ethnic Punjabi population. Methodology: The study was a cross-sectional study using simple random sampling technique. Taking the prevalence of CED as 30% in India, the sample size came out to be 336 but, 400 subjects were selected equally from rural and urban areas for convenience. Results: Subjects having lesser calorie intake than RDA, developed CED more 62(82.9%) than meeting RDA 13(17.1%). Subjects who skipped meals had higher CED rates. Pure vegetarians had higher rates of CED 71(93.4%) than non-vegetarians 5(6.6%). People consuming milk or milk products more than once daily developed lesser CED 1(1.3%) than those taking once daily 15(19.7%) and ones taking only once a week 60(79.0%). Conclusion: According to the study, persons with adequate calorie intake, who do not skip meals, take some kind of non-vegetarian food, and consume milk on daily basis have lesser tendency to develop CED.

Nutritional Optimization: Chronic Energy Deficiency Intervention for Pregnant Women by Consuming Sandwich Biscuits and Chicken Eggs

Introduction: Chronic Energy Deficiency (CED) is a prolonged nutritional condition resulting from insufficient energy intake, which can increase the risk of anemia, preeclampsia, infections, and impaired fetal growth. CED also contributes to preterm birth, low birth weight (LBW), and congenital anomalies and raises the risk of cognitive decline and chronic diseases later in life. Objective: To explore the effectiveness of nutritional optimization through consuming sandwich biscuits and boiled eggs among pregnant women with CED. Method: This study employed a true experimental design with two pretest-posttest groups, involving 20 pregnant women in their second and third trimesters with CED. The intervention group (n=10) consumed 3 sandwich biscuits and 2 boiled eggs daily, while the control group (n=10) consumed 3 sandwich biscuits daily, both for 30 days. Measurements included upper arm circumference (UAC) and body weight (BW), analyzed using independent t-tests and paired t-tests. Results: The intervention group showed a significant increase in UAC (from 22.1 to 23.9 cm) and BW (from 43.2 to 45.4 kg), with mean differences of 1.8 cm and 2.2 kg, respectively (p=0.000). The control group also showed significant increases in UAC (from 22.2 to 23.6 cm) and BW (from 43.8 to 45.3 kg), with mean differences of 1.4 cm and 1.5 kg, respectively (p=0.000). Conclusion: The combined consumption of sandwich biscuits and boiled eggs significantly improves UAC and BW, indicating its potential to reduce CED risk in pregnant women. Further research is needed to understand better CED, particularly in relation to UAC and BW changes.

Determinants and Model for Estimating the Prevalence of Stunting Toddlers in Sleman Regency

Background: The Sleman Regency Government is committed to solving the stunting problem by implementing an integrated stunting prevention program by encouraging the participation of penta-helix. Estimating stunting prevalence accomplishment targets is crucial for measuring progress, guiding strategies, and ensuring stunting reduction success. This study aims to provide information regarding the factors that contribute to the prevalence of stunted toddlers and develop a predictive model for that prevalence. Methods: The study investigated the prevalence of stunting, wasting, and underweight in Sleman Regency using publicly accessible reports, secondary data, and reputable websites. Data was gathered through audits of stunting cases and factors from district-level program managers, and analysed through desk reviews. This research was conducted in Sleman Regency from December 2023 to February 2024. Results: The investigation found that stunting is linked to family smoking, inadequate toddler nutrition, inactive JKN, chronic energy deficiency throughout pregnancy, and low-weight, preterm births. Through rules, policies, and multisectoral multistakeholder collaboration, the Sleman Regency Government aims to reduce stunting. The interventions include maternal and child health, nutritional counselling, drinking water and sanitation, early childhood education, and pre-conception family life preparation. A model to estimate long-term stunting prevalence is needed to track trends, evaluate interventions, and support evidence-based decision-making. Stunting is vital to public health and economic benefit. Based on audit data, child nutrition trends, and prediction models, Sleman Regency should reduce stunting by 0.02% per year for local data and 0.5% per year for national data. The determinants of stunting in Sleman Regency are very diverse, including problems related to nutrition and non-nutrition. Conclusion: Stunting prevention is focused on efforts to overcome habits, improve the nutritional status of pregnant women and optimize better pregnancy outcomes. Based on the analysis, the stunting reduction target was determined based on national and local surveys of 0.5% and 0.02% per year, respectively.Keywords: Under five children; estimation model; prevalence; stunting

Remission of type 2 diabetes: position statement of the Italian society of diabetes (SID)

AbstractThe primary cause of the pandemic scale of type 2 diabetes (T2D) is the excessive and/or abnormal accumulation of adiposity resulting from a chronic positive energy balance. Any form of weight loss dramatically affects the natural history of T2D, favoring prevention, treatment, and even remission in the case of significant weight loss. However, weight regain, which is often accompanied by the recurrence or worsening of obesity complications such as T2D, is an inevitable biological phenomenon that is an integral part of the pathophysiology of obesity. This can occur not only after weight loss, but also during obesity treatment if it is not effective enough to counteract the physiological responses aimed at restoring adiposity to its pre-weight-loss equilibrium state. Over the past few years, many controlled and randomized studies have suggested a superior efficacy of bariatric surgery compared to conventional therapy in terms of weight loss, glycemic control, and rates of T2D remission. Recently, the therapeutic armamentarium in the field of diabetology has been enriched with new antihyperglycemic drugs with considerable efficacy in reducing body weight, which could play a pathogenetic role in the remission of T2D, not through the classical incretin effect, but by improving adipose tissue functions. All these concepts are discussed in this position statement, which aims to deepen the pathogenetic links between obesity and T2D, shift the paradigm from a “simple” interaction between insulin resistance and insulin deficiency, and evaluate the efficacy of different therapeutic interventions to improve T2D management and induce diabetes remission whenever still possible.

Total and H-specific GDF-15 levels increase in caloric deprivation independently of leptin in humans

Mitochondrial-secreted growth differentiation factor-15 (GDF-15) promotes weight loss in animals. Its effects in humans remain unclear, due to limited research and potential measurement interference from the H202D-variant. Our post-hoc analysis investigates total (irrespective of genetic variants) and H-specific GDF-15 (detected only in H202D-variant absence) in humans under acute and chronic energy deprivation, examining GDF-15 interaction with leptin (energy homeostasis regulator) and GDF-15 biologic activity modulation by the H202D-variant. Total and H-specific GDF-15 increased with acute starvation, and total GDF-15 increased with chronic energy deprivation, compared with healthy subjects and regardless of leptin repletion. Baseline GDF-15 positively correlated with triglyceride-rich particles and lipoproteins. During acute metabolic stress, GDF-15 associations with metabolites/lipids appeared to differ in subjects with the H202D-variant. Our findings suggest GDF-15 increases with energy deprivation in humans, questioning its proposed weight loss and suggesting its function as a mitokine, reflecting or mediating metabolic stress response.