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Japan: A large-scale Japanese study has uncovered complex relationships between body mass index (BMI), waist circumference (WC), and the risk of serious complications in individuals with type 2 diabetes mellitus (T2DM). Published in Diabetes, Obesity and Metabolism, the study was led by Dr. Megumi Nokihara and her team from the Department of Hematology, Endocrinology, and Metabolism at Niigata University Faculty of Medicine in Niigata, Japan.
The research drew on data from over 114,000 patients with T2DM, making it one of the most comprehensive investigations of its kind. Participants were followed for a median of 4.6 years to assess how BMI and WC might influence the likelihood of developing major diabetes-related complications.
The study revealed the following findings:
The authors conclude that BMI and waist circumference have nuanced and varied associations with diabetic complications. These results highlight the need for individualized risk assessments when setting weight-related health goals for people with T2DM. Instead of adopting a one-size-fits-all approach, clinicians are encouraged to consider the type of complication when advising patients on weight and abdominal fat targets.
“Body mass index and waist circumference showed both protective and harmful associations with various diabetic complications,” the researchers wrote. “Hence, it is important to individualize BMI and waist circumference targets based on the specific complication being addressed, while also taking into account the potential risk of other related health conditions.”
Reference:
Nokihara M, Fujihara K, Yaguchi Y, Takizawa H, Khin L, Ferreira EA, Sato T, Horikawa C, Kitazawa M, Matsubayashi Y, Kodama S, Sone H. The associations of body mass index and waist circumference with the risk of diabetic complications in people with type 2 diabetes mellitus. Diabetes Obes Metab. 2025 May 16. doi: 10.1111/dom.16461. Epub ahead of print. PMID: 40375805.
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Korea: A recent clinical trial published in the Journal of Hepatology has highlighted the potential of time-restricted eating (TRE) as a practical dietary intervention for individuals with metabolic dysfunction-associated steatotic liver disease (MASLD), a condition formerly referred to as non-alcoholic fatty liver disease.
The study was led by Dr. Joo Hyun Oh from the Department of Internal Medicine, Eulji University College of Medicine, Seoul. They aimed to assess whether TRE could deliver similar benefits to calorie restriction (CR) in reducing liver fat and improving metabolic health.
TRE is a dietary pattern where food intake is limited to a specific time window each day, typically without calorie counting. Although it has gained popularity for its metabolic benefits, its role in managing MASLD remains unclear. This 16-week randomized controlled trial provided clinical evidence for its efficacy and safety.
The study enrolled 337 overweight or obese adults diagnosed with MASLD. Participants were randomly assigned to one of three groups: standard of care (SOC), calorie restriction (CR), or time-restricted eating (TRE), in equal proportions. Ultimately, 333 participants were included in the final analysis: 113 in the SOC group and 110 each in the CR and TRE groups.
The primary focus was to evaluate changes in liver fat using magnetic resonance imaging-proton density fat fraction (MRI-PDFF), a non-invasive and accurate imaging tool. Secondary outcomes included alterations in liver stiffness, body composition, lipid and glucose metabolism, and sleep quality.
The following were the key findings of the study:
The study authors concluded that TRE can be an effective and safe strategy to manage MASLD, offering similar benefits to calorie restriction without requiring strict calorie counting. These findings suggest TRE may be a feasible long-term dietary approach for individuals with fatty liver disease, though further studies are needed to confirm its sustained benefits over time.
Reference:
Oh JH, Yoon EL, Park H, Lee S, Jo AJ, Cho S, Kwon E, Nah EH, Lee JH, Park JH, Ahn SB, Jun DW. Efficacy and safety of time-restricted eating in metabolic dysfunction-associated steatotic liver disease. J Hepatol. 2025 Jun 19:S0168-8278(25)02272-X. doi: 10.1016/j.jhep.2025.06.005. Epub ahead of print. PMID: 40543603.
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A new ESC Clinical Consensus Statement published in the European Heart Journal discusses the key role of vaccination in preventing cardiovascular events following various viral and bacterial infections.
“We have known for many years that influenza can increase the risk of major adverse cardiovascular events such as heart attacks and can exacerbate heart failure,” said Professor Thomas F. Lüscher, ESC President and senior author of the ESC Clinical Consensus Statement. “More recently, evidence suggests that other respiratory infections are also associated with increased cardiovascular morbidity and mortality. The new publication describes how vaccinations not only prevent infections but also reduce the risk of cardiovascular events, particularly in susceptible individuals.”
The ESC Clinical Consensus Statement describes data on the risk of cardiovascular complications following infections such as pneumococcal pneumonia, influenza, SARS-CoV-2 and respiratory syncytial virus, among others, and describes the inflammatory mechanisms that may be responsible. Evidence is then summarised for the beneficial effects of vaccines in reducing cardiovascular events following various viral and bacterial infections, particularly in at-risk patient groups. Clinical practice guidelines from the ESC and from the American College of Cardiology (ACC)/American Heart Association (AHA) are presented, which advocate for vaccination against influenza and other widespread infections in patients with chronic coronary syndromes (including coronary artery disease) and in those with heart failure.
Serious adverse reactions to vaccinations are very rare. The consensus statement also discusses the risks of cardiovascular adverse events after vaccination, such as myocarditis, and describes appropriate management strategies. Then follows advice on which vaccines should be given to patients with cardiovascular diseases and how often. Vaccination of pregnant women and other vulnerable patient groups, such as those with congenital heart disease and heart transplantation, is considered.
Professor Lüscher concluded: “Prevention is crucial for reducing the considerable burden of cardiovascular disease. The totality of the evidence indicates that vaccinations should become a foundational pillar of preventive strategies alongside other established measures.”
Reference:
Heidecker B, Libby P, Vassiliou VS, et al. Vaccination as a new form of cardiovascular prevention: an ESC Clinical Consensus Statement. Eur Heart J. 2025. doi: 10.1093/eurheartj/ehaf384.
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Recent study investigates the pathophysiology of hypoxic-ischemic encephalopathy (HIE) in patients following cardiac arrest (CA), focusing on selective eosinophilic neuronal death (SEND) across various brain regions. A total of 319 patients who experienced successful resuscitation and underwent brain autopsies were analyzed. Eosinophilic neuronal death was quantified in the cerebral neocortex, hippocampus, basal ganglia, cerebellum, and brainstem, categorized according to previously established HIE severity classifications.
Histopathological Findings
Findings revealed that the mean SEND scores varied significantly by brain region, with the hippocampus exhibiting the highest average SEND of 1.8, followed by the neocortex at 1.4, and the brainstem at 0.9. The results identified four distinctive histopathological patterns of HIE: (I) no/mild SEND across all regions, (II) severe SEND localized predominantly to the hippocampus, (III) severe SEND in the neocortex with preserved brainstem function, and (IV) severe SEND impacting the brainstem accompanied by neocortical injury. Notably, 9.7% of patients exhibited substantial heterogeneity in SEND between different neocortical regions, indicating potential clinical implications for neuroprognosis.
Prevalence of Severe SEND
In the cohort studied, 48.3% of patients displayed severe SEND in at least one brain region, with significant proportions demonstrating severe damage to the neocortex while the brainstem remained relatively unaffected. This spatial distribution underscores the hippocampus’s vulnerability, which aligns with previous literature highlighting selective neuronal death patterns following CA.
Variability in SEND Distribution
The inter-regional correlation analysis revealed a predominantly homogeneous SEND distribution across the neocortex. However, a subset of patients indicated substantial regional variation in SEND, challenging the assumption of a uniform HIE pattern following CA. These atypical distributions suggest the necessity for refined neuroprognostic assessments that consider potential nuances in HIE presentations.
Demographic Insights
Demographic data indicated a median patient age of 68, with a higher prevalence of male subjects. Notably, a significant number of patients regained consciousness prior to death, suggesting varying trajectories of neurological recovery linked to the extent of SEND.
Conclusions and Future Directions
The conclusions emphasize the critical need for further investigation into less common HIE patterns and their role in neuroprognostic evaluations. Future research should enable deeper insights into the complex interplay between SEND patterns and clinical outcomes, enhancing predictive accuracy and patient management following CA.
Key Points
– The study analyzes pathophysiological mechanisms of hypoxic-ischemic encephalopathy (HIE) post-cardiac arrest (CA) by examining selective eosinophilic neuronal death (SEND) across brain regions in a cohort of 319 resuscitated patients who underwent brain autopsies, categorizing findings based on established HIE severity classifications.
– Histopathological assessments revealed significant regional variance in mean SEND scores, with the hippocampus showing the highest SEND (1.8), followed by the neocortex (1.4) and brainstem (0.9). Four distinct HIE patterns were identified: (I) no/mild SEND, (II) severe SEND predominantly in the hippocampus, (III) severe neocortical SEND with preserved brainstem, and (IV) severe SEND impacting brainstem and neocortex.
– In this cohort, 48.3% of patients exhibited severe SEND in at least one brain region, with notable neocortical damage often accompanied by relatively intact brainstem function. This finding underscores the susceptibility of the hippocampus to injury in the context of HIE after CA.
– Variability in SEND distribution was observed; while send scores were typically homogeneous across neocortical regions, some patients displayed significant inter-regional differences, suggesting that previous assumptions about uniform HIE patterns need reconsideration. This highlights the complexity of SEND presentations post-CA.
– Demographic analysis revealed a median age of 68 years among subjects, with a notable predominance of males. Additionally, a considerable fraction of patients regained consciousness before death, indicating diverse recovery trajectories linked to the severity and patterns of SEND.
– Conclusions drawn from the study underscore the urgency for further investigations into atypical HIE patterns that could refine neuroprognostic assessments. Future research is recommended to elucidate the relationship between SEND patterns and clinical outcomes, potentially improving predictive models for managing patients after cardiac arrest.
Reference –
C. Endisch et al. (2025). Histopathological Patterns Of Hypoxic-Ischemic Encephalopathy After Cardiac Arrest: A Retrospective Brain Autopsy Study Of 319 Patients.. *Resuscitation*, 110608 . https://doi.org/10.1016/j.resuscitation.2025.110608.
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The researchers have discovered that the increase in microvascular complications in individuals who have type 2 diabetes greatly raises their risk of cardiovascular events and mortality. The results highlight the importance of early intervention and individualized management in patients with poly-microvascular complications, since such patients are at significantly increased risk of heart attack, stroke, and all-cause mortality. The study was published in Diabetes Research and Clinical Practice by Chun-Ta Huang and fellow researchers.
4,527 people with type 2 diabetes took part in the study. Participants were divided into groups according to how many microvascular diseases they had:
Group 0: no microvascular complications
Group 1: one microvascular complication
Group 2: two or more microvascular complications
The main outcome that was measured was a composite of three severe health events: stroke, myocardial infarction (heart attack), and death. Participants were followed up for a median of 3.3 years by researchers to monitor these events.
Key Findings
A clear dose-dependent association was shown by the study between the amount of microvascular complications and severe health outcomes:
13.07 per 1,000 person-years for Group 0
22.98 per 1,000 person-years for Group 1
35.52 per 1,000 person-years for Group 2
Group 2 patients experienced the greatest risk of a primary outcome with a hazard ratio (HR) of 1.73 and a 95% confidence interval (CI) of 1.16–2.59 when compared to patients without microvascular complications.
When the analysis is performed for particular secondary outcomes:
The risk of stroke was considerably greater among Group 2 patients (HR: 2.61; 95% CI: 1.19–5.73)
The risk of myocardial infarction also rose in Group 2 (HR: 1.67; 95% CI: 1.03–2.70)
Overall, the occurrence of more than one microvascular complication in type 2 diabetic patients drastically increases the risk of stroke, myocardial infarction, and mortality. This Taiwanese experience highlights the need to recognize and treat microvascular diseases at the early stages of diabetes. A focused, preventive approach may lower the burden of macrovascular disease and enhance long-term outcomes in this high-risk group.
Reference:
Chun-Ta Huang, Chiao-Ya Chan, Ming-Chieh Tsai, Shih-Ming Chuang, Sung-Chen Liu, Ming-Nan Chien, Chih-Yuan Wang, Horng-Yih Ou, Chun-Chuan Lee,
Microvascular diseases predict mortality and cardiovascular events in type 2 diabetes: A retrospective cohort study,
Diabetes Research and Clinical Practice,
2025,
112356,
ISSN 0168-8227,
https://doi.org/10.1016/j.diabres.2025.112356.
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A recent study published in Engineering has identified a potential new approach to managing sleep disorders. The research, led by a team of scientists from Jiangnan University and other institutions, focuses on the role of S-adenosylmethionine (SAM)-producing probiotics in regulating sleep and circadian rhythms.
Insomnia is a common sleep disorder that affects a significant portion of the global population. Current first-line medications for sleep disorders often have suboptimal effectiveness, highlighting the need for novel therapeutic strategies. In this study, the researchers first conducted a cross-sectional analysis and found that serum SAM levels were significantly reduced in insomnia patients. This discovery suggests that SAM could serve as a potential biomarker and therapeutic target for sleep disorders.
The team then screened 60 gut strains and identified Lactobacillus helveticus CCFM1320, a high-SAM-producing probiotic. In a mouse model of sleep deprivation, treatment with CCFM1320 reversed neurobehavioral abnormalities, such as improved recognition and memory of new objects, reduced hyperactivity, and enhanced spatial exploration ability. Mechanistically, CCFM1320 enhanced the methylation of N-acetylserotonin, a precursor of melatonin synthesis, which normalized the expression of downstream circadian rhythm genes.
To further evaluate the clinical efficacy of CCFM1320, the researchers conducted a four-week placebo-controlled clinical trial involving 60 volunteers with insomnia. The results showed that CCFM1320 significantly improved sleep quality in patients with sleep disorders. Participants had reduced Pittsburgh sleep quality index (PSQI) scores, lower serum cortisol levels, and a decreased prevalence of pathogenic species in the gut. Additionally, probiotic treatment elevated the abundance of SAM synthesis and metabolism-related enzyme genes in the gut microbiome.
The study also explored the impact of CCFM1320 on the gut microbiota of insomnia patients. Although the overall gut microbiota diversity did not change, the intervention affected the composition and abundance of core microbiota species. Probiotic treatment reduced the number of potentially pathogenic species and increased the abundance of some beneficial bacteria.
However, the study has some limitations. The efficiency of gut microbiota-derived SAM supplementation to the circulatory system and brain requires further validation. Also, the differences in the effects of probiotics on sleep quality indices and hormone levels between the human trial and animal studies need to be further investigated.
Overall, this research presents a promising probiotic-based strategy for managing sleep disorders, offering a potential non-pharmacological treatment alternative. Further studies are needed to fully understand the mechanisms and optimize the use of these probiotics in clinical practice.
Reference:
“Regulation of Sleep and Circadian Rhythms by S-Adenosylmethionine-Producing Probiotics,” authored by Peijun Tian, Yuming Lan, Zhiying Jin, Feng Hang, Xuhua Mao, Xing Jin, Gang Wang, Wei Chen. Full text of the open access paper: https://doi.org/10.1016/j.eng.2024.12.025.
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