News & Comment

A large body of indisputable evidence shows that a certain treatment, commonly advocated by all healthcare professionals for a highly prevalent chronic medical condition, is associated with detrimental effects on health and an increased risk of mortality. This ‘treatment’, which needs eradicating from healthcare settings, is weight stigma.

Remission of type 2 diabetes mellitus is highly desirable and potentially reduces risks of complications. Improving the probability of remission requires early detection and substantial weight loss during a 6-year therapeutic window when β-cells remain functional.

Exosomes include plasma-transported vesicles that are secreted by human tissues and reflect metabolic status. The profile of exosomes (particularly microRNA content) is altered in metabolic disease. In type 2 diabetes mellitus, exosomes circulating in plasma induce transcriptional changes related to tumour progression and pro-metastatic phenotypes in target cancer cells, potentially linking obesity to cancer progression and metastasis.

The maintenance and regulation of body temperature in neonates is critical for survival. However, the mechanisms by which human neonates achieve body temperature control are unclear. Current evidence has demonstrated that infrared thermography is a suitable non-invasive technique that can be safely applied to human babies to investigate brown adipose tissue thermogenesis.

Weight gain indicates a positive energy balance, with calorie intake exceeding expenditure. However, this fact of physics cannot inform causality. Potential pathways to obesity include a positive energy balance that drives weight gain or weight gain that drives the positive energy balance. Here, we propose an integrated model of obesity pathogenesis that incorporates both pathways.

Whether or not there is a form of healthy obesity remains controversial. Contemporary imaging techniques might help answer this question. It is proposed that low levels of visceral adipose tissue and ectopic adipose tissue combined with a preferential accumulation of gluteal and femoral adipose tissue might define a ‘super healthy obesity’ phenotype.

An emerging feature of type 1 diabetes mellitus and type 2 diabetes mellitus is their association with pulmonary fibrosis, which negatively affects the prognosis of patients. Here, we provide a brief update of the field and the remaining open questions.

Up to one in four women with type 1 diabetes mellitus (T1DM) also have polycystic ovary syndrome (PCOS). Under subcutaneous insulin administration, systemic hyperinsulinism might trigger PCOS in women predisposed to the condition. However, very little is known about the long-term consequences of androgen excess in women with T1DM, and management guidelines are lacking.

An emerging feature of COVID-19 is a clinically relevant osteo-metabolic phenotype characterized by widespread acute hypocalcaemia and chronic hypovitaminosis D with high prevalence of vertebral fractures. This phenotype might have negative effects on disease severity and its components could represent possible targets for prevention of SARS-CoV-2 infection and poor COVID-19 outcomes.

Cardiometabolic conditions, including type 1 and type 2 diabetes mellitus, are associated with severe COVID-19 and long COVID. Interventions to target multiple risk factors, combined with use of novel glucose-lowering agents that improve metabolic function and the key processes that are impaired in COVID-19, should be the preferred therapeutic options for management of people with long COVID.

The first International Symposium on Phaeochromocytoma in 2005 was followed by considerable progress in the field, largely owing to the many collaborations and networks stimulated by that and subsequent meetings. The rich hereditary background of phaeochromocytomas has since provided for strong interdisciplinary links of genetics with personalized diagnostics, imaging and therapeutic interventions.

This Comment article provides a behind-the-scenes perspective and update of our 2016 Review, which discussed possible factors contributing to thyroid cancer incidence trends worldwide. We also highlight promising research directions that are improving the understanding of thyroid cancer aetiology.

In 2019, we published a Review on the relevance of gut microbial metabolites in obesity, non-alcoholic fatty liver disease and type 2 diabetes mellitus. Here, we highlight the importance of the balance between colonic proteolytic and saccharolytic metabolite production for metabolic health and the need to focus on more subgroup-based or personalized nutritional approaches.

In the past decade, the prevalence of obesity and related comorbidities has continued to increase across the globe, prompting many countries to adopt policies to improve diet quality. Here, we discuss key nutrition policies that have been implemented in the past few years and consider future priorities for global obesity prevention.

Islet inflammation (insulitis) in type 1 diabetes mellitus is triggered by a deleterious dialogue between β-cells and the immune system, inducing β-cell dysfunction and death. This concept, outlined in our 2009 Review, has been confirmed and extended. Here, we provide a brief update of the field and outline key pending questions.

In 2012, we were invited by Nature Reviews Endocrinology to write a Review titled ‘Muscles, exercise and obesity: skeletal muscle as a secretory organ’. At the time, following our findings in the 2000s, we knew the concept of skeletal muscle as an endocrine organ was important. Eight years on, the magnitude of the importance of this concept surprises us.

The sudden outbreak and global spread of COVID-19 represents one of the most profound societal and public health challenges in modern times. In this Comment, we call attention to the possibility that the societal strategies implemented to oppose COVID-19 might have long-term, negative effects on the obesity epidemic.

The COVID-19 pandemic has broad implications for the care of patients with bone fragility. A dramatic surge in fractures and related mortality is expected in the next few months. We pledge to intensify the current efforts to improve the management of bone health, and to prioritize fragility fracture care and prevention.

Preliminary data suggest that people with obesity are at increased risk of severe COVID-19. However, as data on metabolic parameters (such as BMI and levels of glucose and insulin) in patients with COVID-19 are scarce, increased reporting is needed to improve our understanding of COVID-19 and the care of affected patients.

Type 2 diabetes mellitus and hypertension are the most common comorbidities in patients with coronavirus infections. Emerging evidence demonstrates an important direct metabolic and endocrine mechanistic link to the viral disease process. Clinicians need to ensure early and thorough metabolic control for all patients affected by COVID-19.