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Huiyuan Zhai Department of Pharmacy, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Affiliated with Nanjing University of Chinese Medicine, Nanjing, China

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Dongxu Wang Department of Geriatrics, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Affiliated with Nanjing University of Chinese Medicine, Nanjing, China

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Yong Wang Department of Pharmacy, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Affiliated with Nanjing University of Chinese Medicine, Nanjing, China

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Hongwei Gu Central Laboratory, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Affiliated with Nanjing University of Chinese Medicine, Nanjing, China

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Juan Jv Department of Cardiology, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Affiliated with Nanjing University of Chinese Medicine, Nanjing, China

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Liangliang Yuan Department of Pharmacy, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Affiliated with Nanjing University of Chinese Medicine, Nanjing, China

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Chao Wang Department of Pharmacy, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Affiliated with Nanjing University of Chinese Medicine, Nanjing, China

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Leiyao Chen Department of Pharmacy, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Affiliated with Nanjing University of Chinese Medicine, Nanjing, China

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to form a characteristic feature known as a crown-like structure (CLS) ( 8 ). M1 macrophages in adipose tissue are considered instigators of insulin resistance due to the secretion of multiple pro-inflammatory cytokines, including TNFα ( 9 ). Chronic

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Rongpeng Gong Medical College of Qinghai University, Xining, People’s Republic of China

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Yuanyuan Liu Medical College of Qinghai University, Xining, People’s Republic of China

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Gang Luo Medical College of Qinghai University, Xining, People’s Republic of China

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Jiahui Yin College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China

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Zuomiao Xiao Department of Clinical Laboratory, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China

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Tianyang Hu Precision Medicine Center, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China

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Background Insulin resistance (IR) is a systemic disorder of glucose metabolism that results in changes in multiple organs and insulin regulatory pathways ( 1 , 2 , 3 ). The clinical significance of IR has become clear over the past few

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Peter Wolf Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Le Kremlin-Bicêtre, France
Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria

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Alexandre Dormoy Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Le Kremlin-Bicêtre, France

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Luigi Maione Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Le Kremlin-Bicêtre, France

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Sylvie Salenave Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Le Kremlin-Bicêtre, France

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Jacques Young Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Le Kremlin-Bicêtre, France

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Peter Kamenický Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Le Kremlin-Bicêtre, France

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Philippe Chanson Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Le Kremlin-Bicêtre, France

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mortality, mainly because of cardio-metabolic complications ( 1 , 2 , 3 ). Impaired glucose metabolism is frequently observed in acromegaly. It is mainly caused by the insulin-antagonizing effects of GH-inducing hepatic and peripheral insulin resistance

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Jan W Eriksson Department of Medical Sciences, Uppsala University, Uppsala, Sweden

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Reem A Emad Department of Pharmacy, Uppsala University, Uppsala, Sweden

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Martin H Lundqvist Department of Medical Sciences, Uppsala University, Uppsala, Sweden

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Niclas Abrahamsson Department of Medical Sciences, Uppsala University, Uppsala, Sweden

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Maria C Kjellsson Department of Pharmacy, Uppsala University, Uppsala, Sweden

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Introduction Development of type 2 diabetes has been perceived as a process that involves progressive insulin resistance in muscles, adipose tissue, and liver and a gradual failure of pancreatic beta cells to secrete sufficient amounts of

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Yansu Wang Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China

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Yun Shen Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China

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Tingting Hu Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China

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Yufei Wang Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China

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Xiaojing Ma Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China

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Haoyong Yu Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China

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Yuqian Bao Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China

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. Thus, the purpose of this study was to investigate the association between serum clusterin levels and NAFLD in the Chinese population. In addition, due to the tight relationship between insulin resistance and clusterin ( 20 ), a mediation analysis would

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Pernille H Hellmann Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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Jonatan I Bagger Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark

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Katrine R Carlander Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark

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Katrine B Hansen Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark

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Julie L Forman Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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Joachim Størling Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark

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Elizaveta Chabanova Department of Radiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark

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Jens Holst Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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Tina Vilsbøll Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark

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Filip K Knop Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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that expression of 2% of our genome is regulated by glucocorticoids ( 5 ). Prednisolone is known to induce insulin resistance, increased hepatic glucose production, hyperglycaemia and secondary diabetes. Even lean, healthy individuals can experience

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Sarantis Livadas Endocrine Unit, Athens Medical Centre, Athens, Greece

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Christina Bothou Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland

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Justyna Kuliczkowska-Płaksej Department of Endocrinology, Diabetology and Isotope Therapy, University of Medicine, Wrocław, Poland

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Ralitsa Robeva Ushate ‘acad. IV. Penchev’, Department of Endocrinology, Faculty of Medicine, Medical University-Sofia, Sofia, Bulgaria

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Andromahi Vryonidou Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece

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Jelica Bjekic Macut Department of Endocrinology, UMC Bežanijska Kosa, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

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Ioannis Androulakis Endocrine Unit, Athens Medical Centre, Athens, Greece

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Milica Opalic Clinic of Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

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Zadalla Mouslech 1st Medical Propedeutic, Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

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Andrej Milewicz Department of Endocrinology, Diabetology and Isotope Therapy, University of Medicine, Wrocław, Poland

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Alessandra Gambineri Department of Medical and Surgical Science-DIMEC Endocrinology Unit, University of Bologna – S. Orsola-Mapighi Hospital, Italy

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Dimitrios Panidis Gynaecological Endocrinology Infirmary of the Second Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece

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Djuro Macut Clinic of Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

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been observed in prospective studies of large PCOS cohorts of mostly obese women ( 2 , 3 ), since the two preconditions for T2DM development are encountered in PCOS. Specifically, profound insulin resistance (IR) constitutes a key player underlying

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Michelle J Galvan Metabolic, Nutrition, and Exercise Research (MiNER) Laboratory, Department of Kinesiology, University of Texas at El Paso, El Paso, Texas, USA

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Michael J Sanchez Metabolic, Nutrition, and Exercise Research (MiNER) Laboratory, Department of Kinesiology, University of Texas at El Paso, El Paso, Texas, USA

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Andrew J McAinch Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, Melbourne, Victoria, Australia

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Jeffrey D Covington Department of Pathology, University of Massachusetts Medical School, Worcester, Massachusetts, USA

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Jason B Boyle Metabolic, Nutrition, and Exercise Research (MiNER) Laboratory, Department of Kinesiology, University of Texas at El Paso, El Paso, Texas, USA

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Sudip Bajpeyi Metabolic, Nutrition, and Exercise Research (MiNER) Laboratory, Department of Kinesiology, University of Texas at El Paso, El Paso, Texas, USA

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dramatic increase in obesity, insulin resistance, and type 2 diabetes mellitus (T2DM) ( 2 ). Adherence is further challenging for those with obesity and T2DM suffering from defects in lipid oxidation capacity, musculoskeletal pain, and peripheral neuropathy

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Philippe Jean-Luc Gradidge Centre for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Nicole G Jaff Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Shane A Norris SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, UK

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Marketa Toman Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Nigel J Crowther Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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, several studies have shown that low levels of adiponectin are associated with a heightened risk for hypertension ( 3 , 4 ), insulin resistance, diabetes ( 5 ) and inflammation ( 6 ), while higher levels are cardioprotective ( 5 , 7 ). Regional fat

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Yang Yu Department of Endocrinology and Metabolism, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China

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Hairong Hao Department of Endocrinology and Metabolism, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China

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Linghui Kong Department of Endocrinology and Metabolism, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China

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Jie Zhang Department of Endocrinology and Metabolism, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China

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Feng Bai Department of Endocrinology and Metabolism, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China

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Fei Guo Department of Endocrinology and Metabolism, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China

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Pan Wei Department of Endocrinology and Metabolism, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China

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Rui Chen Department of Endocrinology and Metabolism, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China

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Wen Hu Department of Endocrinology and Metabolism, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China

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with insulin resistance. Since then, an increasing number of findings suggest ( 6 , 7 , 8 , 9 , 10 ) that elevated BCAA levels are associated with obesity, type 2 diabetes and cardiovascular disease (CVD). Our previous cross-sectional study of 1302

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