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{"title":"When Metabolically Healthy Is Not Low Risk: BMI Thresholds for Incident Diabetes in East Asian Adults.","authors":"Yibo Li, Xinyi Liu, Lijing Shang, Yuhao Wang, Zhongyin Chen, Yuehang Yang, Linfeng He","doi":"10.1111/dom.71235","DOIUrl":"10.1111/dom.71235","url":null,"abstract":"<p><strong>Aims: </strong>To determine whether metabolic health attenuates body mass index (BMI)-related risk of diabetes in East Asian adults and to identify BMI thresholds at which risk increases among metabolically healthy individuals.</p><p><strong>Materials and methods: </strong>We analysed 125 843 adults from two longitudinal cohorts, including 113 354 Chinese and 12 489 Japanese participants. Metabolic health was stringently defined as the absence of elevated blood pressure, dyslipidaemia and impaired fasting glucose. Participants were categorised by BMI and metabolic health status. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for incident diabetes, using metabolically healthy normal weight (MHNW) as the reference. Restricted cubic splines assessed non-linear BMI-diabetes associations by metabolic health status.</p><p><strong>Results: </strong>During 352 036 Chinese and 89 483 Japanese person-years, 1483 and 312 participants, respectively, developed diabetes. In the primary model adjusted for age, gender, smoking, and drinking, compared with MHNW, metabolically healthy overweight was associated with incident diabetes in Chinese (HR: 2.33, 95% CI: 1.63-3.33) and Japanese participants (HR: 3.32, 95% CI: 1.50-7.35). Metabolically healthy obesity (MHO) was also associated with a higher risk (Chinese: HR: 12.40, 95% CI: 6.77-22.68; Japanese: HR: 27.89, 95% CI: 8.42-92.41). The reported change points were 22.2 kg/m² in Chinese and 21.8 kg/m² in Japanese metabolically healthy participants.</p><p><strong>Conclusions: </strong>Metabolic health did not eliminate BMI-related diabetes risk in East Asian adults. Diabetes risk increased at BMI levels below conventional overweight thresholds, supporting joint assessment of BMI and metabolic health for diabetes risk stratification.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":"10227-10235"},"PeriodicalIF":6.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Butyrate Reduces Progression of Kidney Damage in an L-NAME-Induced Diabetic Kidney Disease Mouse Model.","authors":"Maria Novella Nicese, Angela Koudijs, Reshma Lalai, Cristina Avramut, Rico J E Derks, Elena Sánchez-López, Martin Giera, Amanda C M Pronk, Artemiy Kovynev, Sander Kooijman, Patrick C N Rensen, Roel Bijkerk, Bernard M van den Berg, Joris I Rotmans","doi":"10.1111/dom.71245","DOIUrl":"10.1111/dom.71245","url":null,"abstract":"<p><strong>Aims: </strong>Diabetic kidney disease (DKD) is one of the main causes of kidney failure worldwide. Interestingly, patients affected by DKD are characterised by a low abundance of gut bacteria producing short fatty acids including butyrate, which is suggested to play a role in the decline of renal function. Consequently, we aimed to test the effects of oral butyrate supplementation on kidney health in mice affected by DKD.</p><p><strong>Material and methods: </strong>To this end, we treated diabetic BKS db/db mice (C57BLKS/J Lepr ^db ) via drinking water with the eNOS inhibitor N(ω)-nitro-L-arginine methyl ester (L-NAME), which accelerates the progression of DKD. Simultaneously, mice were fed low-fat chow with or without 5% butyrate.</p><p><strong>Results: </strong>Oral butyrate supplementation reduced mesangial expansion, glomerular enlargement and medullary fibrosis in kidney biopsies of the mice. These protective effects correlated with an increased abundance of Akkermansiaceae in the gut. In mice treated with butyrate, the abundance of Akkermansiaceae positively correlated with glomerular filtration rate (GFR) and plasma concentration of indole-3-methyl acetate and indole-3-acetaldehyde, key metabolites associated with many beneficial cardiovascular effects.</p><p><strong>Conclusions: </strong>In conclusion, oral butyrate supplementation in mice with DKD improves kidney morphology, accompanied by an increased abundance of Akkermansiaceae in the gut. Future studies, such as transplantation of Akkermansia, should reveal whether this relationship is causal and translate into improved kidney function in DKD.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":"10278-10291"},"PeriodicalIF":6.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatiotemporal Dynamics of Cytosolic NADPH in Living Arabidopsis thaliana.","authors":"Danying Lu, Jinhong Liu, Shey-Li Lim, Jia Yi Zhong, Boon Leong Lim","doi":"10.1111/pce.70806","DOIUrl":"10.1111/pce.70806","url":null,"abstract":"<p><p>In plants, an adequate supply of Nicotinamide adenine dinucleotide phosphate (NADPH) in the cytosol is crucial for maintaining a variety of biosynthetic and antioxidant reactions. Cytosolic NADPH is mainly generated via four enzymatic pathways: NADP-dependent malic dehydrogenase (NADP-ME), cytosolic oxidative pentose phosphate pathway (cOPPP), cytosolic NADP-dependent isocitrate dehydrogenase (cyNADP-ICDH), and non-phosphorylating glyceraldehyde-3-phosphate dehydrogenase (np-GAPDH). Here, we employed the cytosolic NADPH sensor mCherry-iNAP1 along with a GUS reporter system and enzyme assays to clarify the contributions of the four NADP(H)-reducing pathways in Arabidopsis seedlings and mature leaves. Our results show that, in 5-day-old seedlings, cyNADP-ICDH and np-GAPDH supply cytosolic NADPH to both roots and shoots, cOPPP could contribute more cytosolic NADPH to roots than to shoots, and NADP-ME2 primarily functions in roots. In leaves of 21-day-old plants, cyNADP-ICDH and np-GAPDH supply cytosolic NADPH throughout the day, while cOPPP could be more active at night, and NADP-ME2 utilizes daytime-accumulated malate to produce substantial cytosolic NADPH at night. Spatiotemporal visualization of cytosolic NADPH through in vivo imaging provides crucial information for future redox engineering of stress-resistant crops.</p>","PeriodicalId":222,"journal":{"name":"Plant, Cell & Environment","volume":" ","pages":"9101-9116"},"PeriodicalIF":6.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148704972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chlorophyll a Fluorescence Kinetics Reveal That Ozone Stress Redistributes Electron Transport Limitations Between PSII and PSI in Wheat.","authors":"Jacques Maynard Berner","doi":"10.1111/pce.70757","DOIUrl":"10.1111/pce.70757","url":null,"abstract":"<p><p>Tropospheric ozone (O₃) reduces crop productivity, but the sites at which ozone alters photosynthetic electron transport remain unclear. We tested whether acute exposure to O₃ shifts the dominant site of electron transport limitation in a cultivar-specific manner, rather than causing a uniform decline in PSII function. The induction kinetics of chlorophyll a fluorescence in two wheat cultivars, PAN 3434 and PAN 3161, were analysed after controlled exposure to 100 ppb O₃ as an acute mechanistic perturbation, using charcoal-filtered air as a low-ozone reference treatment. O₃ induced different cultivar-dependent changes in fluorescence rise phases. In PAN 3434, suppression of the J-I and I-P phases were consistent with a restricted reduction of the plastoquinone pool and a reduced acceptor-side capacity of PSI, accompanied by declines in the density of the active PSII reaction centre and the probabilities of electron transport. In contrast, PAN 3161 showed smaller changes in these parameters, consistent with partial preservation of reaction centre function and intersystem electron transport. These contrasting photochemical signatures were associated with cultivar-specific yield reductions. The findings indicate that acute O₃ exposure alters distinct segments of the PSII-PSI electron transport chain in a cultivar-specific manner, providing mechanistic information relevant to physiological phenotyping and cultivar screening for ozone tolerance in wheat.</p>","PeriodicalId":222,"journal":{"name":"Plant, Cell & Environment","volume":" ","pages":"8497-8508"},"PeriodicalIF":6.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rhizobial Symbiosis Enhances Salinity Tolerance in Legumes Through Coordinated Physiological and Molecular Responses: Evidence From Common Vetch and Pea.","authors":"María Isabel López-Román, Lucía Zurita, Cristina Castaño-Herrero, Lucía De la Rosa, Elena Ramírez-Parra","doi":"10.1111/pce.70790","DOIUrl":"10.1111/pce.70790","url":null,"abstract":"<p><p>Soil salinisation severely constrains crop production. Legumes rely on rhizobial symbiosis for sustainable nitrogen acquisition. Although salinity is known to impair nodulation and nitrogen fixation, how symbiosis influences plant tolerance to salt stress remains unclear. In this study, we integrate physiological, biochemical, transcriptomic, ionomic, and metabolomic analyses to investigate the role of rhizobial symbiosis in salinity tolerance in Vicia sativa (common vetch) and Pisum sativum (pea). In both species, nodulated plants exhibited markedly enhanced survival and grain production under prolonged salt stress compared with nitrogen-fertilised (N-fed) controls. Under moderate salinity, nodulation helped maintain water status and stomatal conductance, reduced Na⁺ accumulation while improving K⁺ retention, and attenuated osmotic and oxidative stress, as evidenced by lower proline and malondialdehyde levels. Transcriptomic profiles in vetch revealed that symbiosis is associated with changes in the plant responses toward growth and microbial signalling, reducing the strong activation of stress pathways that typically occurs in non-nodulated plants. Ionomic and metabolomic data further showed that nodulated plants preserve nutrient balance and maintain a more stable carbon-nitrogen metabolism under salinity. These findings highlight the potential of Rhizobium inoculation to enhance crop resilience in salt-affected agroecosystems and demonstrate that symbiosis correlates with a more efficient and physiologically moderated acclimation to salinity in legumes.</p>","PeriodicalId":222,"journal":{"name":"Plant, Cell & Environment","volume":" ","pages":"8912-8931"},"PeriodicalIF":6.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148667801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: Plozasiran for Recurrent Pancreatitis and the Chinese Burden of Hypertriglyceridaemic Acute Pancreatitis.","authors":"Xingxia Yang, Xiang Lv, Yi Yang","doi":"10.1111/apt.70762","DOIUrl":"10.1111/apt.70762","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":"1320-1321"},"PeriodicalIF":6.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten-Year Cost-Effectiveness of the Risk Assessment and Management Programme-Diabetes Mellitus (RAMP-DM) Relative to Usual Care in Hong Kong Public Primary Care: A Population-Based Cohort Study.","authors":"Eric Ho Man Tang, Ivy Lynn Mak, Emily Tsui Yee Tse, Esther Yee Tak Yu, Julie Yun Chen, Weng Yee Chin, David Vai Kiong Chao, Wendy Wing Sze Tsui, Tony King Hang Ha, Carlos King Ho Wong, Cindy Lo Kuen Lam, Eric Yuk Fai Wan","doi":"10.1111/dom.71242","DOIUrl":"10.1111/dom.71242","url":null,"abstract":"<p><strong>Aims: </strong>The Risk Assessment and Management Programme-Diabetes Mellitus (RAMP-DM) is a multidisciplinary, protocol-driven, risk-stratified care model integrated into public primary care in Hong Kong for patients with type 2 diabetes mellitus (T2DM). This study evaluated the real-world 10-year cost-effectiveness of RAMP-DM from the public healthcare provider perspective.</p><p><strong>Materials and methods: </strong>Programme costs from 2009 to 2019 were estimated using costing questionnaires and reported in 2019 US dollars. Direct medical costs were compared between patients enrolled in RAMP-DM and a propensity-score matched cohort receiving usual care only. Effectiveness was based on previously published 10-year estimates of absolute risk reduction in complications and all-cause mortality. The primary outcome was the incremental total direct medical cost per diabetes-related complication avoided over 10 years. Secondary outcomes included incremental cost per all-cause mortality avoided and programme cost per complication avoided. Sensitivity analyses examined the effects of parameter uncertainty and discounting.</p><p><strong>Results: </strong>A total of 36 746 patients (18 373 in each group) were included. RAMP-DM was associated with absolute risk reductions of 12.1% for any complications and 16.2% for all-cause mortality. Accounting for the programme cost of US$329 per participant, total undiscounted direct medical costs over 10 years was US$10 543 lower per person among RAMP-DM participants (RAMP-DM: $23 430; usual care: US$33 973). RAMP-DM was a cost-saving strategy relative to usual care.</p><p><strong>Conclusions: </strong>RAMP-DM was associated with better 10-year clinical outcomes and lower direct medical costs. These findings support the economic value of structured multidisciplinary diabetes management programmes in publicly funded primary care settings, although residual confounding and uncertainty in cost estimates should be considered.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":"10379-10389"},"PeriodicalIF":6.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148807926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-Dimensional Barriers for Work Productivity and Possible Solutions to Overcome Presenteeism in Young-Onset Diabetes: A Mixed-Methods Study.","authors":"Kelly T C Wong, Jason D C Yin, Sunny C S Chan, Nga Sze Wong, Chun-Kwan O, Yiming Dai, Yuzheng Zhang, Marques S N Ng, Risa Ozaki, Ronald C W Ma, Alice P S Kong, Andrea O Y Luk, Elaine Y K Chow, Juliana C N Chan, Juliana N M Lui","doi":"10.1111/dom.71158","DOIUrl":"10.1111/dom.71158","url":null,"abstract":"<p><strong>Aims: </strong>Young-onset non-type 1 diabetes (YOD, age-at-diagnosis ≤ 40) is associated with poor physical and mental health, presenteeism and productivity loss. We examined patient-perceived barriers to work productivity and key enablers to reduce presenteeism.</p><p><strong>Materials and methods: </strong>In this mixed-methods study, we utilized validated questionnaires to measure presenteeism (World Health Organization Health and Performance Questionnaire); self-care activities (Summary of Diabetes Self-Care Activities; Compliance Questionnaire for Medication); health-related quality of life (HRQoL, EQ-5D-3L) and psychological distress (Depression Anxiety Stress Scale; Chinese Diabetes Distress Scale) among participants with YOD in the Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes-Randomised Controlled Trial (PRISM-RCT). We conducted four semi-structured focus group discussions (FGDs) for inductive thematic analysis.</p><p><strong>Results: </strong>Employees with YOD (n = 465, mean age: 43.4 ± 6.4 years, disease duration: 10.9 ± 6.0 years, 59.8% male) had better cardiometabolic, psychological and HRQoL profiles than non-employees (n = 103). Among the employees, 67.4% had at least one sickness presenteeism episode in the preceding year, with a mean presenteeism score of 7.1 ± 1.6 (out of 10). Increased presenteeism was independently associated with diabetes-related emotional burden (β = -0.08, p = 0.029) and suboptimal HRQoL (β = 3.30, p = 0.041). [Correction added on 11 September 2026, after first online publication: In the preceding sentence, the beta and p values have been corrected.] Participants of FGDs (n = 16) reported distress contributors related to inter-personal (psychological/physical status, family collectivism), work (schedules/types, absence justification, colleagues' attitudes) and societal factors (relationships with providers, out-of-pocket payment, stigmatisation). Enablers included public awareness, early diagnosis (genetic testing for offspring, regular health-check), peer support, treatment choices autonomy and insurance coverage.</p><p><strong>Conclusion: </strong>In YOD, presenteeism is associated with interpersonal, work and societal factors accompanied by psychological distress, suboptimal diabetes care, self-management challenges, calling for holistic assessment and person-centred management.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":"10540-10554"},"PeriodicalIF":6.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cell therapies and liver organogenesis technologies: Promising strategies for end-stage liver disease.","authors":"Shaoyang Qin, Xiaochen Bo, Hongyuan Liu, Zhishuo Zhang, Zhicong Zhao, Qiang Xia","doi":"10.1097/HEP.0000000000001321","DOIUrl":"10.1097/HEP.0000000000001321","url":null,"abstract":"<p><p>End-stage liver disease represents a critical hepatic condition with high mortality, for which liver transplantation remains the only effective treatment. However, the scarcity of suitable donors results in numerous patients dying while awaiting transplantation. Novel strategies, including cell therapies and technologies mimicking liver organogenesis, offer promising alternatives for treating end-stage liver disease by potentially providing new sources of liver grafts. Recently, significant progress has been made in this field, including stem cell transplantation, hepatocyte transplantation, in vitro liver tissue generation, and liver replacement technologies. Several clinical studies have demonstrated that stem cell transplantation and hepatocyte transplantation can prolong patient survival and serve as a bridge to liver transplantation. Furthermore, in vitro liver tissue generation technologies, such as liver organoids and three-dimensional bioprinting, can generate hepatic tissues with sophisticated structures and functions, making them promising transplantation materials. Notably, liver replacement technologies hold considerable potential for producing biologically functional and transplantable liver grafts. In this review, we discuss the fundamental principles and recent advancements in cell therapies and liver organogenesis technologies while also addressing the challenges and future prospects in this rapidly evolving field.</p>","PeriodicalId":177,"journal":{"name":"Hepatology","volume":" ","pages":"1567-1586"},"PeriodicalIF":18.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vegetable-First Meal Sequence Suppresses Postprandial Glycaemic Excursions and Variability in Young Women With High-Risk Phenotype for Early-Onset Type 2 Diabetes: A 4-Arm Randomized Crossover Trial With Continuous Glucose Monitoring.","authors":"Minji Choi, Soyoon Lee, Eujean Bang, Ijae Seo, Jieun Lee, Sehyun Joo, Hyeonseo Kim, Song Vogue Ahn, Yuri Kim, Jieun Oh","doi":"10.1111/dom.71227","DOIUrl":"10.1111/dom.71227","url":null,"abstract":"<p><strong>Aims: </strong>Managing postprandial glycaemic variability is crucial for preventing metabolic diseases. Although the effects of a vegetable-first meal sequence on blood glucose levels have been well documented, there is limited research on consecutive, repeated meal sequencing for healthy young women. This study investigated the effects of 3-day repeated interventions on glycaemic profiles in this population.</p><p><strong>Materials and methods: </strong>In this randomized crossover trial, 33 healthy Korean women consumed isocaloric test meals under four conditions: (1) VPC (vegetables-protein-carbohydrates meal sequence) with 35 min meal limit; (2) CPV (carbohydrates-protein-vegetables meal sequence) with 35 min meal limit; (3) TGR (all together without sequence) with 35 min meal limit; (4) NTL (no meal intake time limit). Glycaemic profiles and variability were examined by continuous glucose monitoring over 3 h after each meal.</p><p><strong>Results: </strong>Compared to CPV, TGR and NTL, the VPC reduced the glucose incremental area under the curve for 0-1 h and 0-2 h and mean glucose for 0-1 h (p < 0.05). VPC also resulted in lower peak glucose and delayed time-to-peak compared to CPV (p < 0.0001). Time in range was the highest for VPC and VPC significantly reduced the mean amplitude of glycaemic excursion (MAGE) compared to all other sequences (p < 0.05).</p><p><strong>Conclusions: </strong>VPC improves postprandial glycaemic control, demonstrating consistent benefits across different meal constraints, including unrestricted eating (NTL). Optimizing meal sequencing represents a potential strategy for managing metabolic health and preventing early-onset type 2 diabetes in young women.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":"10218-10226"},"PeriodicalIF":6.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}