Frontiers in Endocrinology最新文献

{"title":"Integration of digital physicalomics and dual-fluid metabolomics flux ratios reveals tubular secretory dysfunction in early diabetic kidney disease.","authors":"Haili Zhang, Qian Cai, Jing Gao, Fen Wang, Liping Zhang, Huihui Zhao, Xiaoqiao Ren, Mianzhi Zhang","doi":"10.3389/fendo.2026.1802447","DOIUrl":"https://doi.org/10.3389/fendo.2026.1802447","url":null,"abstract":"<p><strong>Background: </strong>Current screening for diabetic kidney disease (DKD) relies on the estimated glomerular filtration rate (eGFR) and albuminuria, which often fail to detect early tubular dysfunction and non-albuminuric phenotypes. The integration of macroscopic urine physical characteristics with metabolic signatures may offer a novel approach to precision stratification.</p><p><strong>Methods: </strong>We conducted a multicenter, prospective-retrospective cohort study involving 364 participants with type 2 diabetes. We developed \"FluxPro-DKD fusion model,\" that integrates \"Digital Physicalomics\" (computer-vision quantification of urine foam stability and chromaticity) and \"Dual-Fluid Metabolomics\" (serum-to-urine flux ratios). The model was trained in a discovery cohort (<i>n</i>=282) and tested in an independent external validation cohort (<i>n</i>=82). The primary outcome was the detection of early-stage DKD. We also assessed the model's prognostic utility for major adverse renal events over a simulated 3-year period.</p><p><strong>Results: </strong>Metabolic profiling identified a distinct \"serum-to-urine flux mismatch\" of protein-bound uremic toxins (e.g., indoxyl sulfate), suggesting tubular secretory failure prior to glomerular damage. Digital physicalomics revealed that urine foam half-life was correlated with albuminuria (<i>r</i>=0.78). In the discovery cohort, the FluxPro-DKD fusion model achieved an area under the receiver operating characteristic curve (AUC) of 0.90 (95% confidence interval [CI], 0.87 to 0.93), significantly outperforming the standard clinical model (AUC, 0.78; <i>P</i><0.001). The model maintained robust discrimination in the external validation cohort (AUC, 0.85; 95% CI, 0.79 to 0.91). Among patients with normoalbuminuria, those classified as high-risk by the model had a significantly higher projected 3-year event rate than those classified as low-risk (35.3% vs. 2.3%).</p><p><strong>Conclusions: </strong>The integration of digital urine physical phenotypes and metabolic flux ratios effectively reveals early tubular secretory dysfunction and improved risk stratification for diabetic kidney disease compared with standard clinical metrics.</p>","PeriodicalId":12447,"journal":{"name":"Frontiers in Endocrinology","volume":"17 ","pages":"1802447"},"PeriodicalIF":4.6,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835887","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":"Ectopic lipid deposition in kidney diseases: mechanisms in specific cell types and therapeutic strategies.","authors":"Qi Zhong, Yue Zhang, Di Sun, Jin Peng, Peng Zhang, Ruolin Wang, Lei Cao, Hailong Chen, Chunwei Wu, Ze He","doi":"10.3389/fendo.2026.1788998","DOIUrl":"https://doi.org/10.3389/fendo.2026.1788998","url":null,"abstract":"<p><p>Kidney diseases represent a major global health burden and arise from complex interactions among multiple cellular and molecular processes. Ectopic lipid deposition (ELD), defined as the accumulation of excess lipids in non-adipose tissues when lipid supply exceeds adipose storage capacity, has emerged as a key contributor to the initiation and progression of renal injury. ELD occurs across multiple renal cell types, including proximal tubular epithelial cells, podocytes, mesangial cells, glomerular endothelial cells, as well as interstitial fibroblasts and macrophages. Owing to differences in metabolic profiles and lipid-handling capacity, these cells exhibit distinct susceptibilities and pathological responses to lipid accumulation. This review summarizes the major sources and underlying mechanisms of renal ELD, with particular emphasis on cell-specific injury pathways driven by different lipid subtypes. It further discusses how these divergent responses collectively contribute to renal dysfunction and structural damage. We also outline current approaches for the clinical assessment and diagnosis of renal ELD, and highlight the relevance of age stratification in improving diagnostic precision. Recent advances in therapeutic strategies targeting renal ELD are also reviewed, including evidence from diabetic kidney disease, obesity-related kidney disease, acute kidney injury, and Alport syndrome. Overall, this review provides a systematic overview of the molecular mechanisms and therapeutic implications of ELD in kidney diseases from a cell-specific perspective, and highlights its potential as a target for improved prevention and treatment strategies.</p>","PeriodicalId":12447,"journal":{"name":"Frontiers in Endocrinology","volume":"17 ","pages":"1788998"},"PeriodicalIF":4.6,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835944","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":"Association of pericoronary fat attenuation index and insulin resistance for the risk of cardiometabolic multimorbidity: a cross-sectional study.","authors":"Linjuan Li, Hui Li, Yuxin Guo, Yawen Wang, Ning Yang, Haimei Du, Zhuanxia Li","doi":"10.3389/fendo.2026.1801280","DOIUrl":"https://doi.org/10.3389/fendo.2026.1801280","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cardiometabolic multimorbidity (CMM) has become an increasingly serious public health problem. Patients with type 2 diabetes mellitus (T2DM) often present with multiple cardiometabolic disorders and carry a significantly higher risk of CMM. Insulin resistance (IR) is the core mechanism of T2DM and atherosclerotic cardiovascular disease. The triglyceride-glucose index (TyG index) can serve as a reliable alternative for evaluating IR. The pericoronary fat attenuation index (FAI) is a non-invasive biomarker of coronary inflammation based on coronary CT angiography. However, the combined associations of the TyG index and FAI with CMM among patients with T2DM remain unknown. Therefore, this study aims to evaluate the TyG index, RCA-FAI, LAD-FAI, and LCX-FAI in relation to CMM among middle-aged and elderly patients with T2DM in China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;We conducted a cross-sectional study and enrolled 497 middle-aged and elderly patients (aged ≥45 years) with T2DM who underwent coronary CT angiography for clinical indications. We defined CMM as the concurrent presence of T2DM together with coronary heart disease or stroke. We used a multivariate logistic regression model to analyze the association between the TyG index and the FAI in each coronary segment (including RCA-FAI, LAD-FAI, and LCX-FAI) with CMM. We presented the study results as odds ratios (ORs) with their corresponding 95% confidence intervals (CIs). We employed restricted cubic splines to analyze the nonlinear relationship and used receiver operating characteristic (ROC) curves to assess the discriminatory capacity of each index in identifying CMM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result: &lt;/strong&gt;After fully adjusting for confounding factors, the TyG index (OR = 2.07, 95% CI: 1.44-2.99), RCA-FAI (for each increase of 1 unit: OR = 1.19, 95% CI: 1.14-1.23), LAD-FAI (OR = 1.16, 95% CI: 1.12-1.21), and LCX-FAI (OR = 1.11, 95% CI: 1.07-1.15) were all significantly and positively associated with CMM (all &lt;i&gt;P&lt;/i&gt; &lt; 0.001).Dosage-response analysis revealed nonlinear associations of the TyG index and LAD-FAI with CMM (&lt;i&gt;P&lt;/i&gt; for nonlinearity &lt; 0.05), whereas RCA-FAI and LCX-FAI showed linear relationships. Receiver operating characteristic (ROC) curve analysis was further performed to evaluate the discriminatory performance of each indicator for CMM. Among these indices, adding the RCA-FAI showed the most pronounced improvement, with a C-statistic of 0.900 (95% CI: 0.873-0.926, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), a net reclassification improvement (NRI) of 0.749 (95% CI: 0.585-0.913, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), and an integrated discrimination improvement (IDI) of 0.141 (95% CI: 0.110-0.171, &lt;i&gt;P&lt;/i&gt; &lt; 0.001). In contrast, adding the TyG index did not meaningfully improve the predictive value of the baseline clinical model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study confirms that among middle-aged and elderly Chinese patients with T2DM, both the TyG index and FAI, including RCA-FAI, LAD-FAI","PeriodicalId":12447,"journal":{"name":"Frontiers in Endocrinology","volume":"17 ","pages":"1801280"},"PeriodicalIF":4.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835715","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":"Enhanced independent discriminative performance of elevated lipoprotein(a) for cardiovascular outcomes in patients with diabetes: a comparative analysis of optimal cutoff values.","authors":"Song Wen, Yanju He, Xiucai Li, Zhimin Xu, Dan Liu, Jiyu Li, Ligang Zhou","doi":"10.3389/fendo.2026.1795181","DOIUrl":"https://doi.org/10.3389/fendo.2026.1795181","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the independent discriminative performance of elevated Lipoprotein(a) [Lp(a)] in identifying prevalent cardiovascular disease (CVD), specifically in patients with Diabetes Mellitus (DM), and to determine the optimal cutoff values for identifying CVD in the DM population.</p><p><strong>Methods: </strong>A stratified analysis was conducted across general, DM, and non-DM patient groups. Correlation analysis was employed to assess the association between elevated Lp(a) levels and metabolic factors in different age groups. Furthermore, binary regression was used to calculate combined risk scores. Receiver operating characteristic (ROC) curve analysis was utilized to determine the area under the curve (AUC) for the discriminative performance of Lp(a) alone, traditional parameters (excluding Lp(a)), and the combined model. This analysis identified the optimal cutoff values for each group.</p><p><strong>Results: </strong>Comparisons of Lp(a) variations showed that Lp(a)>300mg/L was associated with an increased prevalence of CVDs in general and non-diabetic patients, while it was insignificant in patients with DM, unless the cutoff was set as low as 70mg/L; Correlation analyses showed that, regardless of minor nuances between the general and DM groups, Lp(a) was significantly related to Low-density lipoprotein (LDL) and Apolipoprotein B (ApoB), but negatively related to Glycated Hemoglobin A1c (HbA1c), Triglycerides (TG), and free triiodothyronine (FT3); when stratified by age, no correlation was associated with Lp(a), but an association was found with CVD in the 65-75 age group, while Non-alcoholic fatty liver disease (NAFLD) prevalence was higher in the <65 age group across groups except for Lp(a)>70mg/L in the DM group; correlational analyses revealed that Lp(a) was positively related with CVD in the <65 age group compared to the general group. Regression analyses revealed that HbA1c and age significantly contributed to increased CVD in DM and that Lp(a) was determined by FT3 and albumin (Alb) in DM; ROC curves demonstrated that the combination of Lp(a) with traditional parameters significantly enhanced the AUC for CVD in DM.</p><p><strong>Conclusion: </strong>Elevated Lp(a) levels are significantly associated with CVD and demonstrate strong discriminative utility, particularly in patients with DM. These findings suggest that more stringent Lp(a) thresholds may be warranted in the clinical management of diabetic patients to better identify individuals at high risk for cardiovascular outcomes.</p>","PeriodicalId":12447,"journal":{"name":"Frontiers in Endocrinology","volume":"17 ","pages":"1795181"},"PeriodicalIF":4.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835855","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":"Development and validation of a diagnostic nomogram for Wagner grade≥2 diabetic foot ulcers in hospitalized patients with type 2 diabetes.","authors":"Jinying Zhang, Xuesong Jiang, Yan Li, Jiayu Lin","doi":"10.3389/fendo.2026.1792343","DOIUrl":"https://doi.org/10.3389/fendo.2026.1792343","url":null,"abstract":"<p><strong>Background: </strong>Diabetic foot ulcers (DFUs) represent a severe and prevalent complication of diabetes, contributing to substantial disability and elevated mortality. This study aimed to develop and validate a diagnostic nomogram for Wagner Grade ≥2 DFUs in hospitalized patients with type 2 diabetes (T2DM).</p><p><strong>Methods: </strong>This retrospective cohort study included 510 hospitalized patients with T2DM treated at the Second Affiliated Hospital of Fujian Medical University between January 2023 and December 2025, of whom 248 had Wagner Grade ≥2 DFUs. Patients were randomly divided into a training set (n=357) and an internal validation set (n=153) in a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors and construct a diagnostic nomogram. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and clinical impact curves. External validation was performed in an independent cohort of 154 patients from Quanzhou Southeast Hospital, including 86 with Wagner Grade ≥2 DFUs.</p><p><strong>Results: </strong>The nomogram incorporated four independent predictors: Angle α, K time, platelet count (PLT), and lymphocyte count. The model exhibited excellent discrimination in the training set (area under the curve [AUC] = 0.940, 95% confidence interval [CI]: 0.916-0.965) and internal validation set (AUC = 0.914, 95% CI: 0.870-0.956), with modest discrimination in the external validation set (AUC = 0.690, 95% CI: 0.604-0.775). Calibration curves demonstrated strong concordance between predicted and observed probabilities. DCA and clinical impact curves confirmed substantial clinical utility across all cohorts.</p><p><strong>Conclusion: </strong>This nomogram, integrating thromboelastography parameters and hematological indicators, provides a practical tool for identifying the presence of Wagner Grade ≥2 DFUs in hospitalized patients with T2DM, supporting early risk stratification and informed clinical decision-making.</p>","PeriodicalId":12447,"journal":{"name":"Frontiers in Endocrinology","volume":"17 ","pages":"1792343"},"PeriodicalIF":4.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835920","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":"AutoPCOS: a stepwise multimodal intelligent framework for polycystic ovary syndrome risk stratification and diagnostic support.","authors":"Jianping Hou, Yirui Duan, Wanli Zhao, Qianpeng Sun, Jiayin Wang","doi":"10.3389/fendo.2026.1760541","DOIUrl":"https://doi.org/10.3389/fendo.2026.1760541","url":null,"abstract":"<p><strong>Introduction: </strong>Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age, typically diagnosed through a combination of clinical evaluation, laboratory testing, and ultrasonography. However, this multimodal diagnostic pathway is often time-consuming, costly, and dependent on resource availability, thereby limiting its accessibility in real-world clinical settings.</p><p><strong>Methods: </strong>In this study, we propose AutoPCOS, a stepwise multimodal intelligent framework for flexible PCOS risk stratification and diagnostic support. Using a publicly available Kaggle PCOS dataset, features were categorized into three modalities: clinical, laboratory, and ultrasound data. Based on data availability, four predictive models were constructed: (1) clinical-only, (2) clinical + laboratory, (3) clinical + ultrasound, and (4) full multimodal models. Random Forest was employed as the primary classifier, with comparisons against Logistic Regression, Support Vector Machine, Decision Tree, and Gradient Boosting. Subgroup analyses were conducted based on body mass index (BMI) and menstrual cycle patterns.</p><p><strong>Results: </strong>The proposed framework demonstrated robust predictive performance across different data availability scenarios. Notably, the models achieved strong performance in subgroups with BMI < 24 and irregular menstrual cycles, with precision values reaching ≥ 0.929. Comparative analysis confirmed the effectiveness of the Random Forest model. Furthermore, the integration of a knowledge base and the Lingshu large language model enabled interpretable risk explanations and personalized recommendations.</p><p><strong>Discussion: </strong>AutoPCOS provides a flexible and resource-aware framework for PCOS risk assessment that adapts to varying clinical conditions and data accessibility. By supporting stepwise decision-making and enhancing interpretability, the system shows potential as a practical tool for both patients and healthcare providers. Future work will focus on validation using real-world clinical datasets and improving model generalizability.</p>","PeriodicalId":12447,"journal":{"name":"Frontiers in Endocrinology","volume":"17 ","pages":"1760541"},"PeriodicalIF":4.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835725","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":"Predictive factors of permanent hypothyroidism after subacute thyroiditis: a systematic review and meta-analysis.","authors":"Qianhui Cui, Meng Wang, Jingqiu Cui","doi":"10.3389/fendo.2026.1720417","DOIUrl":"https://doi.org/10.3389/fendo.2026.1720417","url":null,"abstract":"<p><strong>Background: </strong>Subacute thyroiditis (SAT) is a self-limiting thyroid inflammatory disorder, but some patients develop permanent hypothyroidism, impacting long-term health. We aimed to systematically synthesize evidence on factors associated with permanent hypothyroidism after SAT.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, the Cochrane Library and Web of Science was conducted up to August 2025. Randomized trials, cohort, and case-control studies evaluating predictors of permanent hypothyroidism after SAT were included. Data were extracted following PRISMA guidelines, and study quality was assessed using the Newcastle-Ottawa Scale (NOS). Random-effects models were preferentially applied given expected clinical heterogeneity, with heterogeneity quantified using I² and τ².</p><p><strong>Results: </strong>Ten studies involving 1294 patients were included. Higher free triiodothyronine (FT3) levels (mean difference = 1.85, 95% CI: 0.60-3.09; Z = 2.91, P = 0.004; I² = 0%) and positive thyroglobulin antibodies (TgAb) (OR = 2.57, 95% CI: 1.35-4.88, P = 0.004; I² = 57%, τ² = 0.13) were significantly associated with an increased risk of permanent hypothyroidism after SAT. Corticosteroid therapy was associated with a lower odds of permanent hypothyroidism compared with NSAID-based management (OR = 0.40, 95% CI: 0.23-0.70, P = 0.001; I² = 36%).</p><p><strong>Conclusions: </strong>FT3, TgAb positivity and treatment modality are associated with the risk of permanent hypothyroidism following SAT. Compared with NSAID-based management, corticosteroid therapy is associated with lower odds of developing permanent hypothyroidism. These findings support early identification of high-risk patients and personalized follow-up strategies.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/, identifier CRD420251064643.</p>","PeriodicalId":12447,"journal":{"name":"Frontiers in Endocrinology","volume":"17 ","pages":"1720417"},"PeriodicalIF":4.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835603","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":"Association of the TyG-GGT index, a novel insulin resistance marker, with incident diabetes mellitus: a large-scale retrospective cohort study.","authors":"Yajing Gao, Yuting Yan, Chuang Gao, Jiaqian Zhu, Yong Han","doi":"10.3389/fendo.2026.1735979","DOIUrl":"https://doi.org/10.3389/fendo.2026.1735979","url":null,"abstract":"<p><strong>Objective: </strong>Research on the association between TyG-GGT index and diabetes mellitus (DM) risk remains scarce. This study aimed to investigate the relationship between TyG-GGT and DM incidence.</p><p><strong>Methods: </strong>This retrospective cohort investigation enrolled 8,678 participants who underwent comprehensive health screenings at Kuichong People's Hospital in Shenzhen from 2018 through 2023. Cox proportional hazards regression models were employed to assess the association between TyG-GGT and DM risk, and Cox proportional hazards regression model with restricted cubic spline functions was used to evaluate non-linear relationships. Subgroup analyses and sensitivity analyses further verified the stability of these findings. Finally, receiver operating characteristic (ROC) curve methodology and time-dependent ROC analysis were performed to determine the predictive capacity of TyG-GGT for incident DM within a 5-year period.</p><p><strong>Results: </strong>Following multivariable adjustments, higher TyG-GGT levels were found to be associated with elevated DM risk, demonstrating an HR of 1.116 (95% CI: 1.041-1.196) per 50-unit increase in TyG-GGT. Additionally, a non-linear association between them was observed, exhibiting a threshold value at 380. When below this inflection point, the HR per 50-unit increase in TyG-GGT was 1.723 (95% CI: 1.500-1.979), while above this value the association was not statistically significant. Additionally, in predicting DM risk, TyG-GGT had the highest AUC value (0.732), while the AUC values of TG (0.635), GGT (0.649), FPG (0.660), and TyG (0.675) were all lower than this value. Time-dependent ROC analysis revealed that the AUC values of TyG-GGT remained stable between 0.7292-0.7338 over a prediction horizon of 1.0 to 5.0 years. The stability of these results was further corroborated via sensitivity analysis.</p><p><strong>Conclusion: </strong>This study found that TyG-GGT demonstrated an independent positive association and non-linear relationship with DM risk, with an inflection point at 380. TyG-GGT below 380 was associated with higher observed DM risk. Additionally, TyG-GGT exhibits discriminatory performance for DM risk assessment and may serve as a clinically useful predictor, thereby aiding clinicians in early identification of high-risk individuals and providing a novel perspective for optimizing clinical prevention and management of DM.</p>","PeriodicalId":12447,"journal":{"name":"Frontiers in Endocrinology","volume":"17 ","pages":"1735979"},"PeriodicalIF":4.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835689","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":"Relationship of HOMA-IR with chronic kidney disease in diabetic and non-diabetic Chinese populations: findings from the REACTION study.","authors":"Yuheng Liao, Mijie Guan, Qijun Wan, Haiying Song, Haofei Hu","doi":"10.3389/fendo.2026.1707947","DOIUrl":"https://doi.org/10.3389/fendo.2026.1707947","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) affects 8.2% of China's population and is a major global health concern. While insulin resistance (IR) is linked to CKD, the relationship between insulin resistance (HOMA-IR) and CKD risk remains unclear, especially in diabetic and non-diabetic populations.</p><p><strong>Methods: </strong>This cross-sectional study analyzed data from 32,055 Chinese adults in the REACTION study. Logistic regression and generalized additive models assessed the association between HOMA-IR and CKD risk in diabetic (DM) and non-diabetic (Non-DM) populations, with nonlinear relationships explored using two-piecewise logistic regression.</p><p><strong>Results: </strong>The overall CKD prevalence was 16.09%(95% CI: 15.68%-16.49%). In the Non-DM group, HOMA-IR was positively associated with CKD risk (OR = 1.037, 95% CI: 1.010-1.066, P = 0.008), while no significant association was found in the DM group (OR = 0.991, 95% CI: 0.952-1.032, P = 0.667). Both groups showed an n-shaped relationship, with inflection points at HOMA-IR values of 2.581 (Non-DM) and 2.587 (DM). Below these thresholds, CKD risk increased with HOMA-IR; above them, risk decreased.</p><p><strong>Conclusion: </strong>Elevated HOMA-IR is independently associated with an increased risk of CKD in non-diabetic individuals, whereas this association is not significant in diabetic patients. These findings strongly highlight the clinical value of HOMA-IR as an early predictor of CKD risk, particularly in non-diabetic populations, emphasizing the importance of monitoring insulin resistance for early risk stratification and tailored management.</p>","PeriodicalId":12447,"journal":{"name":"Frontiers in Endocrinology","volume":"17 ","pages":"1707947"},"PeriodicalIF":4.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835723","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":"Endocrine-related osteoporosis: the state of the art.","authors":"Iacopo Chiodini, Agostino Gaudio, Luigi Gennari, Domenico Rendina, Alfredo Scillitani, Fabio Vescini, Alberto Falchetti","doi":"10.3389/fendo.2026.1797546","DOIUrl":"https://doi.org/10.3389/fendo.2026.1797546","url":null,"abstract":"<p><strong>Background: </strong>Endocrine-related secondary osteoporosis (ERSOP) comprises disorders in which bone fragility results from hormonal abnormalities other than age-related or menopausal hypogonadism. Its prevalence is underestimated, and timely recognition is essential because many forms improve or reverse when the underlying endocrine disturbance is corrected.</p><p><strong>Objective: </strong>This Review highlights the evolving concepts, unmet needs, and research opportunities in ERSOP, with focus on hypercortisolism, primary aldosteronism, male hypogonadism, hypercalciuria, and FGF23-dependent phosphate-wasting disorders.</p><p><strong>Recent findings: </strong>Mild autonomous cortisol secretion (MACS) is increasingly recognized as a contributor to fracture risk even at near-normal cortisol levels.Primary aldosteronism promotes skeletal fragility via mineralocorticoid receptor activation, oxidative stress, hypercalciuria, and secondary hyperparathyroidism.Male hypogonadism is a major driver of bone loss, and optimal fracture prevention may require combined hormonal and anti-osteoporotic therapy.Differentiating PTH-dependent from PTH-independent hypercalciuria is crucial for management.FGF23-mediated phosphate-wasting disorders impair mineralization and may respond to targeted therapy, including burosumab.</p><p><strong>Conclusion: </strong>ERSOP should be considered in patients with atypical osteoporosis phenotypes, including men, younger adults, and individuals with normal BMD but fragility fractures. Optimal care requires structured endocrine assessment, correction of the primary disorder, and integration with bone-specific therapy where appropriate.</p>","PeriodicalId":12447,"journal":{"name":"Frontiers in Endocrinology","volume":"17 ","pages":"1797546"},"PeriodicalIF":4.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835930","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}