Reviews & Analysis

New approaches are required for the prevention and treatment of obesity and its associated pathologies. Here, Martel and colleagues review the potential anti-obesogenic and antidiabetic effects of plants, mushrooms and their derivatives, some of which have longstanding uses in traditional Chinese medicine.

Peroxisome proliferator-activated receptors (PPARs) are integrators of both inflammatory and metabolic signalling networks. In this Review, the authors provide a comprehensive overview of how PPARs contribute to the development of metabolic disorders and how pharmacologically targeting these pathways can be used to develop new therapeutics for such diseases.

In addition to undergoing adaptive thermogenesis, brown adipose tissue secretes a number of adipokines that can influence systemic metabolism. In this Review, Villarroya and colleagues discuss the current evidence for these so-called 'batokines' and how they might influence whole-body metabolic health.

Sergueï Fetissov discusses the possible involvement of gut bacteria in the host regulation of appetite and proposes an integrative homeostatic model of appetite control that includes the energy needs of both the host and its gut bacteria.

The latest report from the Childhood Cancer Survivor Study highlights the effect of cancer therapy on endocrine abnormalities over >30 years of follow up. Overall, 44% of patients had one endocrine abnormality, 16.7% had two and 6.6% had three or more. The findings highlight the need for long-term endocrine monitoring of these patients.

Silver–Russell syndrome (SRS) is an imprinting disorder that causes prenatal and postnatal growth retardation. This Consensus Statement summarizes recommendations for clinical diagnosis, investigation and management of patients with SRS, including the use of growth hormone and gonadotropin-releasing hormone analogues.

In this Review, Heiko Lickert and colleagues discuss β-cell heterogeneity, placing a particular emphasis on the role of islet architecture in defining phenotypic and functional plasticity among β cells. The potential to exploit β-cell heterogeneity and plasticity for diagnostic and therapeutic purposes in the context of regenerative therapies for diabetes mellitus is also discussed.

Adrenal incidentalomas are masses found in the adrenal glands during examination for other indications. New guidelines from the European Society of Endocrinology in collaboration with the European Network for the Study of Adrenal Tumors present evidence-based recommendations for the clinical management of these tumours following their detection in patients.

Diabetic ketoacidosis (DKA) is the leading cause of death, morbidity and excessive health-care utilization and costs in patients with type 1 diabetes mellitus; DKA is common at initial diagnosis, but uncommon thereafter. A new study has determined the risk factors for multiple DKA episodes and their relationship to the risk of death.

Mericq and colleagues review human data supporting an increased risk of metabolic diseases among children born premature or small for gestational age. The adrenal and pubertal modifications that contribute to this risk and the metabolic changes that occur during adolescence and adulthood are discussed.

Hepatic steatosis is prevalent in individuals with obesity and is a risk factor for type 2 diabetes mellitus. In this Review, the authors discuss the disruption of endoplasmic reticulum function in hepatic steatosis and how cellular stress responses to lipid accumulation can promote or inhibit progression to severe liver pathologies.

Monthly or annual bolus doses of vitamin D have been reported to be harmful rather than beneficial, increasing falls and fractures. In this Perspectives, J. Christopher Gallagher proposes that the vitamin D dose recommended by the Institute of Medicine be revised downwards.

Recent data from surveys in the USA have shown that 37.7% of adult individuals and 17.0% of children currently have obesity, with no sign of a reduction despite federal and local obesity prevention strategies. In particular, severe obesity seems to be increasing. Obesity, therefore, remains a major public health problem that requires drastic action.

Lipidomics uses the principles of analytical chemistry to reveal the total lipid content and composition in a cell. In this Review, Xianlin Han provides an overview of lipidomics as applied to the study of metabolic pathways and how this technique can help in the understanding of metabolic diseases.

A recent study by Clayton et al. shows that overall mortality is increased for patients with Cushing disease, even in remission, but that mortality is normal if long-term remission is induced by only one pituitary surgery. These findings emphasize the importance of expert pituitary surgery.

Insulin resistance and type 2 diabetes mellitus are associated with mitochondrial dysfunction, and promoting healthy mitochondrial function could benefit patients. This Review discusses novel molecular targets for therapies that enhance mitochondrial function, with an emphasis on nonpharmacological regulation of factors such as nutrition, exercise, temperature and circadian rhythm.

The human endometrium repeatedly undergoes specific cyclic changes to prepare for embryo implantation. Understanding the mechanisms involved in endometrial cycling is important for the treatment of reproductive pathologies, and can also provide insight into conditions such as wound healing and even cancer.

The incidence of thyroid cancer has increased substantially in many countries over the past few decades. In this Review, Kitahara and Sosa describe the changing incidence of the disease and suggest possible explanations for the trends, emphasizing implications for patients and ongoing strategies to combat this growing public health issue.

Oral contraceptives are the mainstay of long-term PCOS treatment, but have potential adverse cardiometabolic effects. In a randomized controlled trial comparing oral contraceptive use and structured exercise in women with PCOS and overweight on a calorie-restricted diet, androgen excess was ameliorated with oral contraceptive use and structured exercise improved markers of cardiometabolic risk.

Recently, 45 international medical and scientific organizations agreed that bariatric or metabolic surgery should be included among the therapeutic interventions for people with type 2 diabetes mellitus and obesity. The endorsement of these guidelines follows findings that several surgical procedures developed for weight loss improve glycaemia more effectively than any pharmacological or lifestyle approach.