Publications by authors named "Stefan N"

Article Synopsis
  • Liver fibrosis and biological sex influence the likelihood of developing hepatocellular carcinoma (HCC) and extrahepatic cancers (EHCs) in people with metabolic dysfunction-associated steatotic liver disease (MASLD).
  • The differences in cancer risk based on these factors suggest the need for tailored chemoprevention and precision medicine strategies in treating MASLD.
  • This understanding calls for more research to explore how these variables can inform better treatment approaches.
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Objective: Progression of prediabetes to type 2 diabetes has been associated with β-cell dysfunction, whereas its remission to normoglycemia has been related to improvement of insulin sensitivity. To understand the mechanisms and identify potential biomarkers related to prediabetes trajectories, we compared the proteomics and metabolomics profile of people with prediabetes progressing to diabetes or reversing to normoglycemia within 1 year.

Research Design And Methods: The fasting plasma concentrations of 1,389 proteins and the fasting, 30-min, and 120-min post-oral glucose tolerance test (OGTT) plasma concentrations of 152 metabolites were measured in up to 134 individuals with new-onset diabetes, prediabetes, or normal glucose tolerance.

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The global epidemic of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing worldwide. People with MASLD can progress to cirrhosis and hepatocellular carcinoma and are at increased risk of developing type 2 diabetes, cardiovascular disease, chronic kidney disease, and extrahepatic cancers. Most people with MASLD die from cardiac-related causes.

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Background: The potential impact of specific food additives, common in Western diets, on the risk of developing type 2 diabetes is not well understood. This study focuses on carrageenan, a widely used food additive known to induce insulin resistance and gut inflammation in animal models, and its effects on human health.

Methods: In a randomised, double-blind, placebo-controlled, cross-over trial conducted at a university hospital metabolic study centre, 20 males (age 27.

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Article Synopsis
  • - Metabolic dysfunction-associated steatotic liver disease (MASLD) is an increasingly common condition that significantly impacts health by raising risks for liver complications, cardiometabolic issues, and gastrointestinal (GI) cancers, which are a major contributor to cancer deaths globally.
  • - The review explores evidence linking MASLD to non-liver GI cancers, examining factors that may explain this increased risk and highlighting the need for tailored screening for individuals with MASLD.
  • - Potential treatments like aspirin, statins, and metformin may help reduce the risk of GI cancers associated with MASLD, but more research is needed to solidify these findings.
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Article Synopsis
  • - The review focuses on metabolically healthy obesity (MHO), examining its evolution, definitions, and the debate over its existence in relation to cardiovascular diseases and diabetes complications.
  • - It presents epidemiological data showing that individuals with MHO may have moderate cardiovascular risk compared to metabolically healthy normal-weight people, although this risk might not be significant using newer definitions of MHO.
  • - The article also explores the physiological mechanisms of MHO and emphasizes its potential for improving risk assessment and treatment strategies in clinical settings.
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Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a predominant chronic liver condition globally and is strongly associated with obesity, diabetes mellitus, and dyslipidemia. Essential phospholipids (EPL) are recommended as supportive treatment for managing liver conditions, including MASLD or metabolic dysfunction-associated steatohepatitis, cirrhosis, and viral hepatitis. While efficacy of EPL as an adjunctive therapy in MASLD treatment has been established earlier, certain aspects of its usage such as the impact of standard-of-care parameters, effect of EPL on quality of life (QoL) and change in symptoms evaluation in patients with MASLD remain unexplored.

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Purpose: Excess fat accumulation contributes significantly to metabolic dysfunction and diseases. This study aims to systematically compare the accuracy of commercially available Dixon techniques for quantification of fat fraction in liver, skeletal musculature, and vertebral bone marrow (BM) of healthy individuals, investigating biases and sex-specific influences.

Method: 100 healthy White individuals (50 women) underwent abdominal MRI using two-point and multi-echo Dixon sequences.

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Article Synopsis
  • - The study utilized a tree-like graph structure to represent the diverse characteristics of type 2 diabetes, analyzing 927 participants with recent-onset diabetes to identify key health factors and complications over time.
  • - Participants were evaluated on clinical and laboratory measures, including insulin sensitivity and secretion, and factors such as hepatic lipid content and inflammatory biomarkers were linked to different progression outcomes in diabetes.
  • - Findings revealed that lower insulin sensitivity correlated with higher liver fat, inflammation, and cardiovascular risk, while lower insulin secretion was associated with greater need for insulin therapy and increased chance of diabetic neuropathy.
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Background: Heterogeneity in type 2 diabetes presentation and progression suggests that precision medicine interventions could improve clinical outcomes. We undertook a systematic review to determine whether strategies to subclassify type 2 diabetes were associated with high quality evidence, reproducible results and improved outcomes for patients.

Methods: We searched PubMed and Embase for publications that used 'simple subclassification' approaches using simple categorisation of clinical characteristics, or 'complex subclassification' approaches which used machine learning or 'omics approaches in people with established type 2 diabetes.

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Article Synopsis
  • Precision medicine is an evolving approach in healthcare that aims to enhance decision-making and health outcomes, particularly in managing diabetes, which poses serious health risks for millions globally.
  • The second international consensus report on precision diabetes medicine reviews current findings on prevention, diagnosis, treatment, and prognosis across different forms of diabetes, highlighting the potential for translating research into clinical practice.
  • The report also identifies knowledge gaps and sets out key milestones for better clinical implementation, emphasizing the need for standards addressing cost-effectiveness, health equity, and accessibility in treatment options.
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Safe and effective vaccines have been regarded early on as critical in combating the COVID-19 pandemic. Among the deployed vaccine platforms, subunit vaccines have a particularly good safety profile but may suffer from a lower immunogenicity compared to mRNA based or viral vector vaccines. In fact, this phenomenon has also been observed for SARS-CoV-2 subunit vaccines comprising the receptor-binding domain (RBD) of the spike (S) protein.

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Background: Remission of type 2 diabetes can occur as a result of weight loss and is characterised by liver fat and pancreas fat reduction and recovered insulin secretion. In this analysis, we aimed to investigate the mechanisms of weight loss- induced remission in people with prediabetes.

Methods: In this prespecified post-hoc analysis, weight loss-induced resolution of prediabetes in the randomised, controlled, multicentre Prediabetes Lifestyle Intervention Study (PLIS) was assessed, and the results were validated against participants from the Diabetes Prevention Program (DPP) study.

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Previously, we found that human pancreatic preadipocytes (PPAs) and islets influence each other and that the crosstalk with the fatty liver via the hepatokine fetuin-A/palmitate induces inflammatory responses. Here, we examined whether the mRNA-expression of pancreatic extracellular matrix (ECM)-forming and -degrading components differ in PPAs from individuals with normal glucose regulation (PPAs-NGR), prediabetes (PPAs-PD), and type 2 diabetes (PPAs-T2D), and whether fetuin-A/palmitate impacts ECM-formation/degradation and associated monocyte invasion. Human pancreatic resections were analyzed (immuno)histologically.

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This research addresses the assessment of adipose tissue (AT) and spatial distribution of visceral (VAT) and subcutaneous fat (SAT) in the trunk from standardized magnetic resonance imaging at 3 T, thereby demonstrating the feasibility of deep learning (DL)-based image segmentation in a large population-based cohort in Germany (five sites). Volume and distribution of AT play an essential role in the pathogenesis of insulin resistance, a risk factor of developing metabolic/cardiovascular diseases. Cross-validated training of the DL-segmentation model led to a mean Dice similarity coefficient of >0.

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Among 20 leading global risk factors for years of life lost in 2040, reference forecasts point to three metabolic risks-high blood pressure, high BMI, and high fasting plasma glucose-as being the top risk variables. Building upon these and other risk factors, the concept of metabolic health is attracting much attention in the scientific community. It focuses on the aggregation of important risk factors, which allows the identification of subphenotypes, such as people with metabolically unhealthy normal weight or metabolically healthy obesity, who strongly differ in their risk of cardiometabolic diseases.

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Heterogeneity in type 2 diabetes presentation, progression and treatment has the potential for precision medicine interventions that can enhance care and outcomes for affected individuals. We undertook a systematic review to ascertain whether strategies to subclassify type 2 diabetes are associated with improved clinical outcomes, show reproducibility and have high quality evidence. We reviewed publications that deployed 'simple subclassification' using clinical features, biomarkers, imaging or other routinely available parameters or 'complex subclassification' approaches that used machine learning and/or genomic data.

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Non-alcoholic fatty liver disease (NAFLD) is not only a consequence of insulin resistance, but it is also an important cause of insulin resistance and major non-communicable diseases (NCDs). The close relationship of NAFLD with visceral obesity obscures the role of fatty liver from visceral adiposity as the main pathomechanism of insulin resistance and NCDs. To overcome this limitation, in analogy to the concept of adipokines, in 2008 we introduced the term hepatokines to describe the role of fetuin-A in metabolism.

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This work proposes a method for automatic standardized assessment of bone marrow volume and spatial distribution of the proton density fat fraction (PDFF) in vertebral bodies. Intra- and interindividual variability in size and shape of vertebral bodies is a challenge for comparable interindividual evaluation and monitoring of changes in the composition and distribution of bone marrow due to aging and/or intervention. Based on deep learning image segmentation, bone marrow PDFF of single vertebral bodies is mapped to a cylindrical template and corrected for the inclination with respect to the horizontal plane.

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