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AT RNA sequencing was analyzed using linear mixed modeling and pathway enrichment for: (1) sex differences in individual twins, adjusted for BMI, (2) sex\u2010stratified effects of acquired obesity (\u0394BMI between co\u2010twins separately in females and males), (3) sex\u2010specific effects of obesity (differences in the \u0394BMI effect between sexes).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>(1) AT transcriptional profiles differed between sexes, associating with insulin sensitivity. (2) Sex\u2010stratified obesity effects within pairs were stronger in females, with upregulated inflammation and downregulated mitochondrial oxidative phosphorylation; males showed increased inflammation and decreased histone modification. (3) The response to obesity was sex\u2010specific: lower expression of genes in unsaturated fatty acid metabolism in obesity was seen in females only. Sex\u2010specific obesity AT gene expression was associated with metabolic health, with a negative association between unsaturated fatty acid metabolism and insulin sensitivity in males only.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Biological sex influences the AT transcriptome and its response to obesity, highlighting distinct molecular mechanisms that may contribute to sex\u2010specific metabolic health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/oby.70078","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T01:21:22Z","timestamp":1763947282000},"page":"394-406","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sex\u2010Specific Subcutaneous Adipose Tissue Transcriptome in Obesity: Insights From Monozygotic Twin Pairs Discordant for\n                    <scp>BMI<\/scp>"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8750-8998","authenticated-orcid":false,"given":"Hanna","family":"Haltia","sequence":"first","affiliation":[{"name":"Obesity Research Unit, Research Program for Clinical and Molecular Metabolism Faculty of Medicine, University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7624-7948","authenticated-orcid":false,"given":"Maheswary","family":"Muniandy","sequence":"additional","affiliation":[{"name":"Obesity Research Unit, Research Program for Clinical and Molecular Metabolism Faculty of Medicine, University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6342-0577","authenticated-orcid":false,"given":"Sini","family":"Heinonen","sequence":"additional","affiliation":[{"name":"Obesity Research Unit, Research Program for Clinical 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