{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:06:48Z","timestamp":1779253608439,"version":"3.51.4"},"reference-count":28,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Recep Tayyip Erdo\u011fan University Development Foundation","award":["020260050120327"],"award-info":[{"award-number":["020260050120327"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Although obesity is known to cause low-grade chronic inflammation, the extent to which body mass index (BMI) reflects this remains questionable. To investigate this, we classified a national obesity cohort by BMI and evaluated its association with complete blood count (CBC)-derived systemic inflammatory indices. Methods: This retrospective, multi-center study included 6499 adults from the OBREDI-TR cohort with available laboratory data. Patients were categorized by BMI into Class I (30.0\u201334.9 kg\/m2, n = 2751), Class II (35.0\u201339.9 kg\/m2, n = 1804), and Class III (\u226540.0 kg\/m2, n = 1944) obesity. We compared demographic, clinical, and laboratory parameters, especially in terms of CBC-derived inflammation parameters: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). Results: The Class III group was younger (42.73 \u00b1 13.21 vs. 45.14 \u00b1 14.12 in Class I) and predominantly female (p &lt; 0.001 for both). None of the evaluated inflammatory indices showed significant differences across the groups (NLR, p = 0.435; PLR, p = 0.141; LMR, p = 0.520; SII, p = 0.326; SIRI, p = 0.459). Interestingly, hypertension was less common in the Class III obesity group (49.0% vs. 53.5% in Class I, p = 0.009). Conclusions: The failure of increasing inflammatory indices to parallel BMI, creating a \u201cceiling effect,\u201d reflects the inadequacy of BMI in determining inflammatory burden. Evaluating the inflammatory burden of obesity through visceral adiposity and metabolic phenotyping (metabolically healthy (MHO) vs. metabolically unhealthy obesity (MUO) rather than BMI will provide a more accurate basis for objective clinical evaluation and personalized treatment.<\/jats:p>","DOI":"10.3390\/jcm15103794","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T16:27:56Z","timestamp":1778776076000},"page":"3794","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Uncoupling Systemic Inflammation from Body Mass Index: The Unseen Role of Visceral Adiposity and Metabolic Phenotypes\u2014A Subgroup Analysis of the Nationwide OBREDI-TR Cohort"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1376-1488","authenticated-orcid":false,"given":"Kubilay","family":"\u0130\u015fsever","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Giresun University, 28100 Giresun, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1160-9340","authenticated-orcid":false,"given":"Alihan","family":"Oral","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Biruni University, Halkal\u0131 Street No. 99, 34295 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7725-707X","authenticated-orcid":false,"given":"Ahmed Cihad","family":"Gen\u00e7","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ahmed Cihad Genc Private Clinic, 34480 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6624-8063","authenticated-orcid":false,"given":"Ihsan","family":"Solmaz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Diyarbakir Gazi Yasargil Education Research Hospital, 21070 Diyarbakir, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1457-4366","authenticated-orcid":false,"given":"Nizameddin","family":"Koca","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Health Sciences University Bursa Health Application and Research Center, Bursa City Hospital, 16250 Bursa, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulas Serkan","family":"Topaloglu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kayseri City Hospital, 38080 Kayseri, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ismail","family":"Demir","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Bozyaka Education Research Hospital, 35170 Izmir, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmet","family":"Dundar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mardin Savur Prof. Dr. Aziz Sancar State Hospital, 47860 Savur, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7982-9262","authenticated-orcid":false,"given":"Ali","family":"Kirik","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Balikesir University, Altieyl\u00fcl, 10145 Balikesir, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2755-6768","authenticated-orcid":false,"given":"Ozge Kama","family":"Basci","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Balikesir University, Altieyl\u00fcl, 10145 Balikesir, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hacer","family":"Sen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Balikesir University, Altieyl\u00fcl, 10145 Balikesir, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9523-5166","authenticated-orcid":false,"given":"Emine","family":"Binnetoglu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Corlu Vatan Hospital, 59860 Corlu, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0814-2359","authenticated-orcid":false,"given":"Nalan","family":"Okuroglu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Fatih Sultan Mehmet Education Research Hospital, 34752 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8610-768X","authenticated-orcid":false,"given":"Ahmet","family":"Aydin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Medipol University, Bagcilar, 34214 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3954-1985","authenticated-orcid":false,"given":"Zeynep Irmak","family":"Kaya","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Health Sciences University Eskisehir Health Application and Research Center, Eskisehir City Hospital, 26080 Eskisehir, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7858-5123","authenticated-orcid":false,"given":"Hamit","family":"Yildiz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Gaziantep University, 27600 Sehitkamil, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9395-3366","authenticated-orcid":false,"given":"Aycan","family":"Acet","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Kutahya Health Sciences University, 43020 Kutahya, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0737-9450","authenticated-orcid":false,"given":"Gokhan","family":"Tazegul","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Marmara University, 34854 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hasan","family":"Sozel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Akdeniz University, 07100 Antalya, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1212-2251","authenticated-orcid":false,"given":"Osman","family":"Ozudogru","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Erzincan Binali Yildirim University, 24100 Erzincan, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6768-7973","authenticated-orcid":false,"given":"Selcuk","family":"Yaylac\u0131","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Sakarya University, 54100 Sakarya, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7115-2130","authenticated-orcid":false,"given":"Ugur Bayram","family":"Korkmaz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Izmir Katip Celebi Education Research Hospital, 35360 Izmir, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nur Duzen","family":"Oflas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Van Yuzuncu Yil University, 54100 Van, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3261-6689","authenticated-orcid":false,"given":"Celalettin","family":"K\u00fc\u00e7\u00fck","sequence":"additional","affiliation":[{"name":"Vocational School, Biruni University, 34295 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9666-8085","authenticated-orcid":false,"given":"Kamil","family":"Konur","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Recep Tayyip Erdogan University, 53020 Rize, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teslime","family":"Ayaz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Bakircay University Cigli Education Research Hospital, 36610 Izmir, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2690-3067","authenticated-orcid":false,"given":"Aysun","family":"Isiklar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Acibadem Atasehir Hospital, Atasehir, 34642 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6041-3817","authenticated-orcid":false,"given":"Esref","family":"Arac","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Dicle University, 21010 Diyarbakir, 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Research Center, Adana City Hospital, 01230 Adana, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuf Usame","family":"Durmus","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Health Sciences University Adana Health Application and Research Center, Adana City Hospital, 01230 Adana, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atilla","family":"Onmez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Duzce University, 81000 Duzce, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sibel Ocak","family":"Serin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Umraniye Education Research Hospital, Umraniye, 34764 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nazif","family":"Yalcin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Health Sciences University Bursa Health Application and Research Center, Bursa City Hospital, 16250 Bursa, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aysegul","family":"Ertinmaz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Health Sciences University Bursa Health Application and Research Center, Bursa City Hospital, 16250 Bursa, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6310-4240","authenticated-orcid":false,"given":"Alper Tuna","family":"Guven","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Marmara University, 34854 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet","family":"Kok","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Antalya Education Research Hospital, 07080 Antalya, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4907-0766","authenticated-orcid":false,"given":"Yasin","family":"Sahinturk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Antalya Education Research Hospital, 07080 Antalya, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2435-8248","authenticated-orcid":false,"given":"Seyit","family":"Uyar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Antalya Education Research Hospital, 07080 Antalya, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (WHO) (2026, March 20). Obesity and Overweight. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight."},{"key":"ref_2","unstructured":"NCD Risk Factor Collaboration (NCD-RisC) (2024). Worldwide trends in underweight and obesity from 1990 to 2022: A pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet, 403, 1027\u20131050."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/S2213-8587(19)30084-1","article-title":"Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: A position statement","volume":"7","author":"Neeland","year":"2019","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1161\/CIRCULATIONAHA.117.029617","article-title":"Cardiovascular and metabolic heterogeneity of obesity: Clinical challenges and implications for management","volume":"137","author":"Neeland","year":"2018","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"cmag008","DOI":"10.1093\/fampra\/cmag008","article-title":"Can the Finnish Diabetes Risk Score (FINDRISC) be used to predict liver fibrosis risk instead of the fibrosis-4 index (FIB-4)?","volume":"43","author":"Yildiz","year":"2026","journal-title":"Fam. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1161\/CIRCRESAHA.120.316101","article-title":"Obesity phenotypes, diabetes, and cardiovascular diseases","volume":"126","author":"Tchernof","year":"2020","journal-title":"Circ. Res."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"(2017). GBD 2015 Obesity Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N. Engl. J. Med., 377, 13\u201327.","DOI":"10.1056\/NEJMoa1614362"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"C375","DOI":"10.1152\/ajpcell.00379.2020","article-title":"Adipose tissue inflammation and metabolic dysfunction in obesity","volume":"320","author":"Kawai","year":"2021","journal-title":"Am. J. Physiol. Cell Physiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.cmet.2021.12.012","article-title":"Why does obesity cause diabetes?","volume":"34","author":"Klein","year":"2022","journal-title":"Cell Metab."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Podeanu, M.-A., Vintilescu, \u015e.B., Ionele, C.M., Sandu, R.E., Niculescu, C.E., Florescu, M.-M., and Stepan, M.D. (2024). The Role of Paraclinical Investigations in Detecting Inflammation in Children and Adolescents with Obesity and Metabolic Syndrome. Life, 14.","DOI":"10.3390\/life14091206"},{"key":"ref_11","first-page":"1300","article-title":"How obesity affects the neutrophil\/lymphocyte and platelet\/lymphocyte ratio, systemic immune-inflammatory index and platelet indices: A retrospective study","volume":"20","author":"Tulgar","year":"2016","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Podeanu, M.-A., Turcu-Stiolica, A., Subtirelu, M.S., Stepan, M.D., Ionele, C.-M., Gheonea, D.-I., Vintilescu, B.S., and Sandu, R.E. (2023). C-Reactive Protein as a Marker of Inflammation in Children and Adolescents with Metabolic Syndrome: A Systematic Review and Meta-Analysis. Biomedicines, 11.","DOI":"10.3390\/biomedicines11112961"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Liu, X., Zhang, Y., Li, Y., Sang, Y., Chai, Y., Zhang, J., and Zhang, H. (2024). Systemic immunity-inflammation index is associated with body fat distribution among U.S. adults: Evidence from national health and nutrition examination survey 2011\u20132018. BMC Endocr. Disord., 24.","DOI":"10.1186\/s12902-024-01725-y"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1038\/nature05488","article-title":"Abdominal obesity and metabolic syndrome","volume":"444","author":"Lemieux","year":"2006","journal-title":"Nature"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.cmet.2017.07.008","article-title":"Causes, Characteristics, and Consequences of Metabolically Unhealthy Normal Weight in Humans","volume":"26","author":"Stefan","year":"2017","journal-title":"Cell Metab."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Oral, A., Solmaz, I., Koca, N., Topaloglu, U.S., Demir, I., Dundar, A., Kirik, A., Basci, O.K., Sen, H., and Binnetoglu, E. (2025). Obesity-Related Disorders in T\u00fcrkiye: A Multi Center, Retrospective, Cross-Sectional Analysis from the OBREDI-TR Study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14082680"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Liu, K., Tang, S., Liu, C., Ma, J., Cao, X., Yang, X., Zhu, Y., Chen, K., Liu, Y., and Zhang, C. (2024). Systemic Immune-Inflammatory Biomarkers (SII, NLR, PLR and LMR) Linked to Non-Alcoholic Fatty Liver Disease Risk. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1337241"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Xia, Y., Xia, C., Wu, L., Li, Z., Li, H., and Zhang, J. (2023). Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and Risk of All-Cause Mortality and Cardiovascular Mortality: A 20-Year Follow-Up Cohort Study of 42,875 US Adults. J. Clin. Med., 12.","DOI":"10.3390\/jcm12031128"},{"key":"ref_19","unstructured":"National Institute for Health and Care Excellence (NICE) (2026, April 26). Overweight and Obesity Management; Clinical Guideline, NG246, Available online: https:\/\/www.nice.org.uk\/guidance\/ng246\/chapter\/Identifying-and-assessing-overweight-obesity-and-central-adiposity."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Nicoar\u0103, D.-M., Munteanu, A.-I., Scutca, A.-C., Mang, N., Juganaru, I., Brad, G.-F., and M\u0103rginean, O. (2023). Assessing the Relationship between Systemic Immune-Inflammation Index and Metabolic Syndrome in Children with Obesity. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24098414"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Tremblay, E.-J., Biertho, L., Lebel, S., Couture, C.Y., Maltais-Payette, I., Ostinelli, G., Gauthier, M.-F., Lajeunesse-Trempe, F., Mauri\u00e8ge, P., and Tchernof, A. (Obes. Facts, 2026). Visceral, not abdominal subcutaneous, fat cell size associates with metabolic dysfunction-associated liver disease in severe obesity, Obes. Facts, in press.","DOI":"10.1159\/000550650"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1161\/CIRCRESAHA.121.318093","article-title":"Obesity, Adipose Tissue and Vascular Dysfunction","volume":"128","author":"Koenen","year":"2021","journal-title":"Circ. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1038\/s41572-024-00563-5","article-title":"Metabolic syndrome","volume":"10","author":"Neeland","year":"2024","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1038\/s41591-025-04009-7","article-title":"Multi-omic definition of metabolic obesity through adipose tissue\u2013microbiome interactions","volume":"32","author":"Chakaroun","year":"2026","journal-title":"Nat. Med."},{"key":"ref_25","unstructured":"McNaught, J. (2025). Pathophysiology of obesity and energy regulation. J. Clin. Lipidol., PIIS1933287425003319."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e71147","DOI":"10.1002\/brb3.71147","article-title":"Visceral Adiposity and Inflammation Index as Predictors of Stroke Risk in Middle and Older Age: A Cohort Study Across Blood Pressure Groups","volume":"15","author":"Huang","year":"2025","journal-title":"Brain Behav."},{"key":"ref_27","first-page":"480","article-title":"Expression of inflammation-related genes in omental adipose tissue from insulin resistant and insulin sensitive obese human subjects","volume":"7","author":"Hardy","year":"2012","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ichim, C., Boicean, A., Todor, S.B., Anderco, P., and B\u00eerlu\u021biu, V. (2025). Fecal Microbiota Transplantation in Patients with Alcohol-Associated Cirrhosis: A Clinical Trial. J. Clin. Med., 14.","DOI":"10.3390\/jcm14175981"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3794\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:19:03Z","timestamp":1779250743000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3794"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":28,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103794"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103794","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]}}}