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Citations: Honda, Y., Kessoku, T., Sumida, Y

To qualify, Medicare patients generally need a body mass index of 35 or higher

Baseline estimated renal function was normal (eGFR 90 mL/min/1.73m 2 ) in 57.2%, mildly impaired (eGFR 60 to 90 mL/min/1.73m 2 ) in 35.9% and moderately impaired (eGFR 30 to 60 mL/min/1.73m 2 ) in 6.9% of patients

p38 upregulates E3 ligases (Atrogin-1, MuRF1, Nedd4) and autophagy genes (Atg7), while JNK phosphorylates c-Jun and FoxO to enhance their pro-atrophic activity (Kim et al., 2015)

AMPK is a key regulator of cellular energy production They maintain cellular energy homeostasis.62 Furthermore, AMPK is significantly activated during LPS-induced lung damage, resistance to pathogen infection, and other inflammatory reactions.63,64 Previous research has indicated that, under pathological conditions, AMPK inhibits inflammation mainly through its downstream protein SIRT1.6567 SIRT1 is an NAD (+)-dependent deacetylase that regulates cell differentiation and survival, inflammation, apoptosis, autophagy, and glucose and lipid metabolism.68 SIRT1 exerts anti-inflammatory effects by inhibiting NF-B.6971 GLP-1RA can upregulate SIRT1 in endothelial progenitor cells, inhibiting high-glucose-induced damage.72 In skeletal muscle cells, GLP-1RA can activate SIRT1 through the protein kinase A and cyclic adenosine monophosphate pathways to improve IR.73 GLP-1RA can improve the progression of nonalcoholic fatty liver disease by increasing the expression of SIRT1 in the livers of obese mice and alleviating obesity-induced renal mitochondrial dysfunction by activating SIRT1 in the kidneys.74,75 Moreover, previous studies have confirmed that GLP-1 upregulates SIRT1 expression in adipose tissue and ameliorates IR in PCOS mice.76 GLP-1 receptor agonists improve IR by reducing body weight in PCOS patients [31]

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