Jothydev Kesavadev

Adiposity-Based Chronic Disease (ABCD) and the Therapeutic Role of GLP-1 Receptor Agonists Source: Kovil R, Shah T, Tanna S, Negalur V, Patange S, Sanghvi A, et al. Adiposity-based chronic diseases and the therapeutic role of glucagon-like peptide-1 receptor agonists. Int J Diabetes Technol. 2025;4:103–111. @rajivkovil @scottisaacsmd 🌍 Background Adiposity-Based Chronic Disease (ABCD) recognizes obesity not as a cosmetic issue but as a chronic, relapsing, systemic disorder influenced by biological, behavioral, cultural, and environmental factors. The ABCD framework shifts focus from weight loss alone to pathophysiology-based management of metabolic, cardiovascular, hepatic, and reproductive complications. 🧠 Concept Overview ABCD has eight interconnected pillars: Obesity Type 2 Diabetes Cardiovascular Disease and Heart Failure Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Polycystic Ovary Syndrome / Infertility Chronic Kidney Disease (CKD) Hypertension Dyslipidaemia Each pillar is metabolically linked through insulin resistance, inflammation, oxidative stress, endothelial dysfunction, and ectopic fat deposition. 💊 GLP-1 Receptor Agonists (GLP-1RAs): The Game-Changers GLP-1RAs address multiple pathophysiological defects beyond glycemia. They mimic endogenous GLP-1, enhancing insulin secretion, suppressing glucagon, slowing gastric emptying, and promoting satiety. 🔬 System-Wise Benefits 1. Obesity Promote sustained weight loss by reducing appetite and calorie intake. Improve body composition by preferentially reducing visceral fat. 2. Type 2 Diabetes Enhance insulin sensitivity and glycemic control. Reduce glycemic variability and A1c levels without hypoglycemia risk. 3. Cardiovascular Disease / HFpEF Lower blood pressure, improve lipid profile, and reduce inflammatory markers (CRP, IL-6). Shown to improve symptoms and exercise tolerance in obesity-related HFpEF. 4. MASLD Reduce hepatic steatosis, hepatocellular inflammation, and ALT/AST levels. Emerging evidence suggests fibrosis regression with prolonged therapy. 5. PCOS / Infertility Restore menstrual regularity and ovulation. Improve fertility by reducing insulin resistance and central obesity. 6. CKD Slow progression of albuminuria and eGFR decline. Benefits partly mediated through improved blood pressure, glycemia, and anti-inflammatory actions. 7. Hypertension Modest but consistent systolic BP reduction (~4–6 mmHg). Contribute to arterial compliance and vascular protection. 8. Dyslipidaemia Lower triglycerides and small dense LDL. Raise HDL modestly and improve overall lipid quality. 💊 Oral Semaglutide – Expanding Accessibility Oral formulation has revolutionized long-term adherence, especially among patients hesitant about injections. Demonstrates equivalent efficacy to subcutaneous versions in improving glycemic and weight outcomes. 🌟 CME INDIA Clinical Pearls ABCD reframes obesity as a metabolic disease, not a lifestyle failure. GLP-1RAs are the first true disease-modifying drugs that target all eight pillars of ABCD. Beyond glucose lowering, they reduce cardiovascular, renal, hepatic, and reproductive risk simultaneously. Oral semaglutide offers a convenient entry point for broader adoption in early ABCD management. Holistic patient care must integrate nutrition, exercise, behavioral support, and pharmacotherapy — not just weight-centric goals. Future direction: Combination of GLP-1RAs with GIP or glucagon agonists (e.g., tirzepatide, retatrutide) may further redefine ABCD therapy. 🧭 CME INDIA Take-Home Message “GLP-1RAs have transcended their antidiabetic role — they are now central to managing the adiposity continuum, uniting obesity, diabetes, cardiovascular, hepatic, renal, and reproductive disorders under one therapeutic umbrella. journals.lww.com/ijdt/fullte…

The Saboo-Nawaria Paradox 🔹 BMI is Not Enough: Lessons from the Saboo-Nawaria Paradox on Assessing Obesity in South Asians @atherosociety @IntDiabetesFed @IndiaESI @drmohanv @AskDrShashank @DrAmbrishMithal @kamleshkhunti @docanoopmisra @banshisaboo @singhak_endo @EricTopol @scottisaacsmd @KapoorNitinDr 🔹 Key Message: The Saboo-Nawaria Paradox shows that BMI alone is an inadequate tool to assess obesity-related health risk in South Asians, as it fails to capture differences in body composition and visceral fat distribution. 🩺 5 Practical Clinical Pearls: 1️⃣ BMI ≠ Body Composition: BMI cannot differentiate between fat and muscle. Higher BMI may reflect lean mass in one person and visceral fat in another. 2️⃣ South Asians = "Thin-Fat" Phenotype: South Asians tend to have greater visceral adiposity and central obesity at lower BMI thresholds compared to Western populations. This increases their diabetes and cardiovascular risk even when BMI is in the “normal” range. 3️⃣ Visceral Fat is the Culprit: Visceral fat predicts cardiometabolic risk far better than subcutaneous fat or BMI. Waist circumference, waist-hip ratio (WHR), and direct visceral fat estimation must complement BMI. 4️⃣ Clinical Application: Always assess waist circumference, WHR, and skeletal muscle mass alongside BMI — especially in South Asian patients. Use Asian-specific BMI cut-offs: overweight ≥23 kg/m² and obesity ≥25 kg/m². 5️⃣ Why this matters: A patient with “normal” BMI may still harbor high visceral fat and significant metabolic risk (“Metabolically Obese Normal Weight” or MONW phenotype). Individualized risk assessment is critical — one size (or BMI) does not fit all. 🎯 Bottom Line: 👉 The Saboo-Nawaria Paradox highlights why BMI is an oversimplification and why clinicians must “look beyond BMI” when evaluating obesity and cardiometabolic risk, especially in South Asians. 👏 Appreciation: Kudos to Dr Banshi Saboo and Dr Mahendra Nawaria for generously sharing their own data for public health learning. Congratulations to Dr Jothydev for curating this outstanding educational experience at JPEF 2025. 🔗 Read more at CME INDIA cmeindia.in/bmi-is-not-enoug…