Sodium glucose co-transporter 2 (SGLT2) inhibitors are effective antihyperglycemic agents by inhibiting glucose reabsorption in the proximal tubule of the kidney. Besides improving glycemic control in patients with type 2 diabetes, they also have additional favorable effects, such as lowering body weight and body fat. Several clinical studies have demonstrated their positive effect in reducing cardiovascular morbidity and mortality. Furthermore, the use of SGLT2 inhibitors were associated with fewer adverse renal outcomes comparing to other diabetic agents, substantiating their renoprotective effect in diabetic patients. SGLT2 inhibitors have also remarkable effect on lipid metabolism acting at different cellular levels. By decreasing the lipid accumulation, visceral and subcutaneous fat, they do not only decrease the body weight but also change body composition. They also regulate key molecules in lipid synthesis and transportation, and they affect the oxidation of fatty acids. Notably, they shift substrate utilization from carbohydrates to lipids and ketone bodies. In this review we intended to summarize the role of SGLT2 inhibitors in lipid metabolism especially on lipoprotein levels, lipid regulation, fat storage and substrate utilization.

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are novel antihyperglycemic agents. By acting through the central nervous system, they increase satiety and reduce food intake, thus lowering body weight. Furthermore, they increase the secretion of insulin while decreasing the production of glucagon. However, recent studies suggest a more complex metabolic impact through the interaction with various other tissues. In our present review, we aim to provide a summary of the effects of GLP-1 RA on serum lipids, adipose tissue, and muscle metabolism. It has been found that GLP-1 RA therapy is associated with decreased serum cholesterol levels. Epicardial adipose tissue thickness, hepatic lipid droplets, and visceral fat volume were reduced in obese patients with cardiovascular disease. GLP-1 RA therapy decreased the level of proinflammatory adipokines and reduced the expression of inflammatory genes. They have been found to reduce endoplasmic reticulum stress in adipocytes, leading to better adipocyte function and metabolism. Furthermore, GLP-1 RA therapy increased microvascular blood flow in muscle tissue, resulting in increased myocyte metabolism. They inhibited muscle atrophy and increased muscle mass and function. It was also observed that the levels of muscle-derived inflammatory cytokines decreased, and insulin sensitivity increased, resulting in improved metabolism. However, some clinical trials have been conducted on a very small number of patients, which limits the strength of these observations.

Obesity is a major public health problem worldwide, and it is associated with many diseases and abnormalities, most importantly, type 2 diabetes. The visceral adipose tissue produces an immense variety of adipokines. Leptin is the first identified adipokine which plays a crucial role in the regulation of food intake and metabolism. Sodium glucose co-transport 2 inhibitors are potent antihyperglycemic drugs with various beneficial systemic effects. We aimed to investigate the metabolic state and leptin level among patients with obesity and type 2 diabetes mellitus, and the effect of empagliflozin upon these parameters. We recruited 102 patients into our clinical study, then we performed anthropometric, laboratory, and immunoassay tests. Body mass index, body fat, visceral fat, urea nitrogen, creatinine, and leptin levels were significantly lower in the empagliflozin treated group when compared to obese and diabetic patients receiving conventional antidiabetic treatments. Interestingly, leptin was increased not only among obese patients but in type 2 diabetic patients as well. Body mass index, body fat, and visceral fat percentages were lower, and renal function was preserved in patients receiving empagliflozin treatment. In addition to the known beneficial effects of empagliflozin regarding the cardio-metabolic and renal systems, it may also influence leptin resistance.

The high prevalence of obesity in childhood and adolescence has major public health consequences, since it is associated with various chronic diseases in the short- and long-term. The goal of our study was to examine the possible association between obesity and overweight and cardiorespiratory and muscle performance during a 4-year follow up period in adolescents. The body mass index (BMI) and physical performance of adolescents (360 girls and 348 boys) between 14–18 years of age was measured twice a year, and the possible correlation between overweight and obesity and cardiorespiratory and muscle performances were investigated. Our results revealed that cardiorespiratory performance increased significantly in boys during the 4 years (p < 0.001), but the aerobic performance of girls only showed seasonal fluctuation. Muscle performance significantly increased both in boys and girls (p < 0.001). Inverse association between obesity and cardiorespiratory and muscle performance was proved. Overweight was also inversely correlated with cardiorespiratory performance, but it demonstrated no correlation with muscle strength. Avoiding increased BMI and decreased physical fitness is essential for adolescents’ health to prevent short- and long-term adverse effects.

Self-esteem, body image and eating attitudes are important characteristics regarding adolescent mental health. In our present work, we aimed to investigate these psychological items in adolescent boys and girls examining gender differences and correlations with the BMI-for-age and cardiorespiratory performance. 374 students (209 girls with an average age of 16.4 ± 1.08 years, and 165 boys with an average age of 16.5 ± 1.03 years) underwent investigation using the Rosenberg self-esteem scale, EAT-26 and BAT questionnaires. The BMI-for-age was calculated with BMI growth charts and the cardiorespiratory performance was measured with the 20 m shuttle run test. Our results showed that adolescent girls scored lower self-esteem and higher values for BAT and each scale of eating behaviors, such as uncontrolled eating, cognitive restraints and emotional eating compared to boys despite the fact, that obesity and overweight were more common among boys. No significant correlation was found between BMI and psychological test results in either boys or girls, however, subjective body shape and gender predicted self-esteem and BAT scores and the cognitive restraints in the eating attitudes. Uncontrolled and emotional eating were primarily influenced by gender, in which BMI played only a weaker role. Cardiorespiratory performance was positively associated with self-esteem and body image among boys, and it had a negative correlation regarding BMI in both genders.

Physical activity, physical functioning, and pain are some of the most critical factors of low back pain (LBP) treatment and prevention, but it was unknown that the back school program (BSP) influences the physical activity level of the patients with LBP. Data from 306 healthy patients and patients with chronic non-specific low back pain (cnsLBP) were used. We used the Global Physical Activity Questionnaire (GPAQ), the Low Back Pain Knowledge Questionnaire (LKQ), the visual analog scale, and the Roland–Morris Disability Questionnaire (RMDQ). The significance level was set at p < 0.05. The amount of sedentary time in cnsLBP patients enrolled in the BSP was significantly lower compared to the other two groups (p < 0.001). Significantly higher moderate-intensity activities, leisure time activities, and active transportation were observed in the cnsLBP patients enrolled in the BSP than in the other two groups (p < 0.001). RMDQ scores and the pain intensity of the cnsLBP patients enrolled in the BSP were significantly lower than in patients with LBP receiving only exercise therapy (p < 0.001). The physical activity level and low-back-pain-specific knowledge was significantly higher, while back-related disability and pain intensity were significantly lower among patients with low back pain syndrome who participated in a back school program.