تاثیر تمرین تناوبی با شدت متوسط به ‌همراه مکمل بتائین نانوامولسیفیه بر بیان ژن التهابی CD28 در سلول‌های هپاتوسیتی، سطوح سرمی اوره، کراتینین و نیمرخ چربی موش‌های چاق

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری فیزیولوژی ورزش، دانشکده فرهنگ و ارتباطات، واحد کرج، دانشگاه آزاد اسلامی، کرج، ایران.

2 استادیار گروه فیزیولوژی ورزش، دانشکده فرهنگ و ارتباطات، واحد کرج، دانشگاه آزاد اسلامی، کرج، ایران.

3 دانشیار گروه فیزیولوژی ورزش، دانشکده فرهنگ و ارتباطات، واحد کرج، دانشگاه آزاد اسلامی، کرج، ایران.

چکیده

چکیده    زمینه و هدف: افزایش شیوع چاقی و بیماری‌های همراه آن، ازجمله دیابت و کبد چرب، بیانگر اهمیت تمرین منظم به‌ عنوان یک راهبرد درمانی در کنترل چاقی است. افزون بر این، شواهد موجود حاکی از آن است که بتائین از طریق تعدیل متابولیسم چربی و گلوکز کبدی می‌تواند در بهبود چاقی مؤثر باشد. هدف این پژوهش بررسی تأثیر همزمان تمرین تناوبی با شدت متوسط به‌ همراه مکمل بتائین نانوامولسیفیه بر بیان ژن التهابی CD28 در سلول‌های هپاتوسیتی، سطوح سرمی اوره، کراتینین و نیمرخ چربی موش‌های چاق بود. روش تحقیق: در این مطالعه تجربی، ۲۵ سر موش صحرایی نر نژاد ویستار به پنج گروه مساوی سالم، چاق، چاق+مکمل، چاق+تمرین، چاق+مکمل+تمرین تقسیم شدند. موش‌های چاق به مدت شش هفته با رژیم پرچرب تغذیه شدند. تمرین تناوبی شامل دویدن روی نوارگردان به مدت ۳۰ دقیقه و پنج روز در هفته، همراه با افزایش تدریجی شدت، به مدت هشت هفته انجام شد. گاواژ مکمل بتائین نانوامولسیفیه (۵۰ میلی‌گرم/کیلوگرم وزن بدن) قبل از تمرین انجام گرفت. در پایان، بیان ژن CD28 با روش Real-Time PCR و سطوح سرمی کراتینین، اوره، تری‌گلیسرید، کلسترول تام (TC)، لیپوپروتئین کلسترول با چگالی کم (LDL-C)  و لیپوپروتئین کلسترول با چگالی بالا (HDL-C) با بهره‌گیری از روش‌های استاندارد آزمایشگاهی اندازه‌گیری شد. داده‌ها با استفاده از آزمون‌های آماری t مستقل و تحلیل واریانس دو‌عاملی در سطح معنی‌داری 0/05 ≥p تجزیه و تحلیل شدند. یافته‌ها: چاقی موجب افزایش معنی‌دار میزان تری‌گلیسرید، TC، LDL-C، بیان ژن CD28، سطوح کراتینین (0/0001=p) و اوره (0/02=p) و موجب کاهش معنی‌دار HDL-C شد (0/0001=p). تمرین و مکمل هر کدام به‌طور مستقل منجر به کاهش معنی‌دار بیان CD28 (0/0001=p)، TG، TC، LDL-C و سطوح کراتینین (0/0001=p) و افزایش معنی‌دار میزان HDL-C (0/01=p) شدند. در تعامل تمرین و مکمل، نیز اثر آماری معنی‌داری بر CD28 (0/04=p)، LDL-C (0/0001=p)، TC (0/0001=p) و سطوح کراتینین (0/005=p) مشاهده شد. نتیجه‌‌گیری: تمرین هوازی با شدت متوسط و مکمل بتائین نانوامولسیفیه، به‌ صورت مستقل و ترکیبی، از طریق تأثیر بر شاخص‌های لیپیدی، التهابی و عملکرد کلیوی؛ می‌تواند در کاهش اثرات سوء چاقی در موش‌ها مؤثر باشد.

کلیدواژه‌ها


عنوان مقاله [English]

The effect of moderate-intensity interval training combined with nanoemulsified betaine supplementation on the expression of the inflammatory gene CD28 in hepatocyte cells, serum urea, creatinine levels, and lipid profile of obese mice

نویسندگان [English]

  • Mahdiyeh Poursoltani Zarandi 1
  • Amir Sarshin 2
  • Alireza Rahimi 3
  • Foad Feizolahi 2
1 PhD Student in Exercise Physiology, Department of Exercise Physiology, Faculty of Culture and Communication, Karaj Branch, Islamic Azad University, Karaj, Iran.
2 Assistant Professor at Department of Exercise Physiology, Faculty of Culture and Communication, Karaj Branch, Islamic Azad University, Karaj, Iran.
3 Associate Professor at Department of Exercise Physiology, Faculty of Culture and Communication, Karaj Branch, Islamic Azad University, Karaj, Iran.
چکیده [English]

Extended Abstract 
Background and Aim: Obesity, resulting from a chronic imbalance between energy intake and energy expenditure, is widely increasing and is considered a major risk factor for numerous pathological conditions. Excessive energy intake—particularly from high fat diets—leads to abnormal accumulation of triglycerides (TG) within hepatocytes, promoting hepatic steatosis and the development of non-alcoholic fatty liver disease (NAFLD). Obesity often leads to chronic low-grade inflammation, increased insulin resistance, and metabolic disorders in adipose tissue and liver.  The CD28 protein acts as a co-stimulatory receptor essential for the full activation of T lymphocytes and plays an important role in the induction of low-grade inflammation in obesity. Exercise is considered a major regulator of liver metabolism by stimulating beta-oxidation and reducing lipogenesis. Studies have shown that choline and betaine supplementation can reduce hepatic steatosis by reducing hepatic and blood TG levels and stimulating lipolysis.  Given the established benefits of aerobic exercise in improving hepatic lipid metabolism and inflammatory status, along with emerging evidence supporting the fat-reducing and anti-inflammatory effects of betaine, a combined intervention may exert synergistic benefits. These effects may be mediated, at least in part, through modulation of inflammation-related pathways, particularly CD28 signaling. However, the interactive effects of aerobic exercise and betaine supplementation on these parameters in obesity remain largely unexplored, and existing findings regarding their independent effects are inconsistent. Therefore, the present study aimed to investigate the combined effects of moderate-intensity interval training and nanoemulsified betaine supplementation on hepatic CD28 gene expression, serum urea and creatinine levels, and lipid profile in obese mice.
Materials and Methods:  In this experimental study, 25 male Wistar rats (8 weeks old; body weight 270±20 g)  were housed in special cages in an environment with an average temperature of 22±1.4 °C, humidity of 55±4%, and a light-dark cycle of 12:12 h. All animals had free access to water and special rat food. They were then randomly divided into 5 groups (5 rats in each group) including healthy, obese, obese+supplement, obese+exercise, and obese+supplement+exercise. Obesity was induced by feeding the designated groups a high-fat, high-cholesterol diet for 12 weeks. To confirm obesity induction, blood samples were collected from the tail vein at the end of the dietary intervention and prior to the commencement of exercise and supplementation protocols. Following obesity induction, rats in the exercise groups performed moderate-intensity interval aerobic training on a motorized treadmill for 8 weeks, 5 days per week, with progressive overload. During the first week, the protocol consisted of 10 intervals of 1-min running at 10 m/min, interspersed with 2-min active recovery at 5 m/min. Running speed during the work intervals was gradually increased, reaching 16 m/min by weeks 4–8. Nanoemulsified betaine was prepared using high-amplitude ultrasonication to enhance serum stability and bioavailability. The supplement was administered via oral gavage at a dose of 50 mg/kg body weight prior to each exercise session. Rats in the obese+supplement+exercise group received both interventions. At the end of the intervention period, hepatic tissue samples were collected for analysis of CD28 gene expression using quantitative real-time PCR (qRT-PCR). Serum lipid profile, including total cholesterol (TC), TG, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), was measured using standard enzymatic assays. Serum urea and creatinine levels were also assessed as indicators of renal function. Data were analyzed using independent t, two-way ANOVA, and Bonferroni post hoc tests at a significance level of p≤0.05.
Results: Independent t-test analysis demonstrated that obesity significantly increased hepatic CD28 gene expression, TG, TC, LDL-C, and creatinine (p=0.0001) serum, as well as urea levels (p=0.02), while significantly decreasing HDL-C levels (p=0.0001). Two-way ANOVA results (Table 1), followed by Bonferroni post hoc tests, revealed that 8 weeks of moderate-intensity interval training significantly reduced CD28 gene expression in obese rats (p=0.0001). This training intervention also resulted in significant reductions in TG, TC, LDL-C, and creatinine (p=0.0001), as well as urea (p=0.002) levels, accompanied by a significant increase in HDL-C (p=0.01). Similarly, supplementation with nanoemulsified betaine led to a significant decrease in CD28 gene expression (p=0.0001), TG, TC, LDL-C, and creatinine levels (p=0.0001), along with a significant increase in HDL-C (p=0.01). However, nanoemulsified betaine supplementation did not significantly affect serum urea levels in obese rats. Furthermore, two-way ANOVA and Bonferroni post hoc analyses indicated a significant interaction effect between moderate-intensity interval training and nanoemulsified betaine supplementation on CD28 expression (p=0.04), LDL-C (p=0.0001), TC (p=0.0001), and creatinine (p=0.005) levels. No significant interaction effect was observed for serum urea levels.
Conclusion: The findings of the present study demonstrate that interval aerobic training and nanoemulsified betaine supplementation, each alone, reduced TG, TC, LDL-C levels and increased HDL-C. Aerobic training (especially moderate intensity) increases muscle TG utilization and leads to improved fat oxidation. In addition, nanoemulsified betaine supplementation effectively reduced hepatic and circulating TG levels, likely through the stimulation of lipolysis and hepatic β-oxidation, which may attenuate fat accumulation in the liver of obese subjects. The results further indicate that both interval aerobic training and nanoemulsified betaine supplementation, individually and synergistically, significantly reduced CD28 gene expression, a key marker associated with obesity-related inflammation. The underlying mechanisms through which the combined intervention exerts its beneficial effects on fat mass and inflammatory status may involve improved regulation of lipid metabolism, reduced insulin resistance, and enhanced mitochondrial function. Notably, the combined application of moderate-intensity interval training and nanoemulsified betaine supplementation was particularly effective in modulating CD28 gene expression, highlighting its potential role in attenuating inflammatory signaling pathways associated with obesity. Furthermore, the significant improvements in lipid profiles and the reduction in serum creatinine levels support the modulatory effects of this combined intervention on obesity-induced metabolic disturbances and renal dysfunction. Overall, the observed interactive effects between exercise training and nanoemulsified betaine supplementation suggest that this combined approach may serve as a safe, practical, and non-pharmacological strategy for the prevention and management of metabolic complications associated with obesity through the modulation of metabolic pathways and inflammation-related cellular signaling.
Ethical Considerations: Ethical approval was obtained from the Ethics Committee of Islamic Azad University, Karaj Branch (Code: IR.IAU.K.REC.1403.65).
Funding: This research received no external funding. All study-related costs were covered by the researcher.
Conflict of Interest: The authors declare no conflicts of interest 

کلیدواژه‌ها [English]

  • Physical activity
  • Nanoemulsified Betaine
  • Inflammation
  • Obesity
1. Arifah SN, Atho’illah MF, Lukiati B, Lestari SR. Herbal medicine from single clove garlic oil extract ameliorates hepatic steatosis and oxidative status in high fat diet mice. Malaysian Journal of Medical Sciences. 2020;27(1):46-56.  https://doi.org/10.21315/mjms2020.27.1.5.
2. Brunt EM, Wong VW, Nobili V, Day CP, Sookoian S, Maher JJ, et al. Nonalcoholic fatty liver disease. Nature Reviews Disease Primers. 2015;1:15080. https://doi.org/10.1038/nrdp.2015.80.
3.Cigri E, Inan FC, Er E, Yildiz E. The relationship between lipid profile and non-alcoholic fatty liver disease in children and adolescents with obesity. Journal of the College of Physicians and Surgeons Pakistan. 2022;32(5):591-5.  https://doi.org/10.29271/jcpsp.2022.05.591.
4. van der Heijden RA, Sheedfar F, Morrison MC, Hommelberg PP, Kor D, Kloosterhuis NJ, et al. High-fat diet induced obesity primes inflammation in adipose tissue prior to liver in C57BL/6j mice. Aging (Albany NY). 2015;7(4):256-68. https://doi.org/10.18632/aging.100738.
5. Ude UA KM, Ogbonna CL, Usanga VU, Azi SO. Evaluation of urea, creatinine levels, and proteinuria among obese individuals within abakaliki metropolis. Nigerian Journal of Basic and Clinical Sciences. 2022;19(2:120-5. https://doi.org/10.4103/njbcs.njbcs_74_21.
6. Yu J, Laybutt DR, Youngson NA, Morris MJ. Concurrent betaine administration enhances exercise-induced improvements to glucose handling in obese mice. Nutrition, Metabolism and Cardiovascular Diseases. 2022;32(10):2439-49. https://doi.org/10.1016/j.numecd.2022.08.012.
7. Esensten JH HY, Chopra G, Weiss A, Bluestone JA. CD28 costimulation: from mechanism to therapy. Immunity. 2016;44(5):973-88. https://doi.org/10.1016/j.immuni.2016.04.020.
8. Marinari B, Costanzo A, Marzano V, Piccolella E, Tuosto L. CD28 delivers a unique signal leading to the selective recruitment of RelA and p52 NF-kappaB subunits on IL-8 and Bcl-xL gene promoters. Proceedings of the National Academy of Sciences. 2004;101(16):6098-103. https://doi.org/10.1073/pnas.0308688101.
9. Chew NWS, Ng CH, Tan DJH, Kong G, Lin C, Chin YH, et al. The global burden of metabolic disease: Data from 2000 to 2019. Cell Metabolism. 2023;35(3):414-28.e3. https://doi.org/10.1016/j.cmet.2023.02.003.
10. Singh S, Osna NA, Kharbanda KK. Treatment options for alcoholic and non-alcoholic fatty liver disease: A review. World Journal of Gastroenterology. 2017;23(36):6549-70. https://doi.org/10.3748/wjg.v23.i36.6549.
11. Wong VW, Singal AK. Emerging medical therapies for non-alcoholic fatty liver disease and for alcoholic hepatitis. Translational Gastroenterology and Hepatology. 2019;4:53. https://doi.org/10.21037/tgh.2019.06.06.
12. Voudouris D, Horianopoulou M, Apostolopoulou Z, Chryssanthopoulos C, Bardopoulou M, Maridaki M, et al. The effects of a short-term combined exercise program on liver steatosis indices and the lipidemic and glycemic profile in NAFLD individuals: A Pilot Study. Metabolites. 2023;13(10). https://doi.org/10.3390/metabo13101074.
13. Ruan L, Wang G, Qing Lv Z, Li S, Liu Q, Ren Y, et al. The effect of varied exercise intensity on antioxidant function, aortic endothelial function, and serum lipids in rats with non-alcoholic fatty liver disease. Investigación Clínica. 2022;63(4):327-43. https://doi.org/10.54817/ic.v63n4a01.
14. Liu HW, Kao HH, Wu CH. Exercise training upregulates SIRT1 to attenuate inflammation and metabolic dysfunction in kidney and liver of diabetic db/db mice. Nutrition & Metabolism. 2019;16:22. https://doi.org/10.1186/s12986-019-0349-4.
15. Kim D-S, An J-H, Eo K-T. The effects of body composition, blood lipid & lipid metabolism on bicycle exercise of various intensities in obesity middle aged women. Journal of Industrial Convergence. 2021;19(1):137-46. https://doi.org/10.22678/JIC.2021.19.1.137
16. Eklund M, Bauer E, Wamatu J, Mosenthin R. Potential nutritional and physiological functions of betaine in livestock. Nutrition Research Reviews. 2005;18(1):31-48. https://doi.org/10.1079/NRR200493. DOI:10.1079/NRR200493.
17. Sivanesan S, Taylor A, Zhang J, Bakovic M. Betaine and choline improve lipid homeostasis in obesity by participation in mitochondrial oxidative demethylation. Frontiers in Nutrition. 2018;5:61. https://doi.org/10.3389/fnut.2018.00061.
18. Gao X, Zhang H, Guo X-f, Li K, Li S, Li D. Effect of betaine on reducing body fat—a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2019;11(10):2480. https://doi.org/10.3390/nu11102480.
19. Schwab U, Törrönen A, Toppinen L, Alfthan G, Saarinen M, Aro A, et al. Betaine supplementation decreases plasma homocysteine concentrations but does not affect body weight, body composition, or resting energy expenditure in human subjects. The American Journal of Clinical Nutrition. 2002;76(5):961-7. https://doi.org/10.1093/ajcn/76.5.961.
20. Alvarenga L, Ferreira MS, Kemp JA, Mafra D. The role of betaine in patients with chronic kidney disease: a narrative review. Current Nutrition Reports. 2022;11(3):395-406.  https://doi.org/10.1007/s13668-022-00426-z.
21. Norouzzadeh M, Kalantar H, Khorsandi L, Mohtadi S, Khodayar MJ. Betaine ameliorates arsenic-induced kidney injury in mice by mitigating oxidative stress-mediated inflammation. Archives of Biochemistry and Biophysics. 2024;758:110076. https://doi.org/10.1016/j.abb.2024.110076.
22. Xu J, Nie Z, Qiu X, Zhang J, Han S. Effects of betaine supplementation on inflammatory markers: a systematic review and meta-analysis of randomised controlled trials.  International Journal of Food Sciences and Nutrition.  2023;74(7):721-9. https://doi.org/10.1080/09637486.2023.2257906.
23. Wang DQ-H, Schmitz F, Kopin AS, Carey MC. Targeted disruption of the murine cholecystokinin-1 receptor promotes intestinal cholesterol absorption and susceptibility to cholesterol cholelithiasis. The Journal of Clinical Investigation. 2004;114(4):521-8. https://doi.org/10.1172/JCI16801.
24. Li J, Huang L, Xiong W, Qian Y, Song M. Aerobic exercise improves non-alcoholic fatty liver disease by down-regulating the protein expression of the CNPY2-PERK pathway. Biochemical and Biophysical Research Communications. 2022;603:35-40. https://doi.org/10.1016/j.bbrc.2022.03.008.
25. Chen W, Zhang X, Xu M, Jiang L, Zhou M, Liu W, et al. Betaine prevented high-fat diet-induced NAFLD by regulating the FGF10/AMPK signaling pathway in ApoE−/− mice. European Journal of Nutrition. 2021;60:1655-68. https://doi.org/10.1007/s00394-020-02362-6.
26. Rasineni K, Lee SM, McVicker BL, Osna NA, Casey CA, Kharbanda KK. Susceptibility of asialoglycoprotein receptor-deficient mice to lps/galactosamine liver injury and protection by betaine administration. Biology. 2020;10(1):19. https://doi.org/10.3390/biology10010019.
27. Koroleva MY, Yurtov EV. Nanoemulsions: the properties, methods of preparation and promising applications. Russian Chemical Reviews. 2012;81(1):21. https://doi.org/10.1070/RC2012v081n01ABEH004219.
28. Pucek-Kaczmarek A, Celary D, Bazylińska U. Natural-Origin Betaine Surfactants as Promising Components for the Stabilization of Lipid Carriers. International Journal of Molecular Sciences. 2024;25(2):955. https://doi.org/10.3390/ijms25020955.
29. Abulfadle KA SA. Role of obestatin in improvement of obesity-induced metabolic and kidney function changes in exercised rats. American Journal of Biomedical Sciences. 2019;11(2):74-89. https://doi.org/10.5099/aj190200074.
30. de Melo DG, da Cruz Rodrigues VC, de Sá Pereira GJ, de Campos TDP, dos Santos Canciglieri R, Pauli JR, et al. Effects of aerobic exercise on the regulation of mitochondrial carrier homolog-2 and its influence on the catabolic and anabolic activity of lipids in the mesenteric adipose tissue of obese mice. Life Sciences. 2024;345:122567. https://doi.org/10.1016/j.lfs.2024.122567.
31. Liu J, Liu Y, Chen Y, Liu Y, Huang C, Luo Y, et al. Betaine alleviates nonalcoholic fatty liver disease (NAFLD) via a manner involving BHMT/FTO/m(6)A/ PGC1α signaling. The Journal of Nutritional Biochemistry. 2024;134:109738. https://doi.org/10.1016/j.jnutbio.2024.109738.
32. Gonzalo-Encabo P, Maldonado G, Valadés D, Ferragut C, Pérez-López A. The role of exercise training on low-grade systemic inflammation in adults with overweight and obesity: A Systematic Review. International Journal of Environmental Research and Public Health. 2021;18(24). https://doi.org/10.3390/ijerph182413258.
33. Olli K, Lahtinen S, Rautonen N, Tiihonen K. Betaine reduces the expression of inflammatory adipokines caused by hypoxia in human adipocytes. British Journal of Nutrition. 2013;109(1):43-9. https://doi.org/10.1017/S0007114512000888.
34. Zhao G, He F, Wu C, Li P, Li N, Deng J, et al. Betaine in inflammation: Mechanistic aspects and applications. Frontiers in Immunology. 2018;9:1070. https://doi.org/10.3389/fimmu.2018.01070.
35. Straznicky NE GM, Lambert EA, Eikelis N, Dawood T, Lambert GW, Nestel PJ, et al. Exercise augments weight loss induced improvement in renal function in obese metabolic syndrome individuals. Journal of Hypertension. 2011;29(3):553-64. https://doi.org/10.1097/HJH.0b013e3283418875.
36. Zaman GS AM, Ahmad I, Dera AA, Alshahrani MS, Ahmad I, Alam MM, et al. The impact of body resistance training exercise on biomedical profile at high altitude: A randomized controlled trial. BioMed Research International. 2021;2021(1):6684167. https://doi.org/10.1155/2021/6684167.
37. Babu LK SS, Ghosh D. Bone mineral metabolism and different indices of skeletal health of Ladakhi women living at high altitude. Osteoporosis and Sarcopenia.9(4):131-6. https://doi.org/10.1016/j.afos.2023.11.001.
38. Morales E VM, León M, Hernández E, Praga M. Beneficial effects of weight loss in overweight patients with chronic proteinuric nephropathies. American Journal of Kidney Diseases. 2003;41(2):319-27. https://doi.org/10.1053/ajkd.2003.50039.
39. Popov DV, Lysenko EA, Miller TF, Bachinin AV, Perfilov DV, Vinogradova OL. The effect of single aerobic exercise on the regulation of mitochondrial biogenesis in skeletal muscles of trained men: A time-course study. Human Physiology. 2015;41(3):296-303.  https://doi.org/10.1134/S0362119715030123.
40. Takahashi H, Kotani K, Tanaka K, Egucih Y, Anzai K. Therapeutic Approaches to Nonalcoholic Fatty Liver Disease: Exercise Intervention and Related Mechanisms. Frontiers in Endocrinology. 2018;9:588. https://doi.org/10.3389/fendo.2018.00588.
41. Jung GY, Won SB, Kim J, Jeon S, Han A, Kwon YH. Betaine alleviateshypertriglycemia and Tau hyperphosphorylation in db/db Mice. Toxicological Research. 2013;29(1):7-14.  https://doi.org/10.5487/TR.2013.29.1.007.
42. Yang W, Huang L, Gao J, Wen S, Tai Y, Chen M, et al. Betaine attenuates chronic alcohol‑induced fatty liver by broadly regulating hepatic lipid metabolism. Molecular Medicine Reports. 2017;16(4):5225-34. https://doi.org/10.3892/mmr.2017.7295.
43. Ma J, Meng X, Kang SY, Zhang J, Jung HW, Park Y-K. Regulatory effects of the fruit extract of Lycium chinense and its active compound, betaine, on muscle differentiation and mitochondrial biogenesis in C2C12 cells. Biomedicine & Pharmacotherapy. 2019;118:109297. https://doi.org/10.1016/j.biopha.2019.109297.
44. Fromenty B, Roden M. Mitochondrial alterations in fatty liver diseases. Journal of Hepatology. 2023;78(2):415-29. https://doi.org/10.1016/j.jhep.2022.09.020.
45. Trang K, Grant SF. Genetics and epigenetics in the obesity phenotyping scenario. Reviews in Endocrine and Metabolic Disorders. 2023;24(5):775-93. https://doi.org/10.1007/s11154-023-09804-6.
46. Toh SA LM, Rader D. Atherogenic lipid metabolism in obesity. In Metabolic Basis of Obesity. 2010:pp. 293-309. https://doi.org/10.1007/978-1-4419-1607-5.