SIO-Campania Review Details Obesity's Cardiometabolic and Renal Complications, Highlighting GLP-1RAs and VLEKT

Obesity has reached epidemic proportions globally, recognized as a chronic, relapsing disease strongly linked to increased morbidity and mortality from cardio-renal-metabolic conditions. Standard-of-care often falls short, necessitating a deeper understanding of its complications. This review explores the pathophysiological mechanisms and therapeutic strategies for major obesity-related complications, including obstructive sleep apnea syndrome (OSAS), metabolic dysfunction-associated steatotic liver disease (MASLD), dyslipidemia, and chronic kidney disease (CKD), particularly obesity-related glomerulopathy (ORG).

This narrative review, conducted by SIO - Campania region, comprehensively explored the major obesity-related complications. Researchers synthesized current literature to detail pathophysiological mechanisms, clinical consequences, and therapeutic strategies for conditions such as obstructive sleep apnea syndrome (OSAS), metabolic dysfunction-associated steatotic liver disease (MASLD), dyslipidemia, and chronic kidney disease (CKD). The review specifically highlighted the efficacy of lifestyle modifications, pharmacological therapies like glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is), and bariatric surgery. It also focused on the emerging role of Very Low Energy Ketogenic Therapy (VLEKT) in improving metabolic parameters.

The review detailed that obesity contributes to obstructive sleep apnea syndrome (OSAS) by increasing upper airway collapsibility. Metabolic dysfunction-associated steatotic liver disease (MASLD) is driven by ectopic fat accumulation, insulin resistance, and inflammatory responses. Dyslipidemia in obesity presents with elevated triglycerides, small dense LDL particles, and low HDL-C, fueled by chronic inflammation and insulin resistance. Progression of chronic kidney disease (CKD), particularly obesity-related glomerulopathy (ORG), is mediated by metabolic and hemodynamic derangements, including renin-angiotensin-aldosterone system activation and glomerular hyperfiltration. > Therapeutic interventions such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is) demonstrate efficacy not only in promoting weight loss but also in improving the clinical course of these obesity-related conditions. Very Low Energy Ketogenic Therapy (VLEKT) is highlighted as a promising approach for improving metabolic parameters, hepatic steatosis, and cardiovascular risk factors.