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A previous study using labeled cholesterol has demonstrated that the circulating cholesterol level was elevated during the zero-calorie fasting period due to the release of the lipid droplets from adipose tissues [40]

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Intestinal microorganisms metabolize TML into trimethyl-5-aminovaleric acid (TMAVA), which can competitively inhibit the binding of -BB to BBD, thereby inhibiting carnitine biosynthesis and FAO in the liver, promoting steatosis and aggravating fatty liver [250]

Metabolites that significantly correlated with PROMIS-Fatigue T -scores were overrepresented by the steroid hormone biosynthesis pathway (KEGG ID: M00107), including androgen and estrogen metabolism (SMPDB ID: SMP0000068) and androstenedione metabolism (SMPDB ID: SMP0030406) (Figure 4C), which included androsterone sulfate ( r = 0.26, p = 0.0009), epiandrosterone sulfate ( r = 0.25, p = 0.0016), etiocholanolone glucuronide ( r = 0.19, p = 0.018), and dehydroepiandrosterone sulfate (DHEA-S) ( r = 0.18, p = 0.023)

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