Background: Evidence suggests that pathophysiological conditions such as obesity and type 2 diabetes (T2D) are
associated with morphologic and metabolic alterations in the small intestinal mucosa. Exploring these alterations
generally requires invasive methods, limiting data acquisition to subjects with enteropathies or undergoing bariatric
surgery. We aimed to evaluate small intestine epithelial cell homeostasis in a cohort of men covering a wide range of
adiposity and glucose homoeostasis statuses.
Methods: Plasma levels of citrulline, a biomarker of enterocyte mass, and I-FABP, a biomarker of enterocyte death,
were measured by UHPLC‑MS and ELISA in 154 nondiabetic men and 67 men with a T2D diagnosis.
Results: Plasma citrulline was signifcantly reduced in men with insulin resistance and T2D compared to insulin sensi‑
tive men. Decreased citrulline levels were, however, not observed in men with uncontrolled metabolic parameters
during T2D. Plasma I-FABP was signifcantly higher in men with T2D, especially in presence of uncontrolled glycemic
and lipid profle parameters. Integration of both parameters, which estimate enterocyte turnover, was associated with
glucose homeostasis as well as with T2D diagnosis. Diferences in biomarkers levels were independent of age and BMI
and glucose fltration rates.
Conclusions: Our study supports a decreased functional enterocyte mass and an increased enterocyte death rate
in presence of metabolic alterations but emphasizes that epithelial cell homeostasis is especially altered in presence
of severe insulin resistance and T2D. The marked changes in small intestine cellularity observed in obesity and diabe‑
tes are thus suggested to be part of gut dysfunctions, mainly at an advanced stage of the disease
