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Duscha A, Gisevius B, Hirschberg S et al (2020) Propionic acid shapes the multiple sclerosis disease course by an immunomodulatory mechanism

as excess energy accumulates, white adipose tissue (WAT) cells undergo abnormal, hypertrophic growth, leading to poor blood supply (hypoxia), macrophage infiltration, and systemic inflammation

TMAO might explain this puzzle

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Their advantage lies in the ability to sensitively capture the early cascade of events, ranging from impaired mitochondrial fatty acid oxidation to transport defects and tubular metabolic imbalance, thereby complementing the molecular trajectory of DKD that is not adequately reflected by conventional UACR measurements (Table 1)