ELN and Insulin resistance: These Include dysregulation of the hypothalamus-pituitary–adrenal (HPA) axis (Grandner et al., 2016), abnormalities in autonomic nervous system regulation (Johnson et al., 2021), increased sympathetic nervous system (SNS) activity (Parthasarathy et al., 2015; Seravalle et al., 2018), insulin resistance (Kline et al., 2018), changes in inflammatory and hormonal markers (due to increased secretion of pro-inflammatory cytokines or an inverse correlation with the ratio of vascular collagen elastin proteins) (D'Antono and Bouchard, 2019), and impaired endothelial function (De Nys et al., 2022).