The potential pathophysiological contributors to DC include immune dysfunction, impaired nutrient-sensing signaling, insulin resistance, cardiac inflammation, oxidative stress, subcellular component (primarily mitochondria) abnormalities, inappropriate activation of the renin-angiotensin system, and obesity (Huo et al., 2023; Zhang C. et al., 2024; Dhar et al., 2023; Hsuan et al., 2023). This evidence concerns the gene REN and obesity due to melanocortin 4 receptor deficiency.