EXPRESS: Endothelial glycocalyx degradation, systemic inflammation, and central nervous system injury: a comparative cohort study in adults with and without obesity

Obesity is associated with chronic systemic inflammation, vascular endothelial dysfunction, and increased risk of central nervous system (CNS) injury, yet the mechanisms linking peripheral inflammation to brain damage remain incompletely understood. The endothelial glycocalyx, a critical regulator of vascular barrier integrity, may serve as a mechanistic interface between systemic inflammation and CNS impairment. In this prospective observational cohort study, 72 adults (48 with obesity and 24 normal-weight controls) underwent standardized clinical assessments, fasting blood sampling, emotional evaluation, and diffusion tensor imaging of the brain. Circulating inflammatory markers, endothelial glycocalyx degradation products, and CNS injury biomarkers were quantified. After adjusting for age, hypertension, triglycerides, and fasting glucose, individuals with obesity exhibited significantly elevated levels of all inflammatory, glycocalyx, and CNS injury markers, along with reduced white-matter integrity (lower FA, higher MD; all P<0.05). Partial correlation analyses revealed that endothelial glycocalyx degradation was closely associated with systemic inflammation, CNS injury, and white-matter microstructure. Our findings indicated that glycocalyx degradation products might serve as biomarkers for obesity-related neurovascular changes.This study was registered at the Chinese Clinical Trial Registry (ChiCTR 2400085587).