“…Clinical TMAO effects are most closely tied to atherosclerotic phenotypes, although there is some debate [ 30 , 31 ]. Resent TMAO research has recently expanded to include other chronic metabolic diseases [ 20 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Over-nutrition related metabolic phenotypes including insulin resistance, type 2 diabetes (T2D), obesity, metabolic syndrome, and chronic kidney disease (CKD) which are already associated with CVD have been linked to TMAO [ 39 , 44 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ].…”