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Its native range spans multiple Chinese regions (northwest, southeast, north, east, and central) (Xu et al., 2025), with a global distribution extending across East Asia (Japan, Korea) and Southeast Asia (Vietnam, Thailand, Myanmar) and introduced populations in Europe and North America (Wiart, 2012), as depicted in Figure 1E

doi: 10.1210/en.2005-0030 238 TsujiJLiTGrinshpunACoorensTRussoDAndersonLet al

530 Metrnl, an adipokine, has been identified as a key modulator in the insulin signaling pathway, improving impaired insulin responses in myotubes and skeletal muscle through AMPK/PPAR--mediated signaling