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Article History

Received: 20 November 2025

Accepted: 10 March 2026

First Online: 21 April 2026

Acknowledgements

: We gratefully acknowledge the contributions of all study volunteers, whose involvement made this research possible. We also thank A. Mengozzi and G. Nesti at the University of Pisa (Pisa, Italy), M. Borg and Y. Sun at the University of Adelaide (Adelaide, Australia), and all clinical staff, nurses and research coordinators at the two institutions for their assistance with participant recruitment, data collection and study implementation. Preliminary findings from this study were previously presented at the EASD Annual Meeting, held in Vienna, Austria, in September 2025, and the Italian Society of Internal Medicine (SIMI) Annual Meeting, held in Rimini, Italy, in October 2025. The current manuscript provides a comprehensive and updated analysis of the full dataset, incorporating additional results and extended discussion not included in the earlier presentations.

: The data that support the study findings are available from the corresponding authors on reasonable request starting from the date of publication and will remain accessible for a minimum of 10 years, in line with institutional policies. Access will be granted to qualified researchers to address research questions that are consistent with the scope of the original study and meet ethical and legal requirements.

: Open Access funding enabled and organized by CAUL and its Member Institutions. We acknowledge financial support under the National Recovery and Resilience Plan (PNRR), Mission 4, Component 2, Investment 1.1, Call for tender no. 104 published on 2 February 2022 by the Italian Ministry of University and Research (MUR), funded by the European Union – NextGenerationEU – Project Title ‘Exploring the role of SGLT-1 driven intestinal glucose absorption and altered intestinal mucosa integrity in the pathogenesis of non-alcoholic fatty liver disease’ – CUP I53D23005180001, F53D23007130006 and B53D23021760006 – grant assignment decree no. 2022LWXFM4 dated 20 July 2023. Data obtained at the University of Adelaide were funded by an Australian National Health and Medical Research Council (NHMRC) Ideas Grant awarded to CKR (ID 2020454). CX has been supported by an Australian Diabetes Society Skip-Martin Early Career Fellowship. TW has been supported by the Australian Medical Research Future Fund (MRFF) (ID: MRFCDDM000009). CKR is supported by the Michell Bequest Foundation.

: The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.

: The study was conceived by DT and designed by DT, TW, AM, CKR and AN. Funding was obtained by DT, TW, TVF, RB, CKR and AN. All authors contributed to the acquisition, analysis or interpretation of the data. Statistical analysis and mathematical modelling were performed by DT, CX and AM. DT drafted the manuscript, and all authors critically revised it for important intellectual content. CKR and AN supervised the work. All authors approved the final version of the manuscript. DT and AN take responsibility for the integrity of the work as a whole.