Cited by 222Fibroblast Growth Factor ResearchFolate and B Vitamins ResearchPeptidase Inhibition and Analysis

The DOI matches its Crossref record; 153 of the 153 references it cites were found in a registry or an index; 9 of the 250 sources its claims cite were checked for support.

Fibroblast Growth Factor 21: A Versatile Regulator of Metabolic Homeostasis

Open access
BonDurant, Lucas D., Potthoff, Matthew J.·2018·Annual Review of Nutrition

Abstract

Fibroblast growth factor 21 (FGF21) is an endocrine hormone derived from the liver that exerts pleiotropic effects on the body to maintain overall metabolic homeostasis. During the past decade, there has been an enormous effort made to understand the physiological roles of FGF21 in regulating metabolism and to identify the mechanism for its potent pharmacological effects to reverse diabetes and obesity. Through both human and rodent studies, it is now evident that FGF21 levels are dynamically regulated by nutrient sensing, and consequently FGF21 functions as a critical regulator of nutrient homeostasis. In addition, recent studies using new genetic and molecular tools have provided critical insight into the actions of this endocrine factor. This review examines the numerous functions of FGF21 and highlights the therapeutic potential of FGF21-targeted pathways for treating metabolic disease.

Overview

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TL;DR

This review synthesizes human and rodent evidence that fibroblast growth factor 21 (FGF21) is a liver-derived endocrine hormone that regulates nutrient homeostasis, macronutrient preference, thermogenesis, and stress responses, with potent pharmacological effects against obesity and diabetes. It highlights central nervous system actions as key to FGF21’s chronic metabolic benefits and discusses therapeutic promise alongside unresolved safety and mechanism questions.

Key findings

  • FGF21 is dynamically regulated by nutritional state: fasting, low-protein diets, carbohydrate/fructose intake, ketogenic diets, and alcohol all alter circulating FGF21, while liver-derived FGF21 coordinates fasting/refeeding, protein restriction, and sweet-taste preference.
  • Pharmacological FGF21 has strong metabolic effects: a single injection lowered plasma glucose by more than 50% in diabetic/obese animal models, and repeated administration increased metabolic rate and promoted weight loss; human trials with analogs LY2405319 and PF-05231023 reduced body weight and improved lipid profiles, though effects on glucose/insulin varied.
  • The chronic metabolic effects of FGF21 on body weight and glucose homeostasis require CNS β-klotho, not adipose β-klotho; acute insulin sensitization instead requires direct FGF21 signaling to brown adipocytes.
  • Human genetics link FGF21 variants to macronutrient intake and sweet preference: rs838133 and rs838145 associate with higher carbohydrate intake, and a UK Biobank analysis of 451,000 individuals found rs838133 associated with higher carbohydrate intake, body fat distribution, and blood pressure. Other reported numbers include an approximately eightfold increase in circulating FGF21 with excess carbohydrate, a half-life of approximately 0.4–2 hours, and human FGF21 cleavage between Pro-171 and Ser-172 by FAP.

Methods

  • Narrative review of human and rodent studies, including genetic loss- and gain-of-function models, pharmacological FGF21 administration, clinical trials with FGF21 analogs, and human genetic association data.
  • The paper synthesizes findings thematically across fasting/refeeding, ketogenic diets, protein restriction, macronutrient preference, alcohol, thermogenesis, cellular stress, CNS signaling, and translational trials; no primary experimental methods or systematic review protocol are reported.

Limitations

  • The review states several unresolved controversies: whether FGF21 resistance exists in obesity, whether FGF21 is required for ketogenic-diet effects, whether FGF21 directly affects bone loss or female fertility, and whether extrahepatic FGF21 production has physiological relevance.
  • It notes that mechanisms for adverse effects, including gastrointestinal issues, blood pressure changes, and the CNS–adipose circuit, remain unclear and require further study.
  • Evident from the text: this is a narrative review without a stated systematic search strategy, inclusion criteria, or quantitative synthesis, and many conclusions rely on rodent models with acknowledged species differences in FGF21 biology and thermogenesis.

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Integrity signals

Registry

Crossref · 10.1146/annurev-nutr-071816-064800

Cites

153 of 153 references verified0 citation errors · 0 not checkable

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    Humans possess relatively less BAT than rodents.

    “Since humans possess relatively less BAT than rodents, adipose tissue thermogenesis may contribute less to overall energy homeostasis in humans.”
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Metadata

Authors
BonDurant, L. D., & Potthoff, M. J.
Affiliations
University of Iowa (US)
Venue
Annual Review of Nutrition
Published
2018-08-21
Volume
38
Issue
1
Pages
173-196
ISSN
  • 0199-9885 (ISSN-L)
  • 1545-4312
OpenAlex
W2799463911
Cited by
222
References
152
Citations by year
2026: 25 · 2025: 25 · 2024: 29 · 2023: 33 · 2022: 30 · 2021: 34 · 2020: 18 · 2019: 25 · 2018: 3
FWCI
1.96
Type
journal article
Language
en
Open access
Locations
  • Annual Review of Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • Roy J. and Lucille A. Carver College of Medicine, University of Iowa
  • National Institute of General Medical Sciences (T32GM067795)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK106104)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Fibroblast Growth Factor Research
  • Health Sciences › Nursing › Nutrition and Dietetics › Folate and B Vitamins Research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Peptidase Inhibition and Analysis
Keywords
FGF21, metabolic homeostasis, liver, nutrient sensing, nutrient homeostasis, diabetes mellitus, obesity, metabolic disease treatment
MeSH terms
Ethanol, Animals, Fibroblast Growth Factors, Food Deprivation, Gene Expression Regulation, Homeostasis, Humans, Lipid Metabolism

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