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Upon TGR5 activation, adenylyl cyclase (AC) converts ATP to cAMP, which subsequently activates protein kinase A (PKA) and cAMP response element-binding protein (CREB), participating in multiple cAMP signaling pathways (73)

In this study, BMI values were defined as the midpoint of the ICD-10-CM code (e.g., ICD-10-CM code Z68.25 [adult BMI 25.025.9 kg/m 2 ] was defined as BMI 25.45 kg/m 2 in this study)

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