Fasting blood was obtained in chilled, ethylenediaminetetraacetic acid (EDTA) tubes, for GDF15 assay. The serum was extracted at 80 Celsius for 10 minutes, after an immediate centrifuge at 3000 rpm, waiting for hormone analysis. The GDF15 assay was carried out using an enzyme-linked immunosorbent assay kit (ELISA; Cloud-Clone Corp, 1304 Langham Creek Dr, Suite 226, Houston, TX 77084 USA). The insulin resistance homeostasis (HOMA-IR) index was used for the calculation of insulin resistance [(Fasting Glucose-Fasting Insulin)/22.5.

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