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doi: 10.1152/physrev.00031.2018 319 StahonK

Additionally, it disrupts the gutliver axis, leading to endotoxemia and Kupffer cell activation [67]

Several randomized controlled trials have found metabolic surgery in addition to lifestyle and medical interventions is more effective than intensive medical and lifestyle interventions alone for inducing weight loss, improving metabolic health, and resulting in diabetes remission (Courcoulas 2015