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The usual concern with regards to treatment with IGF-1 has historically been hypoglycaemia, however in the trials done so far it has not always occurred and had been lessened when administered with mealsit was also usually connected to an appearance in a loss of appetite [264, 286]

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Sleeve gastrectomy is a procedure in which 7085% of the stomach is removed, resulting in a reduction in gastric reservoir size [51,52] and accelerated nutrient transit time, thus decreasing the absorption of nutrients [52]