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While baseline liver ultrasonography was available for all participants, follow-up imaging assessments were not systematically performed, and hepatic outcomes were therefore primarily inferred from biochemical markers

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Obesity is an important risk factor for various metabolic disorders, including insulin resistance and type 2 diabetes 2 , atherosclerosis 3 , cardiovascular disease 4 , and chronic kidney disease 5 , and can cause oxidative stress 6, 7 , endoplasmic reticulum (ER) stress 8, 9 , and mitochondrial dysfunction 10, 11

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