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This degradation, in turn, allows NF-B activity to increase, resulting in increased transcription of pro-inflammatory genes, including TNF-, IL-1, IL-6, and inducible nitric oxide synthase (iNOS) (Morgan and Liu, 2011)

This timing leverages physiologic factors including reduced somatostatin inhibition during sleep, increased GHRH receptor sensitivity during evening hours, and optimal metabolic conditions supporting growth hormone synthesis and secretion, while morning or midday administration stimulates smaller daytime pulses with less consistent metabolic benefits

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