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2) Artery Hardening High levels of TMAO were associated with increased cIMT (carotid intima-media thickness), an early marker for hardening of the arteries (atherosclerosis), in 220 people irrespective of other factors, such as insulin resistance, obesity, and fatty liver [13]

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These factors are frequently compounded by subsequent pregnancies or further weight gain, which is why the pouch tends to be more pronounced after multiple C-sections