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In the third meta-analysis, Shrestha et al

Adipose Tissue Biology and Effect of Weight Loss in Women With Lipedema

Mitochondrial dysfunction is characterized by various degrees of ultrastructural mitochondrial damage, abnormal morphologic changes, increased permeability of the outer and inner membranes, impaired mitochondrial -oxidation, respiratory chain activity reduction, ROS overproduction, ATP depletion, and oxidative stress-mediated deletions of mtDNA inducing apoptosis (Ramanathan et al

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These limitations matter, and they are why the formal recommendation remains cautious