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Poor sleep disrupts hormones that regulate hunger and satiety, particularly ghrelin and leptin, which can increase appetite and cravings for unhealthy foods

pylori infection increases phosphohistone H2AX, a marker of repair for double-strand DNA breaks (46)

Most GLP-1 users accidentally undereat protein by 40% or more because appetite suppression works so effectively, accelerating muscle loss that undermines long-term metabolic health and creating plateaus that feel like treatment failure

However, despite these efforts, some studies still exhibited unexplained heterogeneity, introducing a potential source of bias into our findings

Availability of data and materials Data sharing is not applicable to this study as data management and analysis were only allowed to be conducted in Health and Welfare Data Science Center in Taiwan for data privacy and safety concerns