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TNF can promote insulin resistance in adipocytes (177), and FAs can activate JNK to promote the additional release of pro-inflammatory cytokines from macrophages (178) and adipocytes (179), inciting a vicious cycle

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Pregnant or nursing mothers on these diets may also need extra B12 support

Outcomes Co-primary endpoints were percentage change in body weight from baseline to week 104 and achievement of weight loss of at least 5% of baseline weight at week 104