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This inevitably results in low IGF-I and high GH that may stray into the acromegaly range (132, 133) and this catabolic state is comparable to prolonged fasting and malnutrition states ( Figure 1E )

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Among those aged 12 and older, in 2023, an estimated 7.9 % had used in their lifetime and 0.8 % had used in the past year