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This 1.4%, reduction in ECV in a relatively short time frame (6 months) is particularly relevant when read in the light of the data published by Wong et al [100], where a 3% increase in ECV in diabetic patients was associated with a 52% increase in the risk of death or HF hospitalization

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This reflects the medical understanding that obesity involves persistent metabolic, hormonal, and neurological changes that often require ongoing pharmacological intervention