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This absence of IGF-1 stimulation is critical for appetite neutrality because IGF-1 has known effects on hypothalamic neuropeptide expression, including alterations to neuropeptide Y (NPY) and agouti-related peptide (AgRP), both potent appetite stimulators

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Gastric bypass increases circulating bile acids and activates hepatic farnesoid X receptor (FXR) but requires intact peroxisome proliferator activator receptor alpha (PPAR) signaling to significantly reduce liver fat content