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Endocrine Versus Paracrine Autocrine IGF-I One of the controversies of the area has been the relative contribution to linear growth of circulating endocrine IGF-I largely produced by the liver versus peripherally produced IGF-I with major paracrine/autocrine actions on local tissues

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Groups vulnerable to these deficiencies include individuals dealing with obesity, impaired nutrient absorption, renal issues, proton pump inhibitor (PPI) users, elderly individuals with elevated Clinical Frailty Scores, women, taller individuals, and post-bariatric surgery patients, especially those lacking postoperative care [3, 43,44,45]

The body has powerful hormonal systems designed to defend its current weight increasing hunger, slowing metabolism, and reducing energy expenditure when calorie intake drops