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This process is marked by chronic low-grade inflammation (inflammaging), diminished adaptive immunity, and a skewed CD4+/CD8+ T cell ratio, leaving older adults more vulnerable to infection, cancer, and poor vaccine responses [47]

For this reason, eligibility decisions in enhanced athletes cannot currently rely on PED-specific validated cut-offs, but must instead be guided by existing sports cardiology principles, individualized risk stratification, and longitudinal reassessment

SICOB Italian clinical practice guidelines for the surgical treatment of obesity and associated diseases using GRADE methodology on bariatric and metabolic surgery

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Medication Adjustments : Increasing the GLP-1 dose (if tolerated) or adding another medication that targets a different pathway may be effective for some