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The mechanisms underlying weight regain are multifactorial and include metabolic adaptation with decreased energy expenditure, hormonal changes affecting appetite regulation, anatomical alterations such as gastric pouch or stoma dilation, and psychosocial factors including maladaptive eating behaviors

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SdaA was reported to be the gene encoding either the structural gene of L-SD that catalyzes the deamination of serine to pyruvate or a positive activator of transcription [31]