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Local inflammation is characterized by an increased number of infiltrating and resident immune cells, such as mast cells [55], neutrophils and T regulatory lymphocytes [56], eosinophils [57], and CD8 T lymphocytes [58] at the injury site, thereby releasing pro-inflammatory effectors

Not only is the health care benefit reduced by nonadherence, but also this results in increased health care costs as physicians use additional diagnostic procedures and alter the treatment to achieve therapeutic success and/or treat the consequences of GH deficiency, eg, increase the dose, prescribe additional drugs, and/or try alternative therapeutic interventions (13, 15)

Furthermore, a High-Fat Diet (HFD) is capable of increasing carnitine and its metabolites production (Kelly, 1998, Kepka et al., 2020)

Acknowledgements We would like to express our gratitude to the following individuals who have contributed as members of the systematic review team: Shinya Agena (Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus)