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Since the liver is the major site of IGF-1 production, when steatosis develops lowering insulin sensitivity, the severity of steatosis at different stages of insulin resistance and metabolic syndrome seems to be correlated with worsened circulating IGF-1 levels [234]

Finally, as with many of the other DWH-related studies attributing effects to relatively low BTEX levels, the authors have not provided a rationale for why this outcome was not recognized in previous comprehensive studies of workers exposed to perhaps three orders of magnitude higher levels of benzene or toluene

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