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The most serious but rare complication is metformin-associated lactic acidosis (MALA), typically occurring in the setting of renal impairment and mechanistically linked to mitochondrial complex I inhibition (Zhou et al., 2001)

Methods Study design and participants This present study was nested within a cross-sectional study conducted in public middle schools in Kuwait, as previously described 61,62

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This, in turn, boosts metabolic rate and activates a gene known as sirtuin-1 (SIRT1), also referred to as the "longevity gene." SIRT1 is involved in reducing the risk of various conditions such as diabetes, obesity, metabolic syndrome, atherosclerosis, cardiovascular disease, kidney disease, liver disease, neurodegeneration, and cancer.

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