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Although leave-one-out and Baujat analyses were performed, they did not meaningfully reduce heterogeneity, indicating that the variability is intrinsic to the studies themselves

Fifth, the inclusion of both RCTs and observational studies introduces potential bias due to differences in design, particularly confounding and selection bias in observational data, which may distort pooled effect estimates

Additionally, dehydration resulting from gastrointestinal side effects may contribute to muscle cramping and joint stiffness