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Jiean Huang, [email protected] These authors have contributed equally to this work Disclaimer All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers

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The goal would be to safely elevate and sustain ketone body levels in preterm infants, thereby optimizing cerebral energy metabolism while carefully managing potential metabolic risks (32)

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Formulation: Tirzepatide 10 mg/mL + Levocarnitine 100 mg/mL Schedule: Weeks 1 to 4: 2.5 mg tirzepatide (25 units) once weekly, delivering 25 mg levocarnitine Weeks 5 to 8: 5 mg tirzepatide (50 units) once weekly, delivering 50 mg levocarnitine Weeks 9 to 12: 7.5 mg tirzepatide (75 units) once weekly, delivering 75 mg levocarnitine Weeks 13+: 10 mg tirzepatide (100 units) once weekly, delivering 100 mg levocarnitine, with potential titration to 12.5 mg or 15 mg based on response and tolerability Supporting measures: Protein intake: 0.7 to 1.0 g per pound of body weight daily Resistance training: 3 to 4 sessions per week minimum Hydration: minimum 64 oz water daily Monitor body composition (not just scale weight) monthly Protocol 2: Enhanced fat oxidation for active researchers Goal: Maximize fatty acid oxidation capacity during concurrent exercise programs