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In the VMH, the orexigenic effects of ghrelin occur through activation of hypothalamic AMPK and inhibition of acetyl-CoA carboxylase (ACC) and fatty acid synthase (FASN), leading to decreased malonyl-CoA levels, increased carnitine palmitoyl-transferase 1 (CPT1) activity, and enhanced mitochondrial reactive oxygen species (ROS) production [86]