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Although we performed multivariate adjust- ments, residual confounding may persist due to unmea- sured factors such as dietary habits (e.g., irregular intake of animal-derived foods or B12-fortied products), unrecorded use of nutritional supplements, and genetic predispositionsparticularly MTHFR polymorphisms, which are known to inuence homocysteine metabolism and folate cycling, thereby potentially altering the func- tional demand for vitamin B12

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