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

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Acknowledgements The authors acknowledge the support of grants from the National Key Research and Development Program of China (grant no