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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 predispositions—particularly MTHFR polymorphisms, which are known to influence homocysteine metabolism and folate cycling, thereby potentially altering the functional demand for vitamin B12