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Although the serum MMA concentration reflects an intracellular cobalamin deficiency, other causes of elevated MMA must be considered, such as renal failure, reduced plasma volume reduction, and abnormalities in hepatic methyl-malonyl CoA mutase activity [15,47]

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In the case of weight loss, a physician-supervised weight loss program will be the most effective way to lose weight and keep it off long-term

Changing one of them may reduce the overall effectiveness of the therapy