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Antagonist at adenosine receptor subtype A1

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Another possibility is that obesity could lower serum vitamin B12 levels through decreased dietary intake or absorption, increased catabolism, and sequestration in adipose tissue, or changes in the gut microbiota profiles which could affect the metabolism of vitamin B12

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There are case reports like ours where the low MCV in BTT was obscured by a high MCV of megaloblastic anemia (You et al