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The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) tool was used to assess the certainty of the evidence for the two primary biochemical outcomesserum vitamin B12 concentration increase and homocysteine reductionacross all included studies, and separately for randomised controlled trials (RCTs) and observational studies

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This finding is particularly noteworthy given that some trials extended to 24 weeks of continuous exposure and included participants with obesity-related comorbidities who might be expected to have higher baseline health risks

These genes encode for the plasma inflammatory and growth factors previously associated with VCD in long COVID in this cohort 4