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In a larger unsupervised clustering analysis ( n = 11,908), four sub-phenotypes were identified, broadly echoing this metabolicreproductive axis and showing substantial overlap with NIH-based subtyping frameworks (52), consistent with prior NIH subtype classifications and related work (50, 53)

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169 It is important to note that folic acid supplementation can hide or mask a B 12 deficiency by preventing or correcting megaloblastic anemia without resolving the neurotoxic effects of B 12 deficiency