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doi: 10.3390/nu12051398

The observed discrepancies stem from differences in study design and methodology

It is possible that the oxidative stress, malnutrition, liver damage, and muscle wasting that occur in more advanced liver disease impair the bodys ability to upregulate carnitine synthesis, while urinary reabsorption is reduced due to renal insufficiency

In this case, a twofold relative risk may be uncommon in absolute terms, yet significant enough to warrant a careful conversation in the clinic