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The observed threshold effect at 358.7 pg/mL (OR = 1.04 per 10 pg/mL, 95% CI: 1.001.08, P = 0.03) suggests a plateau in B12 benefit beyond this level, likely due to saturation of methionine synthase activitya mechanism consistent with non-linear enzymatic dose-response relationships, where additional B12 may not enhance methylation capacity [21]
Additional tests including full blood count, mean corpuscular volume (MCV), and potentially methylmalonic acid or homocysteine levels may be requested to confirm deficiency and assess its severity
2013;5(209):209ra151
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