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A study from The Netherlands (Riphagen, 2020) found that after 8.5 years of follow-up of an older cohort (median baseline age=65), a doubling of baseline MMA levels was associated with an increased risk of mortality (HR 11.48, CI 3.3239.64)

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12 An understanding of how this improvement in pain translates into meaningful changes in quality of life and mental health measures remains limited