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On the other hand, l-carnitine, primarily sourced from red meat, is obtained exogenously through dietary intake 28 .Dietary l-carnitine is metabolized in humans in a gut microbiota-dependent manner to form -butyrobetaine (GBB), which is subsequently converted into trimethylamine (TMA), a precursor of trimethylamine N-oxide (TMAO) 29

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Increased risk of cardiovascular disease is associated with abnormal levels of acylated derivates of carnitine