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Safety Although the studies included in this review identified no important safety issues, orally administered l-carnitine supplementation has been linked to a increase in trimethylamine (TMA) and trimethylamine- N -oxide (TMAO), as unabsorbed carnitine is metabolised by the gut microbiota to TMA and later oxidised to TMAO in the liver

Missing data will be handled primarily using the GEE model, with sensitivity analyses via multiple imputation if needed

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