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Dysbiosis, or an imbalance in gut microbiota, is associated with metabolic diseases, especially T2DM, and can cause changes in the signaling pathways of intestinal hormone secretion, leading to various health problems [156]

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Secondary carnitine deficiencies are most commonly the result of trapping of carnitine in fatty acylcarnitine due to defects in mitochondrial fatty acid -oxidation enzymes such as is the case in medium-chain acyl-CoA dehydrogenase deficiency (MCADD)

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