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Although we performed multivariate adjustments, residual confounding may persist due to unmeasured factors such as dietary habits (e.g., irregular intake of animal-derived foods or B12-fortified products), unrecorded use of nutritional supplements, and genetic predispositionsparticularly MTHFR polymorphisms, which are known to influence homocysteine metabolism and folate cycling, thereby potentially altering the functional demand for vitamin B12

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The population for the analysis of the primary efficacy endpoint included, 36,621 participants 12 years of age and older (18,242 in the Pfizer-BioNTech COVID-19 Vaccine group and 18,379 in the placebo group) who did not have evidence of prior infection with SARS-CoV-2 through 7 days after the second dose