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Our finding of a positive association between TMAO and ASCVD in this community-based study supports and greatly extends the results of prior observational studies, many of which were in clinical samples of patients with preexisting disease 43 , 44 ) particularly since we evaluated a racially and ethnically diverse population and were also able to adjust for a wide variety comorbidities, risk factors, and social/demographic factors typically not available as covariates in most other studies (e.g

Risk of bias of selected articles is shown in Figure 2

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This complexity is not only reflected in the composition and concentration changes of the carnitine pool but also involves the functional diversity of carnitine in different tissues and cell types

Alcohol consumption represents an important interaction consideration, as alcohol may increase the risk of hypoglycemia

Limitations While this study provides valuable insights into the effects of L-carnitine supplementation on athletic performance, several limitations should be considered