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The observed threshold effect at 358.7 pg/mL (OR = 1.04 per 10 pg/mL, 95% CI: 1.001.08, P = 0.03) suggests a plateau in B12 benefit beyond this level, likely due to saturation of methionine synthase activitya mechanism consistent with non-linear enzymatic dose-response relationships, where additional B12 may not enhance methylation capacity [21]

Cachexia (ICD-10-CM R64) is a complex metabolic syndrome associated with underlying chronic illness and characterized by loss of muscle (with or without fat mass), elevated inflammatory markers, anorexia, and functional decline