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This letter will cite the specific clinical criteria you did not meet

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Researchers study these pathways because they play major roles in metabolic disorders, obesity mechanisms, energy expenditure, and fat storage regulation

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This decrease is also potentially a result of several antipsychotic drugs or mood stabilizers (e.g., valproic acid) that are involved in secondary carnitine deficiency which have been found to reduce levels of acyl-carnitines 48,49