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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]

Andersson, Emmanuel Shapira, Biochemical and clinical response to hydroxocobalamin versus cyanocobalamin treatment in patients with methylmalonic acidemia and homocystinuria (cblC), The Journal of Pediatrics, Volume 132, Issue 1, January 1998, Pages 121-124, ISSN 0022-3476, Okuda K, Yashima K, Kitazaki T, Takara I