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In 2019, more than 18 million Americans smoked menthol cigarettes, with higher rates among young people, African Americans and other racial groups, according to the FDA

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Both have been considered biomarkers with high sensitivity, and in the case of MMA, also specificity, indicating B12 deficiency at the tissue level [68], although several authors have reported normal MMA values even with severely low serum B12 concentrations [5, 69,70,71]