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Clinical syndromes associated with carnitine deficiency were first reported by Engel et al in 1973 (4) and 1975 (5), and primary systemic carnitine deficiency associated specifically with a defect in carnitine transport was identified by Treem et al in 1988 (6)

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Indirect evidence: evidence that modulation or attenuation in the magnitude of impact on a specific KE (increased effect or decreased effect) is associated with corresponding changes (increases or decreases) in the magnitude or frequency of one or more downstream KEs