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Inspection of the BMI % phenotype revealed a heavy tailed distribution, so we further quality controlled the BMI % phenotype to remove outlier participants with BMI changes above 20% or below 45% (Extended Data Fig

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Many mammalian studies have shown that only l-carnitine has beneficial effects ( Reference Liedtke, Nellis and Whitesell 16 Reference Spasov, Iezhitsa and Pisarev 18 ) , while d-carnitine can interfere with the uptake and transport of l-carnitine ( Reference Vernez 13 , Reference Paulson and Shug 19 ) , and therefore inhibit the -oxidation of FA ( Reference Spasov and Iezhitsa 20 , Reference Leichter, Ottem and Hahn 21 ) , which has a hepatotoxic effect ( Reference Arafa 22 )

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Because of the potential of these outliers to distort the overall sample representation in the principal component analysis plot (Extended Data Fig