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Acquired causes of B12 deficiency can be 1) dietary, especially in vegetarian and vegan populations, 2) autoimmune, as seen in pernicious anaemia, where there is destruction of IF-producing parietal cells mediated by autoantibodies, 3) iatrogenic secondary to disruption of the acid-base status of the stomach (e.g., with proton pump inhibitor use or metformin), and 4) caused by malfunction of the terminal ileum (e.g., inflammatory bowel diseases like Crohns disease, gastric bypass or surgical resection)

doi: 10.1155/2022/4911205 200 QinSWangYLiLLiuJXiaoCDuanDet al

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Growth hormone secretagogues have a potentially lower risk

The Institutional Review Board of Shinshu University School of Medicine approved the study plans, and granted a waiver of informed consent, since diagnostic use of the samples was completed before this study and there was no risk to the patients