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This usually occurs in individuals with underlying digestive conditions, those who have trouble absorbing all nutrients through digestion, or those with pernicious anemia, which specifically prevents B12 absorption

First, the retrospective nature of the TriNetX database precludes causal inference

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doi: 10.1111/j.1463-1326.2011.01473.x 41 NingGBandgarTHehnkeULeeJChanJCN