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During later infancy and early childhood inadequate intakes of B12 due to low intake of animal-source foods and possibly malabsorption, may play a role (Sobczynska-Malefora et al., 2023)

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The addition of semaglutide to this already high-risk group showed further b12 decline, but whether this represents a medication effect, dietary changes from additional appetite suppression, or natural progression of post-surgical deficiency remains unclear