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Additionally, chronic conditions such as HIV and tuberculosis have been implicated in B12 deficiency due to increased metabolic demand and altered absorption mechanisms ( The diagnosis of vitamin B12 deficiency typically relies on low total B12 levels and elevated concentrations of homocysteine (Hcy), as well as levels of transcobalamin-bound B12 (holoTC) and methylmalonic acid (MMA), which serve as functional indicators of cobalamin insufficiency ( Vitamin B12 requirements fluctuate throughout the life course, influenced by metabolic demand and physiological changes

Certain populations may require more frequent maintenance

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Nicotinamide, a form of Vitamin B3, supports cellular energy production and repair

Approximately 90% of people who follow a vegan or vegetarian diet are deficient in vitamin B12 (The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature)