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These associations were independent of demographic, socioeconomic, lifestyle factors, use of medications that could have an effect on serum vitamin B12 levels, dietary supplement use and fasting time

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Clinical signs of B12 deficiency include nausea, vomiting, loss of appetite, poor absorption of food (malabsorption syndrome), constipation, gas, weight loss, fatigue, lethargy, abdominal pain, and diarrhea

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