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In one weight management observational study comparing characteristics between completers and non-completers, dropout rates were reported to be 21% at 1 month and 57% at 6 months [22]

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This highlights why patients with progressive fatty liver disease, particularly those advancing towards cirrhosis, require careful assessment of their B12 status and overall nutritional health when symptoms or risk factors are present

Another group independently also concluded that disability progression and brain atrophy occur earlier than in the classical secondary progressive stage, with many relapsing patients exhibiting insidious progression without clinical or radiographic evidence of inflammatory disease activity, coining the term silent progression (Cree et al., 2019)