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As absorption is reduced, body stores become low and a deficiency occurs Underlying diseases most commonly include: IBD (inflammatory bowel disease) Intestinal cancer (especially small cell lymphoma) Liver disease Pancreatitis and other pancreatic diseases Symptoms of low B12 levels Typically found in middle-aged or older cats that present with: Weight loss Diarrhea Vomiting Anorexia Thickened intestines In humans, B12 deficiency may also be associated with dementia, cardiovascular disease, and a certain type of anemia, although these are not specifically recognized problems in cats

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For example, an analysis of cross-sectional 20112014 NHANES data on 2,420 adults age 60 years or older found that low vitamin B12 (MMA greater than 0.27 micromol/L or serum vitamin B12 less than 203 pg/mL [150 pmol/L]) combined with high folic acidunmetabolized serum folic acid greater than 0.44 mcg/L (1 nmol/L) or serum total folate higher than 32.7 mcg/L (74.1 nmol/L)was associated with an almost two to three times higher risk of cognitive impairment [84]

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