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The most frequent cause of the deficiency is pernicious anemia.[1] The only Indian report of cutaneous hyperpigmentation due to vitamin B 12 deficiency is of a ten-month-old male child who was exclusively breastfed till three months of age and thereafter received diluted cows milk and occasional cereals.[3] Although the authors do not mention the cause of deficiency, it appears to be inadequate dietary intake

Modern issues like poor dietary choices, busy lifestyles, and food quality concerns make it difficult to maintain optimal B12 levels

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