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B12 testing is recommended in patients with fatty liver disease who have: Symptoms suggestive of deficiency (anaemia, neuropathy, cognitive changes) Long-term metformin use (MHRA 2022 guidance advises monitoring) Long-term proton pump inhibitor use Vegetarian or vegan diets Conditions affecting absorption (pernicious anaemia, coeliac disease, gastric surgery) Advanced liver disease (NASH, fibrosis, or cirrhosis) Monitoring frequency should be individualised based on disease severity and risk factors

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