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Common Risk Factors Include: Northern European descent Age over 50 years Autoimmune disorders (e.g., thyroid disease, type 1 diabetes) Long-term use of acid-suppressing medications Strict vegetarian or vegan diets History of gastric or intestinal surgery Pathophysiology of Pernicious Anemia The development of pernicious anemia follows a predictable sequence: Autoimmune destruction of gastric parietal cells Reduced or absent intrinsic factor production Failure to absorb vitamin B12 in the terminal ileum Impaired DNA synthesis in bone marrow Production of large, dysfunctional red blood cells Reduced oxygen-carrying capacity Over time, vitamin B12 deficiency also affects the nervous system , leading to neurological symptoms

doi: 10.1186/s13048-018-0418-8 472 DaniilidisAKaragiannisV

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Effects of zinc supplementation on inflammatory and cognitive parameters in middle-aged women with overweight or obesity

Another group validated ultra-high-risk criteria in a group of help-seeking adolescents (74)