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The presence of comorbidities can significantly impact the pharmacokinetics of Vitamin B12, making it essential to adjust dosing protocols. Expert Opinion on Vitamin B12 Therapy Genetic Factors Affecting B12 Metabolism Genetics play a role in how well someone can use Vitamin B12

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Fatty change can also be observed in combination with other hepatotoxic injuries (e.g., chronic liver toxicity, degeneration, inflammation, and necrosis) or nutritional disturbance (e.g., diet, vitamin A excess) in both animals and man

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But the evidence is limited, and some research methodologies are flawed, so its difficult to confirm these effects