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This is often due to limited dietary intake, malabsorption, medical conditions, or the use of B12-depleting medications ( Vitamin B12 deficiency is determined as follows ( Because the ability to absorb B12 from food declines with age, deficiency is more common in older adults

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It inhibits NNMT (nicotinamide N-methyltransferase), an enzyme regulating metabolism, fat storage, and NAD+ consumption.[4][27][6] NNMT methylates nicotinamide, a NAD+ breakdown product, diverting it from recycling and reducing available NAD+