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It is particularly common in individuals with certain risk factors, including those who have undergone gastric or small intestine resections, have inflammatory bowel disease, use metformin or proton pump inhibitors, follow a vegan diet, or are older than 75 years
The ingestion of a high-calorie diet or the consumption of substantial amounts of alcohol has been demonstrated to promote DNL through the activation of two transcription factors: carbohydrate response element binding protein (ChREBP) and sterol regulatory element binding protein-1c (SREBP-1c)
As the deficiency may be indistinguishable for either of these essential vitamins, they are often grouped into one product for therapeutic and preventive use