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Patients with long-standing alcohol use, restrictive diets, malabsorption syndromes, or prolonged use of medications that deplete or interfere with B vitamins may particularly benefit when a deficiency is confirmed

The role of IGF-II should be viewed in the light of Efstradiadis series of knock-out experiments in mice (21) where the Igf2 ko mice had the same degree of fetal growth retardation as the igf1 ko which demonstrates that IGF-II is a paracrine/autocrine and not an endocrine hormone

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Tests, like checkingb12 and folate levels, can spot problems early