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doi:10.3390/nu10050541

Under the simulated plateau altitude of 6000 m, partial pressure of oxygen values, sex hormone levels, sperm motility rates, sperm deformity rates and histopathological and morphological features of testicular tissues are obviously altered, suggesting that the environment at an altitude of 6000 m may have a significant impact on the function of the rat's reproductive system

Am J Clin Nutr 70, 10401045 (1999)

It can occur in various malabsorption disorders (which result in reduced absorption of nutrients from the intestines into the blood), malnutrition, or in alternative dietary approaches that exclude animal-based products, such as veganism