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Aging reduces NAD+ synthesis pathways while increasing consumption by enzymes like CD38 and PARPs, activated by inflammation and damage.[13][15] CD38, an immune-related enzyme, ramps up with age, breaking down NAD+ precursors

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These patients are often recommended to receive 1 mg of oral vitamin B12 daily indefinitely, but intramuscular injections may be necessary if oral supplementation is insufficient Mahawar2018Langan2017

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