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NAD + is also involved in metabolic switching, or the Warburg effect, in which the main source of energy production is anaerobic glycolysis through fermentation of pyruvate to lactic acid, as opposed to mitochondrial oxidative phosphorylation 340

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However, in older adults or those with sarcopenia, functional assessment (using tools like grip strength measurement or the SARC-F questionnaire) is warranted to identify patients who may need additional intervention to preserve muscle function