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Most clinical evidence comes from case reports and clinical observations, not large-scale controlled trials It is important to maintain realistic expectations and recognize that animal research does not always translate directly to human outcomes

95,96,97 NAD + and aging An imbalance in the NAD + /NADH or NADP + /NADPH ratio can destabilize cellular homeostasis, causing not only pellagra but also aging, neurodegenerative diseases, inflammatory alterations, infections, cardiovascular diseases, and cancer

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