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Immune decline: Reduced efficiency in pathogen clearance and macrophage removal

Initially focused on metabolism, research showed NNMT elevation with age/weight leads to fat accumulation, inefficiency, and NAD+ loss.[30][31] High NNMT correlates with insulin resistance and obesity in humans

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Malabsorption from coeliac disease, Crohns, gastric surgery or long-term metformin and proton-pump inhibitors accounts for much of the rest