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When NNMT is overactive (common in obesity), cells struggle with energy production and metabolic efficiency

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Gastrointestinal surgery can also affect B12 absorption

Since NNMT is expressed in adipose, hepatic, and gut tissues 50,51,52 , and these tissues heavily cross-talk with the gut microbiome 53,54,55 , NNMTi treatment or its resulting weight loss effects 8,9 may modulate the microbiome

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