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Its mechanism restoring NAD+ availability and reactivating SIRT1-mediated pathways directly addresses mitochondrial dysfunction, impaired glucose tolerance, and hepatic steatosis, all hallmarks of metabolic syndrome

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3) uncontrolled comorbidity related to the following systems: respiratory (bronchial asthma, chronic obstructive lung disease, interstitial pneumonia, pulmonary fibrosis, and respiratory failure), cardiac (cardiac failure and arrhythmias), renal (renal failure with dialysis), neurological (cerebral vascular disorder), hepatic disease (Child classification C with liver cirrhosis, fulminant hepatitis, and liver failure)

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