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KD may increase the NAD + /NADH ratio through various mechanisms

Among them, produce acetate, butyrate of beneficial bacteria such as Catonella , Murimonas intestini and Barnesiella intestinihominis decreased, while harmful bacteria such as, Klebsiella , Escherichia and Streptococcus increased (Li et al., 2024)

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Prospective, longitudinal studies are needed to further elucidate these effects and optimize perioperative strategies in orthopedic populations

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