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For aging populations, MDD presents an even greater concern, as it significantly raises the risk of Alzheimers disease, dementia, frailty, and reduced health span, underlining its multifaceted burden on both mental and physical health in older adults [491,492,493]

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Pivalate is a branched-chain fatty acid anion that is metabolized to form an acyl-CoA ester, which is transesterified to carnitine and subsequently excreted in the urine as pivaloyl carnitine

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