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Oxygen availability influences how the body performs during activity, which directly affects calorie expenditure

This impairment of DNA synthesis affects the rapidly dividing cells of the bone marrow earlier than other cells, resulting in the production of large, immature, hemoglobin-poor red blood cells (macrocytosis), as well as effects on white blood cells, including abnormal (hypersegmented) neutrophils and reduced overall cell counts (pancytopenia)

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A 2021 review in Nature Reviews Molecular Cell Biology describes a gradual drop in tissue and cellular NAD+ across aging in rodents and humans, and links that fall to metabolic disease, cognitive decline, and sarcopenia [1]