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During DKD, downregulation of energy metabolism genes such as Peroxisome Proliferator-Activated Receptor and peroxisome proliferator-activated receptor gamma coactivator 1 (PGC-1) leads to suppressed AMP kinase (AMPK) signaling, followed by downregulation of fatty acid oxidation genes and activation of triglyceride synthesis-related genes in proximal tubular cells (26)

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Potentially, the regeneration of NAD + may be accomplished through external mitochondrial NADH dehydrogenases (NADH DHs) ( Figure 3 )

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This occurs because the digestion of dietary triglycerides relies almost entirely on pancreatic enzymes, whereas protein and carbohydrate digestion are supported by gastric, salivary, and intestinal brush border enzymes