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Both endogenous and exogenous forms of vit-D are inactive and require two successive hydroxylation steps by cytochrome P450 (CYP) enzymes to form fully active vit-D

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The argument goes like this

Nevertheless, TMAO formation from diet-gut microbiota-host interplay might be underestimated by observing fasting plasma TMAO levels because the kidney excretes TMAO efficiently to lower its blood levels [11]

Hyperinflation results in energy loss and breakdown of muscle proteins, leading to diaphragm atrophy, which makes it even less able to withstand increased stress