Big news! The 2026 edition of the consensus from the Chinese Medical Association has been released: There is now an authoritative guideline for NAD+ intervention in aging.
Core consensus: The decline in NAD+ levels is a key driver of aging.
NAD+ Clinical Application Chinese Expert Consensus (2026 Edition) - Authoritative Interpretation
[Abstract]
As global aging accelerates, how to scientifically delay aging has become a national strategy.
Recently, the Geriatrics Branch of the Chinese Medical Association officially released the "Chinese Expert Consensus on the Role of NAD+ in Aging-related Diseases and Its Clinical Applications (2026 Edition)".
This consensus is based on the highest level of evidence-based medical evidence and clearly defines the central role of NAD+ in metabolism, cardiovascular diseases, and neurodegenerative disorders.
Enaidi (Cyclosetin I for Injection), as the only approved pharmaceutical-grade NAD+ drug, has become the preferred solution for implementing the "Healthy China 2030" strategy and addressing aging-related diseases due to its strict GMP production standards and precise clinical efficacy.
【Core Consensus】
Mechanism verification: "core switch" of aging
The consensus clearly states that the significant decline in NAD+ levels with age is a common feature of aging across species.
The depletion of NAD+ directly leads to mitochondrial dysfunction, impaired DNA repair, and chronic inflammation, and is a key pathological factor that triggers metabolic diseases, cardiovascular diseases, and neurodegenerative disorders.
Increasing the level of NAD+ effectively blocks the aging process at its source.
Pathway optimization: "gold standard" for intravenous injection
Regarding the NAD+ supplementation strategy, the consensus particularly emphasizes:
Direct supplementation of NAD+ (such as through intravenous injection) can bypass the metabolic bottleneck, achieving a bioavailability of 100% and rapidly increasing the level in the body.
Compared with oral precursors, coenzyme I for injection can more directly and effectively activate the longevity protein Sirtuins, thereby improving cellular energy metabolism.
Clinical benefits: "Empirical data" for treating both heart and brain simultaneously
Cardiovascular field (Highly recommended):
The consensus cites multiple RCT studies to confirm that enaidi (cyclosporine I for injection) can significantly improve LVEF (left ventricular ejection fraction) in patients with heart failure, reduce NT-proBNP levels, and inhibit myocardial remodeling.
Metabolism and Tumors:
Effectively improve insulin sensitivity, reduce the incidence of white blood cell reduction after chemotherapy, and enhance the quality of life of patients.
Quality barrier: Pharmaceutical-grade "safety commitment"
Unlike food-grade raw materials, Enaidi strictly adheres to the pharmaceutical-grade GMP standards for production and has been strictly approved by the National Medical Products Administration (NMPA).
The consensus-recommended regimen (50mg per dose, intravenous infusion, 14-day course) has demonstrated extremely high safety in clinical applications, with mild and controllable adverse reactions.
【Top 10 Clinical Issues】
Clinical Question 1: How does level of NAD+ change with aging?
Recommendation:
As people age, the level of NAD+ significantly decreases in multiple tissues and organs within the human body (General Recommendation, C, Expert Consensus Degree: 94.4%)
Recommendation Explanation:
NAD+ serves as a crucial coenzyme that maintains cellular energy metabolism, DNA repair, mitochondrial function, and stress responses.
Its reduced level is regarded as one of the core factors driving the aging process and the occurrence and development of various age-related diseases.
In worms, fruit flies, mice and humans, the levels of NAD+ all show a downward trend with increasing age, and this phenomenon has become a common feature of aging across species.
Multiple studies have shown that NAD+ levels are age-relatedly decreased in various tissues of mice, but the extent of the decline varies among different tissues and the conclusions of different studies also differ:
the decline in NAD+ in skeletal muscle ranges from 15% to 65%, while the decline in aging liver is mostly concentrated between 10% and 50%.
During the aging process of humans and age-related diseases, the NAD+ levels in tissues such as skin, brain, heart, monocyte-derived macrophages, and liver decrease by at least 10% to 50%.
It is worth noting that the liver, skeletal muscle, brain tissue and fat tissue of the aged mice all showed a significant decrease in NAD+ levels.
After increasing the NAD+ content in the body, the muscle mass of the aged mice increased by 15% to 20%, and their grip strength and endurance were significantly improved.
Under conditions of actual aging and premature aging, the activity of NAMPT within the cells and the level of NAD both show a significant decline.
Clinical Question 2: How is decline in NAD+ levels associated with occurrence and development of which aging-related diseases?
Recommendation:
The decline in NAD+ levels is closely associated with the occurrence and development of various aging-related diseases, including metabolic disorders, cardiovascular diseases, neurodegenerative diseases, tumors, and sarcopenia (General recommendation, B, Expert consensus degree: 100%)
Recommendation:
The level of NAD+ usually decreases with normal aging, obesity and hypertension, all of which are major risk factors for cardiovascular diseases.
The decrease in NAD+ is a key common pathological factor for neurological diseases, metabolic disorders, heart diseases, degenerative diseases, tissue damage induced by radiation, drugs and inflammation, tumors, aging, etc.
The decrease in NAD+ levels is closely related to the occurrence and development of heart failure.
The decline leads to mitochondrial dysfunction, which in turn affects the energy metabolism of cardiac muscle cells and accelerates the progression of heart failure.
In the field of neurodegenerative diseases, the decline in NAD+ levels is closely associated with the occurrence and development of Alzheimer's disease.
Studies have shown that the decrease in NAD+ levels affects the energy metabolism and DNA repair capabilities of neurons, leading to neuronal dysfunction and cell death.
In the field of oncology, the immune cells in the tumor microenvironment are often inhibited in their functions due to the lack of NAD+, making it impossible for them to effectively recognize and eliminate tumor cells.
A study conducted in 2021 revealed that by increasing the level of NAD+ in the tumor microenvironment, the anti-tumor activity of T cells and natural killer cells could significantly enhanced, thereby effectively inhibiting the growth of tumors.
In the context of metabolic diseases, such as type 2 diabetes and metabolic syndrome, the level of NAD+ significantly decreases.
This decline is closely related to mitochondrial dysfunction and enhanced oxidative stress.
A study has shown that patients with multi-ethnic sarcopenia have disorders in the NAD+ biosynthesis and salvage pathways, and the NAD+ levels in their muscles have significantly decreased.
Clinical Question 3: What are main strategies for NAD+ supplementation?
Recommendation:
The main strategies for NAD+ supplementation include direct supplementation of NAD+, supplementation of NAD+ precursors, and enhancing NAD+ levels in the body through lifestyle interventions (Strong recommendation, B, Expert consensus degree: 100%)
Recommendation:
The NAD+ supplementation strategy mainly includes the following methods: Firstly, directly supplementing NAD+, such as through intravenous injection or intramuscular injection.
This method can rapidly increase the level of NAD+ in the body and has no liver first-pass effect, making it suitable for situations where rapid symptom improvement required.
The study found that a single 750mg IV dose of NAD+ could increase plasma NAD+ levels by 398%, and the plasma level remained elevated for 8 hours after the infusion.
Second, by supplementing the precursors of NAD+, oral administration of nicotinamide (NAM), nicotinamide mononucleotide (NMN), nicotinamide riboside (NR), and nicotinic acid (NA) can convert these precursors into NAD+ within the body to increase its level.
The third approach is to promote the synthesis of NAD+ through lifestyle adjustments, such as regular exercise and a balanced diet.
A clinical study has shown that exercise can enhance the biosynthesis of NAD+ by increasing the level of NAMPT, thereby strengthening its anti-aging effect.
Clinical Question 4: Can NAD+ supplementation improve metabolic disorders associated with aging?
Recommendation:
NAD+ supplements may have certain potential benefits for improving diabetes-related indicators (such as insulin sensitivity), regulating fat metabolism in higher weight individuals, and reducing low-density lipoprotein (LDL). (Weak recommendation, B, Expert consensus degree: 86.1%)
Recommendation Note:
Current research indicates that increasing the level of NAD+ in postmenopausal higher weight women can enhance the glucose processing capacity stimulated by insulin and the insulin signaling in skeletal muscle, and upregulate the expression of genes related to muscle remodeling.
For middle-aged and older people who are higher weight, increasing the level of NAD+ in the body can help reduce weight and LDL.
NAD+ is closely related to oxidative stress and inflammatory responses in the liver. Under normal physiological conditions, the antioxidant system in the liver can maintain the redox balance.
When the level of NAD+ decreases, the activity of antioxidant enzymes declines, reactive oxygen species (ROS) accumulate, thereby activating inflammatory signaling pathways, and further exacerbating liver damage.
Increasing the level of NAD+ can enhance the liver's antioxidant capacity, reduce the production of ROS, alleviate oxidative stress and inflammatory damage, and improve the pathological state of fatty liver.
An increase in NAD+ levels can alter liver metabolism: By raising the NAD+ levels in the body, it can down-regulate the ethanol-induced overexpressed genes and restore the extracellular signal-regulated kinase transduction, which is of great significance for the treatment of alcoholic fatty liver.
In pancreatic β cells and thyroid cells, increasing the level of NAD+ can enhance mitochondrial function, regulate the activity of related enzymes, and maintain normal hormone secretion.
NAD+ also regulates the expression of multiple genes through Sirtuins, thereby indirectly influencing the health status of the endocrine system.
For instance, in the endocrine system, the silent information regulator 2 homolog protein 1 (sirtuin1, SIRT1) can regulate the hormone secretion related to the hypothalamic-pituitary-gonadal axis and the hypothalamic-pituitary-thyroid axis.
NAD+ serves as an essential substrate for the activity of Sirtuins and is of great significance for maintaining the function of the endocrine system.
For patients with metabolic syndrome or diabetes who receive NAD+ supplementation, a comprehensive risk-benefit assessment should conducted, and regular monitoring of indicators such as blood sugar, blood lipids, liver and kidney functions should carried out.
Clinical Question 5: How effective is NAD+ supplementation in treating cardiovascular diseases associated with aging?
Recommendation:
(NAD+ injection) has potential benefits for patients with coronary heart disease and myocardial infarction, and is beneficial for improving cardiac function.
It is recommended for clinical use in patients with coronary heart disease and myocardial infarction when there is no pressure from multiple medications (general recommendation, B, expert consensus degree: 83.3%).
(2) NAD+ can improve the cardiac function indicators of patients with heart failure.
It is recommended for clinical use in patients with heart failure when there no pressure from multiple medications (general recommendation, A, expert consensus degree: 88.9%)
Recommendation:
NAD+ depletion is a core feature of heart diseases.
Increasing the intracellular NAD+ level by inhibiting NAD+ degrading enzymes and/or stimulating NAD+ biosynthesis or supplementing NAD+ precursors is an effective approach for treating heart diseases.
NAD+ maintains cardiovascular health through multiple mechanisms such as antioxidative stress, promoting nitric oxide (NO) synthesis, maintaining myocardial energy supply, and regulating calcium ion channels.
It improves vascular endothelial function by activating SIRT1, and increasing NAD+ levels can reverse the vascular dysfunction associated with aging.
The NAD+-dependent PARP1 and SIRT3 reduce the formation of atherosclerotic plaques by repairing DNA damage and inhibiting inflammation.
CD38 inhibitors can reduce plaque burden by 30% to 40%.
A decrease in the ratio of NAD+ to reduced nicotinamide adenine dinucleotide (NADH) associated with insufficient synthesis of adenosine triphosphate (ATP) and heart failure.
Supplementing NAD+ can improve cardiac function.
Clinical Question 6: Does NAD+ supplementation have any beneficial effect on sarcopenia?
Recommendation:
For patients with Parkinson's disease, using NAD+ supplements may have a slight improvement effect on motor symptoms (weak recommendation, B, expert consensus degree: 86.1%).
Recommendation note:
Some studies suggest that increasing the level of NAD+ in the blood of the older people population may help improve muscle strength or muscle mass.
Basic research indicates that NAD+ plays a crucial role in the function of skeletal muscles, the recovery from exercise fatigue, and the protection of neuromuscular connections.
A study conducted muscle biopsies on 119 older people individuals of different skin colors, observing the global gene expression changes in the muscle sarcopenia group compared to the age-matched control group.
The results showed that the reduction in NAD+ levels was closely related to sarcopenia.
By supplementing NAD+, the content of NAD+ in the muscles can increased to a certain extent, enhancing the function of mitochondria, reducing tissue amyloidosis, thereby delaying muscle aging, maintaining muscle strength and vitality, and promoting muscle repair function.
Further verification needed in the future to determine the effectiveness of NAD+ supplements in preventing sarcopenia in the older people population.
Clinical Question 7: How effective is NAD+ supplementation in treating neurodegenerative diseases associated with aging?
Recommendation:
For patients with Parkinson's disease, using NAD+ supplements may have a slight improvement effect on motor symptoms (weak recommendation, B, expert consensus degree: 86.1%)
Recommendation note:
During the aging process, the decline in NAD+ levels is closely related to mitochondrial dysfunction, chronic inflammation, etc., and is an important factor contributing to neurodegenerative diseases.
Basic research indicates that NAD+ not only maintains the normal function of neurons, but also alleviates neurodegenerative diseases by regulating synaptic plasticity and enhancing the stress resistance of neurons.
Some small-sample exploratory studies have shown that increasing the level of NAD+ in the brains of patients with Parkinson's disease can affect brain metabolism and show a slight improvement trend in motor symptoms.
Basic research indicates that NAD+ involved in the regulation of synaptic plasticity and neuronal stress tolerance, and may play an important role in counteracting the pathological processes associated with neurodegenerative diseases (such as Alzheimer's disease).
Supplementation of NAD+ can improve the cognitive dysfunction in rats with chronic cerebral hypoperfusion, and it can inhibit neuritis by protecting mitochondria and reducing ROS production.
Due to the lack of clinical studies on the use of NAD+ supplements for the treatment of Alzheimer's disease at present, the efficacy and safety of this approach still need to be further verified.
Clinical Question 8: Does NAD+ supplementation have any beneficial effect on cancer treatment?
Recommendation:
For cancer patients, the use of Coenzyme I for injection is helpful in reducing the incidence of white blood cell reduction after chemotherapy (weak recommendation, B, expert consensus degree: 88.9%)
Recommendation note:
A randomized controlled trial included 82 patients who underwent chemotherapy after rectal cancer surgery.
They randomly divided into the combined treatment group and the conventional treatment group.
The control group received conventional chemotherapy, while the combined group received intramuscular injection of coenzyme I in addition to the conventional chemotherapy (14 days constituted one treatment cycle, and the treatment carried out for 2 consecutive cycles.
The intramuscular injection of coenzyme I administered on days 1 to 5 of each cycle, with 1 vial per day).
The research results show that the use of intravenous coenzyme I can reduce the incidence of chemotherapy-induced leukopenia in patients with rectal cancer who have undergone chemotherapy.
NAD+ can enhance the anti-tumor immune response through various mechanisms, significantly improving the function and activity of T cells, enabling them to more effectively identify and eliminate tumor cells.
By regulating the level of NAD+, it is possible to alter the immunosuppressive state in the tumor microenvironment and promote anti-tumor immune responses, which provides a theoretical basis for the development of new immunotherapy strategies.
Clinical Question 9: What are safety implications of supplementing NAD+?
Recommendation:
When using NAD+, adverse reactions such as flushing, warmth sensation, mild gastrointestinal symptoms (such as nausea, vomiting), dizziness, headache or muscle discomfort may occur due to differences in infusion speed or individual tolerance.
Most of the reactions were mild and could relieved by adjusting the infusion rate or discontinuing the medication (strong recommendation, A, expert consensus degree: 94.4%).
Recommendation:
A systematic review that included 10 RCTs (with 489 patients) summarized the adverse reactions of NAD+.
The results showed that the most common adverse reactions associated with the use of NAD+ were:
Muscle pain (24%), nerve disorders (22%), fatigue (20%), sleep disorders (20%), headache (18%), gastrointestinal disorders (9%), infection (7%), heart disorders (2%), immune system disorders (1%), nausea (1%), and rash (1%).
And the adverse reactions that occurred were all relatively mild, indicating that the supplementation of NAD+ is relatively safe.
Clinical Question 10: What is recommended intravenous administration regimen for pharmaceutical-grade NAD+?
Recommendation:
For the injection of Coenzyme I, 50mg per dose recommended. Administer by intravenous drip, once daily.
The treatment course lasts for 14 days. Dissolve it in more than 100ml of normal saline.
The duration of a single infusion should be no less than 30 minutes (general recommendation, B, expert consensus degree: 94.4%)
Recommendation:
Currently, the large-dose intravenous supplementation of NAD+ has become popular worldwide (NAD+ IV therapy), where NAD+ is directly injected into the body through intravenous infusion, rapidly increasing the NAD+ level in the human body, thereby activating the longevity protein sirtuins family, promoting ATP production, regulating metabolism, anti-inflammatory and antioxidant effects, enhancing immunity, nourishing the heart and brain, and delaying the aging process.
Intravenous injection of NAD+:
The main advantage is that it can bypass the metabolic bottleneck and directly enter the bloodstream.
Through transport proteins CX43 and SLC25A51, it is transported to the cells and reaches the mitochondria, achieving 100% bioavailability.
The study found that a single 750mg dose of NAD+IV could increase plasma NAD+ levels by 398%, and the plasma level remained elevated for 8 hours after the infusion.