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Supplements to treat prediabetes

Boosting nicotinamide adenine dinucleotide (NAD+) improves health in a clinical study Nicotinamide adenine dinucleotide (NAD+) is an essential metabolic co-factor that is central to energy metabolism. During aging, obesity, and diabetes, NAD+ concentrations in cells decline. NAD+ is synthesized de novo from tryptophan precursors, from nicotinic acid through the Preiss-Handler pathway, or from nicotinamide through the salvage pathway. The rate-limiting enzyme in the salvage pathway, nicotinamide phosphoribosyltransferase (NAMPT), recycles nicotinamide into nicotinamide mononucleotide (NMN), which is converted into NAD+ (see the figure). Restoration of NAD+ concentrations in cells of old or diseased mice through administration of NMN improves health; however, it is unclear whether NMN therapy is practical in humans. On page 1224 of this issue, Yoshino et al. (1) show in a randomized, placebo-controlled, double-blind trial that NMN supplementation promotes NAD+ metabolism and improves skeletal muscle insulin sensitivity in postmenopausal prediabetic women who are overweight or obese. Thus, NMN may be a viable therapeutic strategy in humans to improve metabolic health during obesity.