Effects of nicotinamide adenine dinucleotide precursors on measures of physical performance and physical frailty: A systematic review
Effects of nicotinamide adenine dinucleotide precursors on measures of physical performance and physical frailty: A systematic review
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烟酰胺腺嘌呤二核苷酸前体对身体表现和身体虚弱测量的影响：系统评价
DOI：
10.1002/crt2.56
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发表时间：
2022
影响因子：
--
通讯作者：
Barker F
中科院分区：
文献类型：
--
作者：
Barker F
背景烟酰胺腺嘌呤二核苷酸（NAD）是肌肉代谢和能量产生的关键分子;患有肌肉减少症的老年人骨骼肌浓度较低。虽然临床前数据表明NAD前体补充剂的有益作用，但对人类骨骼肌功能和身体虚弱的影响尚不清楚。这一系统的审查评估的影响NAD前体补充剂的措施，身体的表现和身体frailty在human.MethodsWe包括随机对照试验评估结果相关的物理性能或任何弗里德的脆弱表型域：缓慢，虚弱，疲惫，低体力活动和体重减轻。所有审查阶段均由两名独立作者独立进行。采用系统性检索策略检索多个数据库（MEDLINE、EMBASE、CINAHL、CENTRAL、ISRCTN、ClinicalTrials.gov、NHS电子图书馆和Google Scholar），以查找适当的试验。使用科克伦偏倚风险2工具评估偏倚风险。结果按干预和表型领域分组，并通过叙述性合成进行描述。对平均年龄>60岁的试验和偏倚风险低的试验进行敏感性分析，结果23项研究中的26个试验人群符合纳入标准;规模从2到77名参与者不等。没有试验将虚弱评估为复合结局，尽管在几乎所有纳入的试验中至少评估了一个Fried虚弱领域。研究了一系列干预措施;烟酸（n= 8）和烟酰胺核苷（n= 7）是最常见的评估。大多数试验检查了持续时间长达6个月的短期干预措施，26项试验中有13项持续时间为1周或更短。试验中共评估了96项主要结局，其中10项有利于NAD前体，1项有利于安慰剂;其余的在任何明确的方向上都没有统计学意义。试验间的方法学异质性排除了任何结局的Meta分析。试验人群具有异质性，只有4项试验入组了平均年龄≥60岁的受试者。偏倚风险分析发现，除一项试验外，所有试验均存在偏倚风险不明确或高风险。有没有明确的模式，无论是NAD前体改善任何措施的物理性能或任何领域的脆弱表型;大多数试验报告中性的结果为大多数outcome.ConclusionsThere是没有足够的证据来确定是否NAD前体补充剂可以改善身体表现或身体虚弱的措施在人类。未来的试验需要更长，更大，并针对骨骼肌功能障碍的老年人。
BackgroundNicotinamide adenine dinucleotide (NAD) is a key molecule in muscle metabolism and energy production; skeletal muscle concentrations are low in older people with sarcopenia. Although preclinical data suggest beneficial effects of NAD precursor supplementation, the effects on skeletal muscle function and physical frailty in humans are unclear. This systematic review evaluated the effects of NAD precursor supplementation on measures of physical performance and physical frailty in humans.MethodsWe included randomized controlled trials assessing outcomes relevant to either physical performance or any of Fried's frailty phenotype domains: slowness, weakness, exhaustion, low physical activity and weight loss. All review stages were conducted independently by two separate authors. A systematic search strategy was used searching multiple databases (MEDLINE, EMBASE, CINAHL, CENTRAL, ISRCTN, ClinicalTrials.gov, NHS e‐Library, and Google Scholar) to find appropriate trials. Risk of bias was assessed using the Cochrane Risk‐of‐Bias 2 tool. Results were grouped by intervention and phenotypic domain and were described through narrative synthesis. Sensitivity analyses were conducted for trials with a mean age >60 years and trials with low risk of bias.ResultsTwenty‐six trial populations across 23 studies met inclusion criteria; size ranged from 2 to 77 participants. No trials assessed frailty as a composite outcome, though at least one Fried frailty domain was assessed in almost all included trials. A range of interventions were investigated; niacin (n= 8) and nicotinamide riboside (n= 7) were the most commonly assessed. Most trials examined short‐term interventions of up to 6 months duration, with 13 out of 26 trials lasting 1 week or less. A total of 96 primary outcomes were assessed across trials, 10 of which were in favour of an NAD precursor whereas 1 was in favour of placebo; the remainder were not statistically significant in any clear direction. Methodological heterogeneity across trials precluded meta‐analysis for any outcome. Trial populations were heterogeneous and only four trials enrolled participants with a mean age ≥60 years. Risk of bias analysis found unclear or high risk of bias in all but one trial. There was no clear pattern as to whether NAD precursors improved any measure of physical performance or any domain of the frailty phenotype; the majority of trials reported neutral findings for most outcomes.ConclusionsThere is insufficient evidence to ascertain whether NAD precursor supplementation can improve physical performance or physical frailty measures in humans. Future trials need to be longer, larger, and target older people with skeletal muscle dysfunction.
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