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10.1016/S1286-4579(02)01549-6

For more context on how NAD+ compares to other mitochondrial health compounds, see Urolithin A vs

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Stage III

As an essential amino acid, it cannot be synthesized de novo by the human body due to a lack of the require metabolic pathway needed for its synthesis

We refer commenters to the testing results in this rule, as well as the results calculated using the July 2023 Overall Star Rating as reported in the CY 2025 OPPS/ASC final rule with comment period (89 FR 94514 through 94521) which produced similar findings