The NAD⁺–Insulin–AMPK–mTOR Axis: A Systems Biology Framework Linking Metabolic Dysregulation to Aging, Neurodegeneration, and Chronic Disease (2026)
Abstract Background: Aging and major chronic diseases—including type 2 diabetes, cardiovascular disease, neurodegeneration, and certain cancers—share overlapping metabolic abnormalities. Emerging evidence suggests that disturbances in redox balance (NAD⁺/NADH), insulin signaling, and nutrient-sensing pathways (AMPK and mTOR) may represent convergent upstream mechanisms. Objective: To synthesize mechanistic and translational evidence into a unified systems biology model describing how chronic nutrient excess and impaired metabolic oscillation influence aging and disease pathogenesis. Methods: Narrative synthesis of peer-reviewed literature across redox biology, mitochondrial physiology, insulin signaling, geroscience, and neurodegeneration. Emphasis was placed on mechanistic plausibility, human interventional data where available, and cross-disease convergence. Results: Chronic energy surplus is associated with altered NAD⁺/NADH ratios, mitochondrial dysfunction, hyperinsulinemia, p...