Ageing is an important risk factor of non‐alcoholic fatty liver disease (NAFLD). Here, we investigated whether the deficiency of nicotinamide adenine dinucleotide (NAD⁺), a ubiquitous coenzyme, links ageing with NAFLD.

Hepatic concentrations of NAD⁺, protein levels of nicotinamide phosphoribosyltransferase (NAMPT) and several other critical enzymes regulating NAD⁺ biosynthesis, were compared in middle‐aged and aged mice or patients. The influences of NAD⁺ decline on the steatosis and steatohepatitis were evaluated in wild‐type and H247A dominant‐negative, enzymically‐inactive NAMPT transgenic mice (DN‐NAMPT) given normal or high‐fat diet (HFD).

Hepatic NAD⁺ level decreased in aged mice and humans. NAMPT‐controlled NAD⁺ salvage, but not de novo biosynthesis pathway, was compromised in liver of elderly mice and humans. Given normal chow, middle‐age DN‐NAMPT mice displayed systemic NAD⁺ reduction and had moderate NAFLD phenotypes, including lipid accumulation, enhanced oxidative stress, triggered inflammation and impaired insulin sensitivity in liver. All these NAFLD phenotypes, especially release of pro‐inflammatory factors, Kupffer cell accumulation, monocytes infiltration, NLRP3 inflammasome pathway and hepatic fibrosis (Masson's staining and α‐SMA staining), deteriorated further under HFD challenge. Oral administration of nicotinamide riboside, a natural NAD⁺ precursor, completely corrected these NAFLD phenotypes induced by NAD⁺ deficiency alone or HFD, whereas adenovirus‐mediated SIRT1 overexpression only partially rescued these phenotypes.

These results provide the first evidence that ageing‐associated NAD⁺ deficiency is a critical risk factor for NAFLD, and suggest that supplementation with NAD⁺ substrates may be a promising therapeutic strategy to prevent and treat NAFLD.