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Creatine and lean mass: grade A

Strong evidence. Direction: Benefit.

A Strong

Educational guidance, not medical advice

Why this grade

Rubric condition met: >=1 meta-analysis of RCTs in healthy adults doing resistance training, consistent direction

A three-level meta-analysis of 63 studies found creatine plus resistance training increased lean mass (g = 0.30) with no significant change in fat mass, and meta-analyses of older adults and of postmenopausal women (lean mass 0.37 kg, with at least 5 g a day plus resistance training) found greater gains than training alone. Results apply to creatine combined with resistance training; part of the early weight gain is water, which the lean-mass measures may include.

How we grade evidence

Studies this grade rests on

EffectMixedNo effectSize shows participants (n)20102015202020252030Meta-analysisWang 2026, 2026: meta-analysis, n = 1,489, result not recordedNaddafha 2026, 2026: meta-analysis, n = 608, result not recordedDevries 2014, 2014: meta-analysis, n = 357, result not recorded
each study this grade rests on, by publication year and design. Solid: effect versus the comparator; half-filled: mixed; hollow: no effect; dashed: result not recorded yet. Larger marks had more participants.
Show the numbers
StudyYearDesignParticipantsResult
Devries 20142014meta-analysis357result not recorded
Naddafha 20262026meta-analysis608result not recorded
Wang 20262026meta-analysis1489result not recorded

Creatine monohydrate for lean mass, strength, and bone density in postmenopausal women: a systematic review and meta-analysis.

Naddafha S, Antonio J, Kreider RB. Creatine monohydrate for lean mass, strength, and bone density in postmenopausal women: a systematic review and meta-analysis J Int Soc Sports Nutr, 2026. PMID 42141930

Result not recorded
Design
Systematic review and meta-analysis of 7 randomized placebo-controlled trials (not prospectively registered)
Sample
n = 608
Population
Postmenopausal women (mean age about 62), with or without resistance training
Funding
Funding: not stated in the PubMed or Crossref record; full text not read. The COI statement thanks Alzchem for paying the remaining article processing charge.

Creatine supplementation during resistance training in older adults-a meta-analysis.

Devries MC, Phillips SM. Creatine supplementation during resistance training in older adults-a meta-analysis Med Sci Sports Exerc, 2014. PMID 24576864

Result not recorded
Design
Systematic review and meta-analysis of randomized placebo-controlled trials
Sample
n = 357
Population
Older adults (mean age about 64) doing resistance training
Funding
not stated

Resistance training combined with creatine supplementation: a three-level meta-analysis of multidimensional outcomes from strength enhancement to body composition remodeling.

Wang H, Wang H, Xin X. Resistance training combined with creatine supplementation: a three-level meta-analysis of multidimensional outcomes from strength enhancement to body composition remodeling J Int Soc Sports Nutr, 2026. PMID 42765482

Result not recorded
Design
Systematic review and three-level meta-analysis of 63 studies
Sample
n = 1,489
Population
Adults doing resistance training
Funding
Science and Technology Strengthening Project of Capital University of Physical Education and Sports (Crossref funder list)

Search and history

Search (): creatine[ti] AND (strength[tiab] OR power[tiab] OR resistance training[tiab]) AND (meta-analysis[pt])

  • Graded A (proposed): Proposed in the monograph draft
  • A to A (approved): Editor sign-off November 13, 2026: grade matches the editor-approved final page