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NAD+ precursors (nicotinamide riboside and nicotinamide mononucleotide) and strength and power output: grade C

Limited evidence. Direction: No effect.

C Limited

Educational guidance, not medical advice

Why this grade

Rubric condition met: Meta-analyses in older adults (some clinical) and a network meta-analysis are null for grip and strength; N not proposed under the rubric because the pooled trials are small and populations mixed, so C with direction none

A 2025 meta-analysis of RCTs in adults with mean age 60.9 to 83, including some clinical groups, found no significant effect of NMN on handgrip strength, gait speed or the chair-stand test, and concluded the evidence does not support NR or NMN for preserving muscle mass and function. A 2026 network meta-analysis found neuromuscular strength unchanged. A 28-day MIB-626 trial, funded in part by its developer, found no significant difference in muscle strength. In 108 older Japanese adults, sit-to-stand times improved in all groups, including placebo, with the largest effect in the afternoon NMN group. A 12-week trial in older men, funded by Mitsubishi Corporation Life Sciences, reported only nominal improvements in left grip. One 2025 meta-analysis of 9 RCTs reported faster gait speed, a walking measure rather than strength. An editor may consider N once a meta-analysis restricted to healthy adults exists.

How we grade evidence

Studies this grade rests on

EffectMixedNo effectSize shows participants (n)202020252030Meta-analysisRCTGao 2026, 2026: meta-analysis, n = 1,599, result not recordedWang 2025, 2025: meta-analysis, n = 412, result not recordedPencina 2023, 2023: RCT, n = 30, result not recordedIgarashi 2022, 2022: RCT, n not recorded, result not recordedProkopidis 2025, 2025: meta-analysis, n not recorded, 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
Igarashi 20222022RCTnot recordedresult not recorded
Pencina 20232023RCT30result not recorded
Wang 20252025meta-analysis412result not recorded
Prokopidis 20252025meta-analysisnot recordedresult not recorded
Gao 20262026meta-analysis1599result not recorded

Effects of Nicotinamide Mononucleotide Supplementation on Muscle and Liver Functions Among the Middle-aged and Elderly: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Wang JP, Wang L, Wang T. Effects of Nicotinamide Mononucleotide Supplementation on Muscle and Liver Functions Among the Middle-aged and Elderly: A Systematic Review and Meta-analysis of Randomized Controlled Trials Curr Pharm Biotechnol, 2025. PMID 39185644

Result not recorded
Design
Systematic review and meta-analysis of 9 RCTs
Sample
n = 412
Population
Middle-aged and older adults
Funding
National Natural Science Foundation of China; Wuhan Municipal Health Commission; Wuhan Asia General Hospital

Chronic nicotinamide mononucleotide supplementation elevates blood nicotinamide adenine dinucleotide levels and alters muscle function in healthy older men.

Igarashi M, Nakagawa-Nagahama Y, Miura M. Chronic nicotinamide mononucleotide supplementation elevates blood nicotinamide adenine dinucleotide levels and alters muscle function in healthy older men NPJ Aging, 2022. PMID 35927255

Result not recorded
Design
Randomized, double-blind, placebo-controlled, parallel-group trial, 6 or 12 weeks
Population
Healthy older men
Funding
Mitsubishi Corporation Life Sciences Limited (Crossref funder)

The Effect of Nicotinamide Mononucleotide and Riboside on Skeletal Muscle Mass and Function: A Systematic Review and Meta-Analysis.

Prokopidis K, Moriarty F, Bahat G. The Effect of Nicotinamide Mononucleotide and Riboside on Skeletal Muscle Mass and Function: A Systematic Review and Meta-Analysis J Cachexia Sarcopenia Muscle, 2025. PMID 40275690

Result not recorded
Design
Systematic review and meta-analysis of RCTs
Population
Adults with mean age 60.9 to 83 years, including clinical groups
Funding
not stated in the PubMed or Crossref record

Nicotinamide Adenine Dinucleotide Augmentation in Overweight or Obese Middle-Aged and Older Adults: A Physiologic Study.

Pencina KM, Valderrabano R, Wipper B. Nicotinamide Adenine Dinucleotide Augmentation in Overweight or Obese Middle-Aged and Older Adults: A Physiologic Study J Clin Endocrinol Metab, 2023. PMID 36740954

Result not recorded
Design
Randomized, placebo-controlled trial (2:1), 28 days
Sample
n = 30
Population
Overweight or obese adults aged 45 and older
Funding
Metro International Biotech (developer of MIB-626) and NIH

Domain-specific effects of NAD(+) precursors on fatigue and functional performance: a systematic review and network meta-analysis.

Gao Y, Li S, Guan J. Domain-specific effects of NAD(+) precursors on fatigue and functional performance: a systematic review and network meta-analysis Front Nutr, 2026. PMID 42774067

Result not recorded
Design
Systematic review and network meta-analysis of 25 RCTs and 2 quasi-experimental studies
Sample
n = 1,599
Population
Adults, including clinical cohorts (NR, NMN, NADH and nicotinamide)
Funding
not stated in the PubMed or Crossref record (authors declare no commercial or financial relationships)

Search and history

Search (): (nicotinamide mononucleotide[tiab] OR nicotinamide riboside[tiab]) AND (grip[tiab] OR strength[tiab] OR "gait speed"[tiab] OR "muscle"[tiab]) AND randomized controlled trial[pt]

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