Network Meta-Analysis: NMN Improved Endurance, but No NAD+ Precursor Improved Perceived Fatigue
A network meta-analysis of 27 studies with 1,599 adults compared the NAD+ precursors NR, NMN, NADH and nicotinamide. No precursor significantly improved perceived fatigue or sleep. Medium- and high-dose NMN, by contrast, improved endurance, while muscle strength remained unchanged.
1. What the Research Says
The review followed the PRISMA-NMA guidelines and included 25 randomized and 2 quasi-experimental studies. For cognitive performance, NADH ranked best, especially in people with cognitive impairment, although this finding depended heavily on individual studies. Quality of life improved moderately, mainly with NMN. The authors argue for looking at effects separately by outcome type, dose and population.
2. How It Fits Earlier Research
An earlier meta-analysis in adults over 60 found no clear effect of NMN and NR on muscle mass, grip strength or gait speed; only in people with peripheral artery disease did NR lengthen the six-minute walk distance. This fits the new finding: no gain in strength, rather an effect on endurance. The Effect of Nicotinamide Mononucleotide and Riboside on Skeletal Muscle Mass and Function: A Systematic Review and Meta-Analysis (2025)
3. Source
Full evidence overview: NAD+ Precursors
Every statement on this page carries its evidence tier — proven, plausible or hypothesis — and leads to the original work. The decision in the individual case rests with the practitioner; we provide the connections.