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NR7.2
Nicotinamide Riboside Research
Mostly mechanism / observationalHigh safety
33 peer-reviewed studies
What the evidence says
Mostly mechanism / observational
Most Nicotinamide Riboside studies are mechanism or observational rather than RCTs that measure a clinical effect — keep findings provisional.
Most evidence is from high-quality meta-analyses and randomised trials published 2017–2026 with a typical study size of 36 participants.
Based on 33 studies · 1 meta-analysis · 23 RCTs · 1,082 total participants
Confidence
High
What the studies found
2helped· 31 more without graded effect data
By outcome
Longevity & agingIncreased NAD+ levels supporting cellular repair, sirtuin activity, and mitochondrial function associated with healthy aging · 2–4 weeks
Mostly mechanism / observational32 studies
Therapeutic & clinical
Mostly mechanism / observational12 studies
Safety profile
Mostly mechanism / observational6 studies
Energy & fatigueImproved mitochondrial energy production and reduced fatigue in daily activity · 4–8 weeks
Mostly mechanism / observational5 studies
Lean body mass & muscle growth
Mostly mechanism / observational4 studies
Heart & blood pressurePotential modest reductions in blood pressure and arterial stiffness · 6–12 weeks
Mostly mechanism / observational4 studies
Neuroprotection & brain agingSupports neuronal NAD+ and mitochondrial function · 8-12 weeks
Mostly mechanism / observational3 studies
InflammationReduction in circulating inflammatory cytokines and systemic inflammation markers · 4–8 weeks
Mostly mechanism / observational3 studies
Cognitive functionStabilization or modest improvement in memory metrics in older adults with mild cognitive impairment · 10–16 weeks
Too few graded studies2 studies
Glucose & metabolicBoosts NAD+ for mitochondrial efficiency and metabolic flexibility · 8-12 weeks
23 studies in the last 5 years · Latest meta-analysis: 2025
20172026
1NAD+ metabolism and tolerabilityCrossoverCited 451×n=24 · very small study2018
Chronic supplementation with the NAD+ precursor vitamin, nicotinamide riboside (NR), is well tolerated and effectively stimulates NAD+ metabolism in healthy middle-aged and older adults.
2Whole blood NAD+ levelsRCTCited 152×n=140 · medium study2019
Consumption of 100, 300 and 1000 mg NR dose-dependently and significantly increased whole blood NAD+ (i.e., 22%, 51% and 142%) and other NAD+ metabolites within 2 weeks.
Conze D et al. · Scientific reports (2019)
Huge benefit
← WorseNo effectBetter →
8-week RCT with doses of 100, 300, and 1000 mg NR vs. placebo in healthy overweight adults
Dose-dependent increases in whole blood NAD+ of 22%, 51%, and 142% respectively within 2 weeks
NAD+ elevations maintained throughout the 8-week study duration
3Cerebral NAD levelsRCTCited 226×n=30 · small study2022
NR treatment was well tolerated and led to a significant, but variable, increase in cerebral NAD levels and related metabolites in the cerebrospinal fluid, with NR recipients showing increased brain NAD levels exhibiting altered cerebral metabolism associated with mild clinical improvement.
Brakedal B et al. · Cell metabolism (2022)
Phase I RCT of 1000 mg NR vs. placebo for 30 days in 30 newly diagnosed, treatment-naive Parkinson's patients
NR significantly increased cerebral NAD+ levels measured by 31P-MRS and related metabolites in CSF
Increased brain NAD levels were associated with altered cerebral metabolism (18FDG-PET) and mild clinical improvement
This RCT provides important evidence for NR supplementation in a rare neurological disease population, demonstrating both NAD+ elevation and potential functional neurological benefit.
Nachbauer W et al. · The Lancet Neurology (2024)
NR supplementation significantly elevated blood NAD+ levels throughout the 12-month trial
The combination of NR plus individualized exercise produced the greatest improvements in ataxia rating scales
NR was well tolerated with no serious adverse events attributed to supplementation
7Skeletal muscle NAD+ metabolomeRCTCited 349×n=12 · very small study2019
NR supplementation augments the NAD+ metabolome in aged human skeletal muscle and induces transcriptomic signatures consistent with anti-inflammatory and mitochondrial repair responses.
Elhassan YS et al. · Cell reports (2019)
RCT in healthy older adults examining NR 1000 mg/day effects on skeletal muscle NAD+ metabolome
NR significantly augmented NAD+ and related metabolites in aged skeletal muscle tissue
Transcriptomic analysis revealed upregulation of anti-inflammatory pathways and mitochondrial repair signatures
Nicotinamide riboside supplementation elevated NAD+ levels in patients with peripheral artery disease but did not significantly improve the primary walking performance endpoint compared to placebo.
McDermott MM et al. · Nature communications (2024)
Multi-center RCT examining NR effects on walking performance in peripheral artery disease (PAD) patients
NR effectively elevated NAD+ levels confirming target engagement in this cardiovascular disease population
Primary endpoint of walking performance did not show statistically significant improvement vs. placebo
9Insulin sensitivityRCTCited 217×n=40 · small study2018
NR supplementation was safe and well-tolerated in obese men and increased NAD+ metabolites, but did not significantly improve insulin sensitivity or lipid metabolism vs. placebo over 12 weeks.
Dollerup OL et al. · The American journal of clinical nutrition (2018)
12-week placebo-controlled RCT of NR 1000 mg/day in obese but otherwise healthy men
NR significantly elevated blood NAD+ metabolites vs. placebo confirming target engagement
No significant improvement in insulin sensitivity (primary outcome) or lipid metabolism parameters
NR, NMN, and niacin each elevated blood NAD+ through distinct metabolic routes with differential effects on the gut microbiome and peripheral NAD+ metabolome.
Christen S et al. · Nature metabolism (2026)
Head-to-head RCT comparing three NAD+ boosters (NR, NMN, and niacin) on circulatory NAD+ and gut microbiome
All three compounds elevated blood NAD+ but with distinct metabolomics profiles and pathway utilization
NR and NMN showed preferential conversion through the NRK/NMNAT pathway while niacin used the Preiss-Handler pathway
11Airway inflammation markersRCTCited 21×n=40 · small study2024
NR supplementation reduced markers of airway inflammation in COPD patients, suggesting NAD+ repletion may attenuate inflammatory pathology in chronic obstructive pulmonary disease.
Norheim KL et al. · Nature aging (2024)
RCT examining NR effects on airway inflammation in patients with COPD
NR treatment significantly elevated NAD+ levels in blood of COPD patients
Reductions in airway inflammation markers observed in the NR group vs. placebo
12Hepatic inflammation markersRCTCited 38×n=80 · small study2023
NRPT supplementation significantly reduced markers of hepatic inflammation in patients with non-alcoholic fatty liver disease, providing the first clinical evidence for NAD+ therapy in NAFLD.
Dellinger RW et al. · Hepatology (2023)
Double-blind RCT of NR + pterostilbene vs. placebo in patients with non-alcoholic fatty liver disease
NRPT significantly reduced hepatic inflammation markers including ALT and inflammatory cytokines vs. placebo
Treatment was well-tolerated with no significant adverse events
13NAD+ levels and functional benefitsSystematic Review2026
NAD+ precursor supplementation demonstrates consistent safety and NAD+ elevation in clinical trials, though functional benefits require larger and longer-duration studies to confirm.
Gallagher C et al. · Ageing research reviews (2026)
PRISMA-guided systematic review of both preclinical and clinical NAD+ supplementation literature
NR and NMN consistently and robustly elevate NAD+ levels in human clinical trials
Preclinical evidence strongly supports multiple aging hallmark targets including mitochondrial function, DNA repair, and inflammation
14Blood NAD+ concentrationsRCTCited 29×n=20 · very small study2024
NR significantly increased blood NAD+ concentrations (2.6-fold) in older adults with mild cognitive impairment, was well tolerated, and was associated with a modest reduction in epigenetic age.
Orr ME et al. · GeroScience (2024)
Noticeable benefit
← WorseNo effectBetter →
10-week pilot RCT of NR dose-escalated to 1 g/day vs. placebo in 20 older adults with MCI
2.6-fold increase in blood NAD+ in NR group with no between-group difference in adverse events
Cognitive metrics (MoCA and others) remained stable; no significant improvement or worsening
This framework offers a theoretical foundation for mitochondrial-targeted anti-aging interventions while laying the groundwork for future clinical research, nutritional interventions, and the development of multi-target combination strategies.
Sun Y et al. · Redox biology (2026)
Collectively, by conceptualizing mitochondrial aging as a systemic imbalance rather than isolated molecular defects, this paper highlights a three-axis model of NMN/NR, PQQ, and EGT.
This framework offers a theoretical foundation for mitochondrial-targeted anti-aging interventions while laying the groundwork for future clinical research, nutritional interventions, and the development of multi-target combination strategies.
The combination of nicotinamide riboside plus exercise for 12 weeks was safe and increased cardiopulmonary fitness in children and adults with Friedreich's ataxia.
Lin KY et al. · The Lancet. Neurology (2026)
The combination of nicotinamide riboside plus exercise for 12 weeks was safe and increased cardiopulmonary fitness in children and adults with Friedreich's ataxia.
Longer studies are needed to establish whether adding nicotinamide riboside to exercise could be considered as part of a long-term, comprehensive treatment approach.
This review underscores PANoptosis as a critical pathological mechanism in AD and highlights novel therapeutic avenues aimed at disrupting this cell death program to mitigate AD progression.
Paidlewar M et al. · Free radical biology & medicine (2026)
Dysregulation of signalling pathways, including cGAS-STING, PI3K/AKT, JAK/STAT/IRF1, and p38/ERK/JNK MAPK contribute to PANoptosis by enhancing inflammation, free radical generation, mitochondrial damage, synaptic impairment, and BBB disruption.
Preclinical studies on compounds like celasterol, magnoflorin, calycosin, and liproxstatin-1, along with clinical trials on the drugs including nicotinamide riboside, barcitinib, dexmeditomidine, and semaglutide, suggest a neuroprotective potential by modulating PANoptotic pathways.
This review underscores PANoptosis as a critical pathological mechanism in AD and highlights novel therapeutic avenues aimed at disrupting this cell death program to mitigate AD progression.
Most studies indicated that the NAD+ precursors NAM, NR, NMN, and to a lesser extent NAD+ and NADH had a favourable outcome on several age-related disorders associated with the accumulation of chronic oxidative stress, inflammation and impaired mitochondrial function.
Braidy N et al. · Experimental gerontology (2020)
Systematic review of 147 articles (113 preclinical, 34 clinical) on NAD+ precursor therapy
NAD+ precursors including NR showed favorable outcomes across multiple age-related conditions
Limited acute toxicity profile identified across reviewed compounds
20Blood NAD+ levels and neurodegeneration biomarkersRCTCited 51×n=22 · very small study2023
Oral NR supplementation raised blood NAD+ and was associated with reductions in biomarkers of neurodegenerative pathology in plasma extracellular vesicles of neuronal origin.
Vreones M et al. · Aging cell (2023)
RCT examining effects of NR on NAD+ levels and neurodegeneration biomarkers in extracellular vesicles
NR significantly elevated blood NAD+ concentrations in treated participants
Significant reductions in neurodegenerative pathology biomarkers (including phospho-tau and amyloid-related markers) detected in neuronally-enriched plasma extracellular vesicles