Vol. IV · No. 19
Tuesday, June 23, 2026
Issue: Spring · 2026
Established · MMXXVI
— The evidence base for longevity medicine —
Indexed by PubMed · CTG · Cochrane
Editorial team · geroevidence.com
Subscription · app.geroevidence.com
NAD+ precursor · NAD+

NR nicotinamide riboside

NAD+ precursor ·NAD+ pathway

Nicotinamide riboside (NR) is a NAD+ precursor that increases intracellular NAD+ availability through the salvage pathway, primarily via NRK1-mediated phosphorylation, serving as a substrate for NAD+-dependent enzymes including sirtuins and PARPs. By restoring NAD+ levels—which decline with age—NR modulates multiple aging-related pathways including mitochondrial function, DNA repair, metabolic homeostasis, and cellular stress responses. In preclinical models, NR supplementation has demonstrated improvements in mitochondrial biogenesis, exercise capacity, metabolic flexibility, and lifespan extension in C. elegans and some mammalian models. Human clinical evidence remains limited but phase 2 trials show improvements in muscle insulin sensitivity, arterial stiffness, and cardiometabolic parameters; definitive healthspan or lifespan data in humans is absent, and long-term safety and efficacy require further investigation.

Last reviewed: May 19, 2026
Evidence strength
Emerging
— for healthspan endpoints
Strong Ph. III
Moderate ≥2 RCTs
Emerging 1 RCT
Insufficient pre-clin
Single RCT or pooled small-trial signal. Promising but limited.
Key outcome
Surrogate endpoints
Martens 2020 · aortic stiff
Evidence tier
Emerging
Updated May 19, 2026
Active trials
from ClinicalTrials.gov
Drug class
NAD+ precursor
NAD+

Recent papers — reviewed before publication

10 indexed
Review
Jul 1, 2026
Role of nicotinamide adenine dinucleotide in cardiovascular disease.
Prasanna et al. · Current opinion in cardiology
Mechanism
Jul 1, 2026
Comparative lipidomics and NAD⁺ metabolism in pectoris muscle reveal a lean metabolic phenotype in Daweishan miniature chickens versus arbor acre broilers.
Wu et al. · Poultry science
More papers available — with plain language summaries
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Active trials — from ClinicalTrials.gov

0 tracked
Full trial tracking
Active trials, phase, enrollment, primary endpoints, and completion dates — available to subscribers.
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Frequently asked

Is NR (nicotinamide riboside) the same as NMN?

No. NR and NMN are both NAD+ precursors but are chemically distinct compounds, metabolized through different pathways. Both are sold as dietary supplements, not FDA-approved drugs.

What human data exists for NR specifically?

Available data (e.g., Martens 2020) has examined surrogate cardiovascular markers such as aortic stiffness rather than hard clinical outcomes. See the full profile for indexed papers and trial status.

How does NR's evidence tier compare to NMN's?

Both are currently graded Emerging on Geroevidence, reflecting a similarly early-stage human evidence base built primarily on surrogate endpoints.

Are there known safety concerns with NR supplementation?

Available human trials have not identified major safety signals at studied doses; long-term and high-dose safety data remain limited.

How does NR compare to NMN as a NAD+ precursor?

Both target NAD+ repletion through different metabolic pathways and currently hold similar Emerging evidence tiers. See the NMN profile for direct comparison.

This information is provided for educational reference only and does not constitute medical advice or a treatment recommendation.
Evidence profiles are reviewed by the Geroevidence editorial team. Key outcomes are from published meta-analyses or landmark RCTs. No clinical recommendations are made. Full evidence dossiers with paper summaries and weekly updates are available to subscribers.