Creatine and body composition in adults: what the evidence says
Summary
What is it? A look at what creatine does to the body weight, fat-free mass and body fat of adults: does it add muscle, water or fat? The main source is a 2024 systematic review and meta-analysis of 143 randomized trials [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. A meta-analysis pools the results of many studies into one overall estimate. See also Creatine.
Why would I need it? If you take creatine, you may want to know whether the extra weight is muscle, water or fat.
Is it useful? Creatine added a small amount of body weight (0.86 kg) and fat-free mass (0.82 kg) compared with placebo, and the authors rated both as high-certainty evidence [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. It did not change total fat mass, and the fall in body fat percentage was very small (0.28 percentage points) [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. Part of the gain may be water held in the muscle [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. The gain in fat-free mass was clearer when people also did resistance training [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry[2]Influence of age, sex, and type of exercise on the efficacy of creatine supplementation on lean body mass: A systematic review and meta-analysis of randomized clinical trials. Delpino FM, Figueiredo LM, Forbes SC, et al. Nutrition, 2022.
FAQ
Does creatine make you gain weight? Yes, a little. Across 154 comparisons, body weight was 0.86 kg higher than with placebo (95% CI 0.76 to 0.96) [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. A position stand of a sports nutrition society also lists weight gain as the only consistently reported side effect [3]International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Kreider RB, Kalman DS, Antonio J, et al. J Int Soc Sports Nutr, 2017Paid for by industry7 authors declare ties to industry.
Does creatine build muscle? It adds fat-free mass, which is muscle, bone, organs and water: +0.82 kg (95% CI 0.57 to 1.06) [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. With resistance training the gain was 0.99 kg, and with no exercise it was 0.24 kg and not significant [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. The test for a difference between these exercise groups was not significant, so treat the difference as a trend [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry.
Does creatine burn fat? No. Total fat mass did not change (+0.05 kg, 95% CI -0.24 to 0.35) [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. Body fat percentage fell by 0.28 percentage points (95% CI 0.09 to 0.47), most likely because fat-free mass rose, not because fat was lost [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. A review of 12 trials in adults under 50 who lifted weights also found a small fall in body fat percentage (-1.19 points) with no change in absolute fat mass (-0.18 kg, not significant) [4]Resistance Exercise and Creatine Supplementation on Fat Mass in Adults < 50 Years of Age: A Systematic Review and Meta-Analysis. Candow DG, Prokopidis K, Forbes SC, et al. Nutrients, 20234 authors declare ties to industry.
Do men and women respond the same? Men gained 1.20 kg of fat-free mass and women 0.54 kg. The test for a difference was not significant (P = 0.120) [1 Table 3]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. An earlier meta-analysis found 1.46 kg and 0.29 kg, with the same direction [2]Influence of age, sex, and type of exercise on the efficacy of creatine supplementation on lean body mass: A systematic review and meta-analysis of randomized clinical trials. Delpino FM, Figueiredo LM, Forbes SC, et al. Nutrition, 2022.
Does the dose matter? For body weight and fat-free mass, doses up to 5 g a day and above 5 g a day gave similar gains [1 Table 3]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. For body fat percentage, only the group above 5 g a day showed a significant fall [1 Table 3]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry.
Article
What the review did
The authors searched PubMed, Web of Science and Scopus up to July 2023. They included randomized controlled trials of creatine against placebo that measured body composition. They found 143 trials with 172 study arms and 3,655 people [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. The trials were published from 1993 to 2023 and lasted from 4 days to 365 days. Of the 143 trials, 124 were parallel-group and 19 were crossover trials. Twenty-one studies were done only in women and 81 only in men [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. The authors rated the risk of bias as low in 111 trials, high in 17 and unclear in 15 [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry.
What the evidence says
| Outcome | Comparisons | Average difference from placebo | I2 | Certainty (GRADE) |
|---|---|---|---|---|
| Body mass | 154 | +0.86 kg (95% CI 0.76 to 0.96) | 0% | High |
| Fat-free mass | 95 | +0.82 kg (95% CI 0.57 to 1.06) | 0% | High |
| Body fat percentage | 89 | -0.28 percentage points (95% CI -0.47 to -0.09) | 0% | High |
| Fat mass | 62 | +0.05 kg (95% CI -0.24 to 0.35), not significant | 0% | Moderate |
| Body mass index | 13 | +0.20 kg/m2 (95% CI -0.17 to 0.58), not significant | 0% | Moderate |
Source: [1 Table 3 and Table 6]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. I2 measures how much the trials disagree; 0% means no disagreement beyond chance. The authors found no sign of publication bias, and removing any one trial did not change the results [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry.
What changed the size of the effect
All subgroup values are from [1 Table 3]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry.
| Group | Fat-free mass change | Body fat percentage change |
|---|---|---|
| With resistance training | +0.99 kg (95% CI 0.64 to 1.35) | - |
| With no exercise | +0.24 kg (95% CI -0.26 to 0.75), not significant | - |
| Men | +1.20 kg (95% CI 0.80 to 1.60) | -0.36 points (95% CI -0.61 to -0.11) |
| Women | +0.54 kg (95% CI 0.03 to 1.06) | -0.18 points (95% CI -0.52 to 0.16), not significant |
| Dose of 5 g a day or less | +0.77 kg (95% CI 0.46 to 1.08) | -0.04 points (95% CI -0.29 to 0.20), not significant |
| Dose above 5 g a day | +0.89 kg (95% CI 0.49 to 1.29) | -0.60 points (95% CI -0.89 to -0.30) |
Only the dose difference for body fat percentage was statistically significant between groups (P = 0.005). The other differences in this table were not significant [1 Table 3]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. The abstract says that maintenance dosing and resistance training gave greater effects, but the paper's own tests do not support a firm statement for fat-free mass [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry.
Forms other than creatine monohydrate were studied in very few trials. For fat-free mass they gave +0.91 kg with a very wide interval (95% CI -3.06 to 4.88), so no conclusion about other forms is possible [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry.
Adults under 50 who lift weights
A 2023 systematic review and meta-analysis looked at one narrow case: creatine monohydrate plus resistance training against placebo plus resistance training, in adults with a mean age under 50. It included 12 randomized trials with 266 people, as the authors report. Trials lasted from 4 to 14 weeks. Most studied healthy young men, many of them athletes; one studied men with HIV [4]Resistance Exercise and Creatine Supplementation on Fat Mass in Adults < 50 Years of Age: A Systematic Review and Meta-Analysis. Candow DG, Prokopidis K, Forbes SC, et al. Nutrients, 20234 authors declare ties to industry.
| Outcome | Trials | Average difference from placebo | I2 |
|---|---|---|---|
| Body fat percentage | 10 | -1.19 points (95% CI -2.03 to -0.34), p = 0.006 | 0% |
| Fat mass | 6 | -0.18 kg (95% CI -1.32 to 0.96), not significant | 0% |
Source: [4]Resistance Exercise and Creatine Supplementation on Fat Mass in Adults < 50 Years of Age: A Systematic Review and Meta-Analysis. Candow DG, Prokopidis K, Forbes SC, et al. Nutrients, 20234 authors declare ties to industry. The authors call the fall in body fat percentage clinically unimportant, because fat mass in kilograms did not fall. They suggest that more muscle can lower the percentage without any fat loss, but they did not test this. In subgroups, age, sex, dose (up to 5 g or more than 5 g a day), length (under or over 8 weeks), training frequency and the method that measured fat did not change the fat mass result [4]Resistance Exercise and Creatine Supplementation on Fat Mass in Adults < 50 Years of Age: A Systematic Review and Meta-Analysis. Candow DG, Prokopidis K, Forbes SC, et al. Nutrients, 20234 authors declare ties to industry. Four trials had a low risk of bias, six moderate and two high [4]Resistance Exercise and Creatine Supplementation on Fat Mass in Adults < 50 Years of Age: A Systematic Review and Meta-Analysis. Candow DG, Prokopidis K, Forbes SC, et al. Nutrients, 20234 authors declare ties to industry. Many people believe that creatine adds fat; this review found no sign of that [4]Resistance Exercise and Creatine Supplementation on Fat Mass in Adults < 50 Years of Age: A Systematic Review and Meta-Analysis. Candow DG, Prokopidis K, Forbes SC, et al. Nutrients, 20234 authors declare ties to industry.
Is the gain muscle or water?
Creatine holds water in muscle cells. The authors say the weight gain is probably a mix of water and more lean tissue, and that few trials measured body water, so they could not say how much is which [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry. The position stand reports 0.5 to 1.0 L of extra body water during a loading phase, which matches the early weight gain [3]International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Kreider RB, Kalman DS, Antonio J, et al. J Int Soc Sports Nutr, 2017Paid for by industry7 authors declare ties to industry.
Limits of this evidence
- Most trials measured body composition as a secondary outcome, not the main one [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry.
- Few trials measured muscle creatine levels, dietary creatine or protein intake [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry.
- Trials used several different ways to measure body composition. Only 8 of 143 used bioelectrical impedance, the method that can estimate body water [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry.
- The paper is not consistent about doses. Its text says the fall in body fat percentage occurred with up to 5 g a day, but its Table 3 shows the fall only above 5 g a day. This page follows the table [1 Table 3]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry.
- The 2024 review shares authors with the reviews used to check it. Authors of the 2023 review report advisory roles, patents or research funding linked to creatine makers [4]Resistance Exercise and Creatine Supplementation on Fat Mass in Adults < 50 Years of Age: A Systematic Review and Meta-Analysis. Candow DG, Prokopidis K, Forbes SC, et al. Nutrients, 20234 authors declare ties to industry, and D. G. Candow reports the same kind of ties in the 2024 review and in the earlier meta-analysis [1]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry[2]Influence of age, sex, and type of exercise on the efficacy of creatine supplementation on lean body mass: A systematic review and meta-analysis of randomized clinical trials. Delpino FM, Figueiredo LM, Forbes SC, et al. Nutrition, 2022. The numbers agree across them, but they are not fully independent.
- The trials mostly studied healthy adults. The result does not apply to people with a disease.
Talk to a doctor before you start a supplement, especially if you take medicines or are pregnant.
Verification
Checked on 2026-11-10. The 2024 review was read in full text. The 2023 meta-analysis of adults under 50 [4]Resistance Exercise and Creatine Supplementation on Fat Mass in Adults < 50 Years of Age: A Systematic Review and Meta-Analysis. Candow DG, Prokopidis K, Forbes SC, et al. Nutrients, 20234 authors declare ties to industry was read in full text. The earlier meta-analysis [2]Influence of age, sex, and type of exercise on the efficacy of creatine supplementation on lean body mass: A systematic review and meta-analysis of randomized clinical trials. Delpino FM, Figueiredo LM, Forbes SC, et al. Nutrition, 2022 was read as an abstract. The 2017 position stand [3]International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Kreider RB, Kalman DS, Antonio J, et al. J Int Soc Sports Nutr, 2017Paid for by industry7 authors declare ties to industry was read only for its passages on weight gain and water.
| Claim | Result | What the check found |
|---|---|---|
| Fat-free mass rises by about 0.8 kg | Partly verified | An earlier meta-analysis of 35 studies found +0.68 kg overall [2]Influence of age, sex, and type of exercise on the efficacy of creatine supplementation on lean body mass: A systematic review and meta-analysis of randomized clinical trials. Delpino FM, Figueiredo LM, Forbes SC, et al. Nutrition, 2022. Not independent: two authors, D. G. Candow and S. C. Forbes, wrote both papers |
| The gain is clearer with resistance training | Partly verified | The earlier meta-analysis found +1.10 kg with resistance training and +0.03 kg (not significant) with no exercise [2]Influence of age, sex, and type of exercise on the efficacy of creatine supplementation on lean body mass: A systematic review and meta-analysis of randomized clinical trials. Delpino FM, Figueiredo LM, Forbes SC, et al. Nutrition, 2022. Not independent: the same two authors wrote both papers |
| Men gain more than women | Partly verified | Same direction in both reviews. The 2024 test for a difference was not significant [1 Table 3]Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 20241 author declares ties to industry |
| Body fat percentage falls very little and fat mass does not change | Partly verified | A review of 12 trials in adults under 50 who lifted weights found the same pattern: body fat percentage fell (-1.19 points, 95% CI -2.03 to -0.34) and fat mass did not change (-0.18 kg, 95% CI -1.32 to 0.96) [4]Resistance Exercise and Creatine Supplementation on Fat Mass in Adults < 50 Years of Age: A Systematic Review and Meta-Analysis. Candow DG, Prokopidis K, Forbes SC, et al. Nutrients, 20234 authors declare ties to industry. The direction agrees, but the fall in percentage is larger than in the 2024 review (-0.28). The same two authors wrote both reviews |
| Body weight rises | Partly verified | The position stand lists weight gain as the only consistently reported side effect [3]International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Kreider RB, Kalman DS, Antonio J, et al. J Int Soc Sports Nutr, 2017Paid for by industry7 authors declare ties to industry. Not fully independent: D. G. Candow is an author of both papers, and a supplement trade group paid for the position stand |
| Part of the gain is water | Partly verified | The position stand reports extra body water during loading [3]International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Kreider RB, Kalman DS, Antonio J, et al. J Int Soc Sports Nutr, 2017Paid for by industry7 authors declare ties to industry. No second source covers long-term use |
| The high-certainty rating | Opinion | The rating is from the review authors. No second source rated it |
See also
Sources
Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis. Pashayee-Khamene F, Heidari Z, Asbaghi O, et al. J Int Soc Sports Nutr, 2024
1 author declares ties to industry · Meta-analysis · Same authors as [2], [3], [4] · About this source- Paid for by industry · 7 authors declare ties to industry · Expert opinion · Same authors as [1], [2], [4] · About this source
- 4 authors declare ties to industry · Meta-analysis · Same authors as [1], [2], [3] · About this source