J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Review

Volume 7, Number 12, December 2015, pages 926-931

Nutrition for Sarcopenia

**Table 1.** Clinical Trials to Study Effects of Protein, Amino Acids, Leucine, Vitamin D, HMB Intake on Sarcopenia
Authors	Subjects	Study design	Resuts/Conclusions
AAS: amino acid supplementation; CMR: competitive meal replacement; EAA: essential amino acids; EAAMR: whey protein + essential amino acid meal replacement; HE: health education; HMB: beta-hydroxy-beta-methylbutyrate; LM: lean mass.
Aleman-Mateo et al [18]	Patients with sarcopenia, ≥ 60 years (n = 40)	The intervention group received 210 g/day of ricotta cheese plus the habitual diet, while the control group followed the habitual diet with no additional intervention for 3 months.	The adding daily 210 g of ricotta cheese to the habitual diet improved the markers of sarcopenia in subjects without a pronounced loss of skeletal muscle mass.
Tieland et al [19]	Frail elderly people (n = 65)	Subjects were randomly allocated to either daily protein or placebo supplementation (15 g milk protein at breakfast and lunch), for 24 weeks.	Dietary milk protein supplementation improved physical performance, but did not increase skeletal muscle mass in frail elderly people.
Walrand et al [20]	Healthy elderly men (71.8 ± 2.4 (mean ± SD) years, n = 31)	Adequate-protein or high-protein diet together with the protein source as caseins or soluble milk proteins was provided for 10 days.	Fast-digesting soluble milk proteins improved postprandial muscle protein synthesis in elderly subjects.
Shahar et al [21]	Sarcopenic elderly Malays aged 60 - 74 years (n = 65)	Subjects were assigned to the control group, exercise group, protein supplementation group, or the combination of exercise and protein supplementation group for 12 weeks.	The exercise program improved muscle strength and body composition, while protein supplementation reduced body weight and increased upper body strength.
Kim et al [22]	Sarcopenic women aged 75 and older (n = 155)	Subjects were randomly assigned to exercise and AAS (n = 38), exercise (n = 39), AAS (n = 39), or HE (n = 39). The exercise group attended a 60-min comprehensive training program twice a week, and the AAS group ingested 3 g of a leucine-rich EAA mixture twice a day for 3 months.	Walking speed significantly increased in all three intervention groups, leg muscle mass in the exercise + AAS and exercise groups, and knee extension strength only in the exercise + AAS group. The odds ratio for leg muscle mass and knee extension strength improvement was more than four times as great in the exercise + AAS group as in the HE group.
Dillon et al [23]	Elderly women (68 ± 2 years) (n = 14)	Subjects were assigned to receive either placebo (n = 7), or 15 g EAA/day (n = 7) for 3 months.	EAA improved LM and basal muscle protein synthesis in elderly individuals.
Solerte et al [24]	Elderly subjects (66 - 84 years) with sarcopenia (n = 41)	Subjects were assigned to EAA and placebo. EAA treatment consisted of 8 g of EAA snacks twice a day.	Significant increases in whole-body LM in all areas were seen after 6 months and more consistently after 18 months of oral nutritional supplementation with EAA.
Scognamiglio et al [25]	Elderly subjects (> 65 years) with reduced physical activity (n = 100)	Subjects were randomized to receive an oral amino acids mixture (12 g/day) or placebo for 3 months.	An oral amino acids supply improved ambulatory capacity, maximal isometric muscle strength in elderly subjects.
Borsheim et al [26]	Glucose intolerant subjects (67.0 ± 5.6 years, seven females, five males)	Subjects ingested 11 g of a nutritional supplement containing EAA + arginine twice a day, between meals for 16 weeks.	Supplementation of the diet with EAA + arginine improved LM, strength and physical function.
Coker et al [27]	Elderly individuals (n = 12)	Caloric restriction diet utilizing equivalent caloric meal replacements (800 kcal/day): 1) EAAMR or 2) CMR in conjunction with 400 kcal of solid food that totaled 1,200 kcal/day designed to induce 7% weight loss.	Both groups lost about 7% of total body weight. While EAAMR did not promote a significant preservation of LM, the reduction in adipose tissue was greater in EAAMR compared to CMR.
Bukhari et al [28]	Elderly women (66 ± 2.5 years; n = 8/group)	Whey protein or novel low-dose leucine-enriched EAA (3 g, 40% leucine), single-dose administration.	There was no difference in muscle anabolism between whey protein and novel low-dose leucine-enriched EAA.
Cangussu et al [29]	Postmenopausal women (50 - 65 years) with a history of falls (n = 160)	Subjects were randomized into vitamin D group consisting of patients receiving vitamin D 1,000 IU/day orally (n = 80) or placebo group (n = 80) for 9 months.	In the vitamin D group, there was significant increase in muscle strength (+25.3%) of the lower limbs by chair rising test. In the placebo group, there was considerable loss (-6.8%) in LM.
Verschueren et al [30]	Institutionalized elderly females aged over 70 years (mean age 79.6 years) (n = 113)	In a 2 × 2 factorial-design trial, subjects were randomly assigned either to a whole-body vibration or a no-training group, receiving either a conventional dose (880 IU/day) or a high dose (1,600 IU/day) of vitamin D.	After 6 months of treatment, dynamic muscle strength improved significantly in all groups. A higher dose of vitamin D did not provide additional musculoskeletal benefit compared with conventional doses.
Daly et al [31]	Women aged 60 - 90 years who were residing in 15 retirement villages (n = 100)	Subjects were allocated to receive lean red meat (about 160 g cooked) to be consumed 6 days/week or control (1 serving pasta or rice/day) for 4 months. All women undertook resistance training 2 times/week and received 1,000 IU vitamin D/day.	A protein-enriched diet equivalent to 1.3 g/kg/day achieved through lean red meat was safe and effective for enhancing the effects of progressive resistance training on LM and muscle strength.
Bauer et al [32]	Sarcopenic primarily independent-living elderly adults (n = 380)	The active group (n = 184) received a vitamin D and leucine-enriched whey protein nutritional supplement to consume twice daily for 13 weeks. The control group (n = 196) received an isocaloric control product to consume twice daily for 13 weeks.	The 13-week intervention of a vitamin D and leucine-enriched whey protein oral nutritional supplement resulted in improvements in muscle mass and lower-extremity function among sarcopenic elderly adults.
Verreijen et al [33]	Obese elderly adults (63 ± 5.6 years; body mass index, 33 ± 4.4 kg/m², n = 80)	All subjects followed a hypocaloric diet (-600 kcal/day) and performed resistance training 3 times/week. A high whey protein-, leucine-, and vitamin D-enriched supplement including a mix of other macro- and micronutrients (150 kcal, 21 g protein; 10 times/week) or an isocaloric control.	A high whey protein-, leucine-, and vitamin D-enriched supplement compared with isocaloric control preserved muscle mass.
Hsieh et al [34]	Bed-ridden elderly nursing home residents receiving tube feeding (n = 79)	Subjects were randomly assigned to HMB (n = 39, 2 g/day) or control group (n = 40) for 4 weeks.	HMB supplementation for 2 - 4 weeks could reduce muscle breakdown in bed-ridden elderly nursing home residents receiving tube feeding.
Flakoll et al [35]	Women (mean 76.7 years, n = 50)	Subjects were randomized to a placebo group (n = 23) or an experimental treatment group (2 g HMB, 5 g arginine, and 1.5 g lysine daily; n = 27) for 12 weeks.	Daily supplementation of HMB, arginine, and lysine for 12 weeks positively altered measurements of muscle functionality, strength, fat-free mass, and protein synthesis.
Baier et al [36]	Elderly (76 ± 1.6 years) women (n = 39) and men (n = 38)	Participants were randomly assigned to either an isonitrogenous control-supplement (n = 37) or a treatment-supplement (HMB/arginine/lysine) (n = 40) for 1 year.	Consumption of a simple amino acid-related cocktail increased protein turnover and LM in elderly individuals in a year-long study.

Table 1. Clinical Trials to Study Effects of Protein, Amino Acids, Leucine, Vitamin D, HMB Intake on Sarcopenia

Authors

Subjects

Study design

Resuts/Conclusions

AAS: amino acid supplementation; CMR: competitive meal replacement; EAA: essential amino acids; EAAMR: whey protein + essential amino acid meal replacement; HE: health education; HMB: beta-hydroxy-beta-methylbutyrate; LM: lean mass.

Aleman-Mateo et al [18]

Patients with sarcopenia, ≥ 60 years (n = 40)

The intervention group received 210 g/day of ricotta cheese plus the habitual diet, while the control group followed the habitual diet with no additional intervention for 3 months.

The adding daily 210 g of ricotta cheese to the habitual diet improved the markers of sarcopenia in subjects without a pronounced loss of skeletal muscle mass.

Tieland et al [19]

Frail elderly people (n = 65)

Subjects were randomly allocated to either daily protein or placebo supplementation (15 g milk protein at breakfast and lunch), for 24 weeks.

Dietary milk protein supplementation improved physical performance, but did not increase skeletal muscle mass in frail elderly people.

Walrand et al [20]

Healthy elderly men (71.8 ± 2.4 (mean ± SD) years, n = 31)

Adequate-protein or high-protein diet together with the protein source as caseins or soluble milk proteins was provided for 10 days.

Fast-digesting soluble milk proteins improved postprandial muscle protein synthesis in elderly subjects.

Shahar et al [21]

Sarcopenic elderly Malays aged 60 - 74 years (n = 65)

Subjects were assigned to the control group, exercise group, protein supplementation group, or the combination of exercise and protein supplementation group for 12 weeks.

The exercise program improved muscle strength and body composition, while protein supplementation reduced body weight and increased upper body strength.

Kim et al [22]

Sarcopenic women aged 75 and older (n = 155)

Subjects were randomly assigned to exercise and AAS (n = 38), exercise (n = 39), AAS (n = 39), or HE (n = 39). The exercise group attended a 60-min comprehensive training program twice a week, and the AAS group ingested 3 g of a leucine-rich EAA mixture twice a day for 3 months.

Walking speed significantly increased in all three intervention groups, leg muscle mass in the exercise + AAS and exercise groups, and knee extension strength only in the exercise + AAS group. The odds ratio for leg muscle mass and knee extension strength improvement was more than four times as great in the exercise + AAS group as in the HE group.

Dillon et al [23]

Elderly women (68 ± 2 years) (n = 14)

Subjects were assigned to receive either placebo (n = 7), or 15 g EAA/day (n = 7) for 3 months.

EAA improved LM and basal muscle protein synthesis in elderly individuals.

Solerte et al [24]

Elderly subjects (66 - 84 years) with sarcopenia (n = 41)

Subjects were assigned to EAA and placebo. EAA treatment consisted of 8 g of EAA snacks twice a day.

Significant increases in whole-body LM in all areas were seen after 6 months and more consistently after 18 months of oral nutritional supplementation with EAA.

Scognamiglio et al [25]

Elderly subjects (> 65 years) with reduced physical activity (n = 100)

Subjects were randomized to receive an oral amino acids mixture (12 g/day) or placebo for 3 months.

An oral amino acids supply improved ambulatory capacity, maximal isometric muscle strength in elderly subjects.

Borsheim et al [26]

Glucose intolerant subjects (67.0 ± 5.6 years, seven females, five males)

Subjects ingested 11 g of a nutritional supplement containing EAA + arginine twice a day, between meals for 16 weeks.

Supplementation of the diet with EAA + arginine improved LM, strength and physical function.

Coker et al [27]

Elderly individuals (n = 12)

Caloric restriction diet utilizing equivalent caloric meal replacements (800 kcal/day): 1) EAAMR or 2) CMR in conjunction with 400 kcal of solid food that totaled 1,200 kcal/day designed to induce 7% weight loss.

Both groups lost about 7% of total body weight. While EAAMR did not promote a significant preservation of LM, the reduction in adipose tissue was greater in EAAMR compared to CMR.

Bukhari et al [28]

Elderly women (66 ± 2.5 years; n = 8/group)

Whey protein or novel low-dose leucine-enriched EAA (3 g, 40% leucine), single-dose administration.

There was no difference in muscle anabolism between whey protein and novel low-dose leucine-enriched EAA.

Cangussu et al [29]

Postmenopausal women (50 - 65 years) with a history of falls (n = 160)

Subjects were randomized into vitamin D group consisting of patients receiving vitamin D 1,000 IU/day orally (n = 80) or placebo group (n = 80) for 9 months.

In the vitamin D group, there was significant increase in muscle strength (+25.3%) of the lower limbs by chair rising test. In the placebo group, there was considerable loss (-6.8%) in LM.

Verschueren et al [30]

Institutionalized elderly females aged over 70 years (mean age 79.6 years) (n = 113)

In a 2 × 2 factorial-design trial, subjects were randomly assigned either to a whole-body vibration or a no-training group, receiving either a conventional dose (880 IU/day) or a high dose (1,600 IU/day) of vitamin D.

After 6 months of treatment, dynamic muscle strength improved significantly in all groups. A higher dose of vitamin D did not provide additional musculoskeletal benefit compared with conventional doses.

Daly et al [31]

Women aged 60 - 90 years who were residing in 15 retirement villages (n = 100)

Subjects were allocated to receive lean red meat (about 160 g cooked) to be consumed 6 days/week or control (1 serving pasta or rice/day) for 4 months. All women undertook resistance training 2 times/week and received 1,000 IU vitamin D/day.

A protein-enriched diet equivalent to 1.3 g/kg/day achieved through lean red meat was safe and effective for enhancing the effects of progressive resistance training on LM and muscle strength.

Bauer et al [32]

Sarcopenic primarily independent-living elderly adults (n = 380)

The active group (n = 184) received a vitamin D and leucine-enriched whey protein nutritional supplement to consume twice daily for 13 weeks. The control group (n = 196) received an isocaloric control product to consume twice daily for 13 weeks.

The 13-week intervention of a vitamin D and leucine-enriched whey protein oral nutritional supplement resulted in improvements in muscle mass and lower-extremity function among sarcopenic elderly adults.

Verreijen et al [33]

Obese elderly adults (63 ± 5.6 years; body mass index, 33 ± 4.4 kg/m², n = 80)

All subjects followed a hypocaloric diet (-600 kcal/day) and performed resistance training 3 times/week. A high whey protein-, leucine-, and vitamin D-enriched supplement including a mix of other macro- and micronutrients (150 kcal, 21 g protein; 10 times/week) or an isocaloric control.

A high whey protein-, leucine-, and vitamin D-enriched supplement compared with isocaloric control preserved muscle mass.

Hsieh et al [34]

Bed-ridden elderly nursing home residents receiving tube feeding (n = 79)

Subjects were randomly assigned to HMB (n = 39, 2 g/day) or control group (n = 40) for 4 weeks.

HMB supplementation for 2 - 4 weeks could reduce muscle breakdown in bed-ridden elderly nursing home residents receiving tube feeding.

Flakoll et al [35]

Women (mean 76.7 years, n = 50)

Subjects were randomized to a placebo group (n = 23) or an experimental treatment group (2 g HMB, 5 g arginine, and 1.5 g lysine daily; n = 27) for 12 weeks.

Daily supplementation of HMB, arginine, and lysine for 12 weeks positively altered measurements of muscle functionality, strength, fat-free mass, and protein synthesis.

Baier et al [36]

Elderly (76 ± 1.6 years) women (n = 39) and men (n = 38)

Participants were randomly assigned to either an isonitrogenous control-supplement (n = 37) or a treatment-supplement (HMB/arginine/lysine) (n = 40) for 1 year.

Consumption of a simple amino acid-related cocktail increased protein turnover and LM in elderly individuals in a year-long study.