Effect of beta-hydroxy-beta-methylbutyrate supplementation on muscle loss in older adults: A systematic review and meta-analysis
Introduction
Sarcopenia, or loss of muscle mass, is associated with various diseases and with aging, beginning as early as age 40. After age 40, muscle mass declines at a rate of approximately 8% per decade until age 70, after which loss increases at a rate of 15% per decade (Grimby & Saltin, 1983). Loss of muscle mass is an important clinical problem in older adults, and leads to a loss of muscle strength and decreased physical activity, and contributes to multiple adverse consequences, including frailty, disability, morbidity, and mortality (Landi et al., 2013; Malafarina, Uriz-Otano, Iniesta, & Gil-Guerrero, 2012).
Maintenance of muscle mass is dependent on the dynamic equilibrium between protein synthesis and degradation. Multiple strategies have been proposed to reduce muscle loss, including exercise training (Montero-Fernandez & Serra-Rexach, 2013), nutritional supplements (Karelis, Messier, Suppere, Briand, & Rabasa-Lhoret, 2015; Malafarina, Uriz-Otano, Iniesta, & Gil-Guerrero, 2013), and hormone replacement (Brioche et al., 2013). Among these, nutritional supplementation is considered an efficient and a safe method. Beta-hydroxy-beta-methylbutyrate (HMB) is a metabolite of the branched-chain amino acid leucine (Nissen & Abumrad, 1997), which has been investigated due to its potential role in improving muscle quality. Multiple studies have explored mechanisms that link HMB to muscle loss; it has been suggested that HMB can enhance protein synthesis via upregulation of anabolic signaling pathways and attenuate proteolysis via downregulation of catabolic signaling pathways (Hasselgren, 2014). Likewise, population surveys and clinical studies suggest that HMB treatment decreased muscle proteolysis (Baier et al., 2009) and muscle damage and increased fat-free mass gain both in young and older adults (Molfino, Gioia, Rossi Fanelli, & Muscaritoli, 2013). Indeed, HMB has been extensively used as an ergogenic aid, especially among bodybuilders and power athletes, who use it to promote exercise performance and skeletal muscle hypertrophy (Wilson et al., 2013a). However, not all studies have found beneficial effects of HMB supplementation. Muscle loss and strength decline are a common comorbid condition in elderly populations, especially in older adults with severe pathological conditions, such as cancer, acquired immunodeficiency syndrome, or chronic disease. Low levels of muscle mass and strength can contribute to disease development and poor responses to treatment. Therefore, it is necessary to establish whether HMB intervention has a beneficial effect on muscle mass in older adults.
We conducted a meta-analysis to evaluate available studies assessing the effect of HMB supplementation on body composition and muscle strength in both healthy older adults and those with pathological conditions. We considered available randomized controlled trials in which HMB was administered either alone or in combination with other compounds.
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Data sources and searches
Pubmed (http://www.ncbi.nlm.nih.gov/pubmed/), Medline (http://www.medline.com/), and Embase (http://www.embase.com/) were used to search for relevant articles from the earliest possible year to September 2014. Search terms used were (HMB or beta-hydroxy-beta-methylbutyrate) and (supplementation, replacement, therapy, treatment, effects or administration) and (muscle strength, grip, muscle loss, muscle mass or sarcopenia) and (aged, aging, older or elderly) and randomized controlled trails. Key
Included studies characteristics
Our literature search identified 263 records, 13 of which were reviewed for inclusion. After further exclusions based on our selection criteria, seven provided sufficient information for data extraction and were deemed suitable for final analysis (Fig. 1). In total, these randomized controlled trials (performed in the United States) contributed 287 older adults; 147 received HMB intervention and 140 were assigned to control groups (Table 2).
The mean age ± SD of the participants in these studies
Discussion
The purpose of this review was to explore the effect of HMB supplementation on changes in body composition, muscle strength, and physical performance in older adults. The majority of studies were of medium to high methodological quality, as assessed using the Cochrane collaboration’s tool. This meta-analysis demonstrates that HMB intervention significantly improved the fat free mass in healthy older subjects and in older patients with different pathological conditions. This effect was specific
Conclusion
Overall, this meta-analysis indicates that HMB can prevent lean body mass loss in older adults. But the effects of HMB on muscle strength and physical function appears to vary in different populations. Additional well-designed clinical studies are necessary to confirm the effectiveness of HMB in the prevention of loss of muscle strength and physical function.
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgement
The study was supported by 2014 Chinese Nutrition Society (CNS) Nutrition Research Foundation—DSM Research Fund (No. 2014-071).
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2021, Clinical NutritionCitation Excerpt :Research studies have consistently demonstrated that oral nutritional supplements (ONS) can be used as a means to increase energy and protein intakes, body weight, and reduce hospital readmissions and healthcare costs in older adults [28–32]. In addition, beta-hydroxy-beta-methylbutyrate (HMB) has been reported to have potential benefits on muscle mass and muscle strength [33–37]. Prior research has focused on outcomes using oral and enteral nutritional support in hospitalized adults at risk of malnutrition [38].