Elsevier

Archives of Gerontology and Geriatrics

Volume 61, Issue 2, September–October 2015, Pages 168-175
Archives of Gerontology and Geriatrics

Effect of beta-hydroxy-beta-methylbutyrate supplementation on muscle loss in older adults: A systematic review and meta-analysis

https://doi.org/10.1016/j.archger.2015.06.020Get rights and content

Highlights

  • Aim was to access the effect of HMB on muscle loss in older adults.

  • HMB can prevent lean body mass loss in older adults.

  • HMB supplementation does not result in a significant change in fat mass.

Abstract

Background

Beta-hydroxy-beta-methylbutyrate (HMB), a metabolite of the branched-chain amino acid leucine, has been investigated as a potential supplement to improve muscle quality; however, whether HMB supplementation has beneficial effects on muscle loss in older adults remains unclear.

Design

Systematic review with meta-analysis.

Setting

PubMed, Medline and EMBASE databases were searched from the earliest possible year to September 2014.

Participants

Individuals aged 65 years and older that reported absolute changes in body composition with use of HMB.

Measurements

Two review authors working independently reviewed the trials, and standard mean difference was calculated using a fixed effects model.

Results

A total of seven randomized controlled trials were included, in which 147 older adults received HMB intervention and 140 were assigned to control groups. The meta-analysis showed greater muscle mass gain in the intervention groups compared with the control groups (standard mean difference = 0.352 kg; 95% confidence interval: 0.11, 0.594; Z value = 2.85; P = 0.004). There were no significant fat mass changes between intervention and control groups (standard mean difference = −0.08 kg; 95% confidence interval: −0.32, 0.159; Z value = 0.66; P = 0.511).

Conclusion

Beta-hydroxy-beta-methylbutyrate supplementation contributed to preservation of muscle mass in older adults. HMB supplementation may be useful in the prevention of muscle atrophy induced by bed rest or other factors. Further studies are needed to determine the precise effects of HMB on muscle strength and physical function in older adults.

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.

Section snippets

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).

References (27)

  • J.R. Stout et al.

    Effect of calcium beta-hydroxy-beta-methylbutyrate (CaHMB) with and without resistance training in men and women 65+yrs: A randomized, double-blind pilot trial

    Experimental Gerontology

    (2013)
  • M.D. Vukovich et al.

    Body composition in 70-year-old adults responds to dietary beta-hydroxy-beta-methylbutyrate similarly to that of young adults

    The Journal of Nutrition

    (2001)
  • S. Baier et al.

    Year-long changes in protein metabolism in elderly men and women supplemented with a nutrition cocktail of beta-hydroxy-beta-methylbutyrate (HMB), L-arginine, and L-lysine

    Journal of Parenteral and Enteral Nutrition

    (2009)
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