Original articleEffects of adequate dietary protein with whey protein, leucine, and vitamin D supplementation on sarcopenia in older adults: An open-label, parallel-group study
Introduction
The aging population is rapidly increasing in Taiwan. By 2050, people over 65 years old will be as high as 35.5% of the total population [1,2]. Aging leads to the progressive loss of muscle mass and strength which called sarcopenia, that may consequently result in muscle functional impairment and physical disability [3,4]. Elderly people with sarcopenia have increased risks of accidental falls and nosocomial infection during hospitalization [5,6], and even a higher mortality rate [7,8]. Thus, strategies to prevent or retard the progression of muscle mass loss and its associated decline in physical function are of high clinical relevance and mandate further exploration [9].
The gold standard for preventing and treating sarcopenia is adequate dietary protein intake coupled with resistance exercise. Since older adults with sarcopenia are often observed to have a reduced exercise capacity [10], increasing the protein intake is an effective strategy to enhance muscle mass and strength to counteract sarcopenia [11]. Previous studies concerned with the influence of supplementing specific nutrients on physical performance focused mostly on the frail [12,13] or healthy elder subjects [[14], [15], [16], [17], [18], [19]]. Studies investigating the effects of specific nutritional supplementations on sarcopenic elderly are scarce, and the results are inconsistent [[20], [21], [22]].
A previous study demonstrated that supplementing 15 g of milk protein at breakfast and lunch to pre-frail and frail elderly showed significant improvement in physical performance, yet failed to show benefits in enhancing muscle mass or strength [13]. A clinical trial performed by Bauer et al. reported that a 13 weeks of administration of vitamin D and leucine-enriched whey protein nutritional supplements improved the muscle mass and lower extremity function in sarcopenic older adults [21]. Whey protein is a high-quality protein that was shown to result in a significant transient rise in plasma amino acid levels, which in turn leads to increased postprandial protein synthesis [23]. Whey protein is also believed to enhance protein production due to its rich content of leucine [24]. Evidence also supports a vitamin D deficiency being associated with poor muscle function and physical performance. Previous studies showed that vitamin D supplementation was able to improve muscle strength and gait, especially in the elderly [25,26]. Since daily protein intake of the aforementioned studies between the intervention and control groups were not identical, the beneficial effect of whey protein plus vitamin D supplementation on elderly with sarcopenia are far from conclusive. Therefore, this study design was based on the recommended protein intake in relation to the subject's body weight (BW) to evaluate whether adequate protein intake with supplements containing whey protein, leucine, and vitamin D can achieve greater muscle mass and improve muscle strength and function compared to additional protein intake via dietary counseling in the sarcopenic elderly.
Section snippets
Subjects and design
This was a 12-week, double parallel-group clinical prospective cohort study conducted in a tertiary medical center hospital located in New-Taipei City. The study protocol was approved (105096-F) by the institutional review boards of Far Eastern Memorial Hospital. The screening, recruitment and trial period were carried out from Mar, 2017 to Dec, 2017. Study procedures were performed in accordance with the Declaration of Helsinki ethical principles for medical research involving human subjects.
Baseline demographics of the two groups
There were no differences in age, gender distribution and biochemical parameters between the Diet and Supp groups (Table 1). Body composition did not differ between the two groups at the beginning of the clinical trial. However, after 4- and 12-week period of either dietary counseling or the supplement intervention, the BW, FFM and AMM had significantly increased in both the Diet and the Supp groups. In regard to changes in body composition, although participants of both groups gained BW, FM
Discussion
In this study, dietary counselling was provided to all participants to encourage adequate intake of calorie and high quality-protein (1.2–1.5 g/kg BW/day), which is greater than dietary guideline (1.2/kg BW/day) suggest. However, this protein amount is the current recommendation for the elderly as endorsed by the European Society for Clinical Nutrition and Metabolism (ESPEN) [29]. A previous study has shown that insufficient protein intake or consumption of poor-quality protein result in the
Funding sources
The study was supported by a grant (900400110685) from SMAD Biotechnology Co., Ltd. (Taipei, Taiwan).
Author contributions
C-C Lin performed the study, analyzed the data and prepared the draft of the manuscript; M-H Shih and C-D Chen did part of the analysis and helped interpret the data, and S-L Yeh designed the study and revised the manuscript. All authors read and approved the final submitted manuscript.
Conflict of interest
The authors declare that no conflict of interest exists in this study.
Acknowledgments
We are very grateful to all the participants and thank all the staff at the Department of Family Medicine, Far Eastern Memorial Hospital who participated in this study.
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2023, Journal of Functional FoodsEffects of leucine-rich protein supplements in older adults with sarcopenia: A systematic review and meta-analysis of randomized controlled trials
2022, Archives of Gerontology and GeriatricsCitation Excerpt :Therefore, dietary supplementation with leucine has been investigated as one strategy to increase muscle protein synthesis, and is a promising approach for treating sarcopenia (Martínez-Arnau et al., 2019). However, recent studies confirming the effects of nutritional interventions with leucine were not performed specifically in subjects with sarcopenia (Kim et al., 2021) or used a combination of various nutrients including leucine (Lin et al., 2021). Therefore, we conducted a meta-analysis to evaluate whether leucine-rich protein supplement can improve muscle quality and quantity in sarcopenic older adults.