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Systematic Review
The effectiveness of protein supplementation combined with resistance exercise programs among community-dwelling older adults with sarcopenia: a systematic review and meta-analysis
Phatcharaphon Whaikid, Noppawan Piaseu
Epidemiol Health. 2024;46:e2024030.   Published online February 14, 2024
DOI: https://doi.org/10.4178/epih.e2024030
  • 4,100 View
  • 282 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The combination of protein supplementation and resistance exercise shows promise for improving and maintaining muscle mass, strength, and performance in older adults with sarcopenia. This systematic review aimed to evaluate the effects of this combination on muscle mass, muscle strength, and physical performance in community-dwelling older adults with sarcopenia.
METHODS
We conducted a comprehensive search of 4 electronic databases: PubMed, Scopus, Embase, and the MEDLINE Library. The search covered literature from January 2013 to January 2023 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers assessed the methodological quality of each study using the standard critical appraisal tool from the Joanna Briggs Institute (JBI). Meta-analysis was performed with the JBI Sumari program.
RESULTS
The review included 7 randomized controlled trials and 1 quasi-experimental study, encompassing a total of 854 participants aged 60 years and above. The study durations ranged from 10 weeks to 24 weeks. An analysis of standardized mean differences (SMDs) showed that protein supplementation combined with resistance exercise significantly increased muscle mass (SMD, 0.95; 95% confidence interval [CI], 0.13 to 1.78; p<0.05) and muscle strength (SMD, 0.32; 95% CI, 0.08 to 0.56; p<0.05).
CONCLUSIONS
Although the limited number of randomized controlled trials restricts the robustness of our conclusions, the evidence suggests that protein supplementation combined with resistance exercise is effective in enhancing muscle mass and strength in community-dwelling older adults with sarcopenia.
Summary
Key Message
Sarcopenia is a significant health concern. Given the contextual variations and the diverse factors that contribute to the prevalence of sarcopenia, delivering precision interventions to older adults diagnosed with sarcopenia who still reside in the community poses unique challenges. Therefore, precision interventions are vital for proper and feasible treatment planning, especially for early management actions, to reduce the impact of sarcopenia and its associated adverse effects in older adults. Our systematic review and meta-analysis showed that protein supplementation combined with resistance exercise is effective in enhancing muscle mass and strength in community-dwelling older adults with sarcopenia.

Citations

Citations to this article as recorded by  
  • The Impact of Protein in Post-Menopausal Women on Muscle Mass and Strength: A Narrative Review
    Katherine Elizabeth Black, Penelope Matkin-Hussey
    Physiologia.2024; 4(3): 266.     CrossRef
Original Articles
Regional differences in the associations of diet quality, obesity, and possible sarcopenia using the seventh Korea National Health and Nutrition Examination Survey (2016-2018)
Hyeongyeong Lee, Sohyun Park
Epidemiol Health. 2023;45:e2023059.   Published online June 19, 2023
DOI: https://doi.org/10.4178/epih.e2023059
  • 6,002 View
  • 143 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Sarcopenic obesity is closely related to aging and the prevalence of various chronic diseases and frailty. The purpose of this study was to analyze whether diet quality is related to obesity, sarcopenia, and sarcopenic obesity, and if so, to explore the difference in that relationship between urban and rural settings.
METHODS
Using data from the Korea National Health and Nutrition Examination Survey of 2016-2018, a total of 7,151 participants aged 40 years or older were analyzed. Sarcopenia was diagnosed using handgrip strength. Diet quality was assessed using Korea Healthy Eating Index (KHEI) scores, and obesity was determined based on participants’ abdominal circumference. Multinomial logistic analysis was used for testing statistical significance.
RESULTS
Rural participants had significantly lower KHEI scores and a higher prevalence of sarcopenic obesity than urban participants. The study findings demonstrate that participants without obesity, sarcopenia, or sarcopenic obesity had significantly higher KHEI scores in both rural and urban settings. Multinomial regression analysis further revealed that a higher KHEI score was associated with a lower risk of sarcopenia and sarcopenic obesity among urban residents, while only the risk of obesity was lower with higher diet quality scores among rural residents.
CONCLUSIONS
Since diet quality and health status were lower in rural areas, it is important to address this regional disparity with appropriate policy measures. To mitigate urban health disparities, urban residents in poor health with few resources should also be supported.
Summary

Citations

Citations to this article as recorded by  
  • Association of Dietary Protein Sources and Their Adequacy, Body Composition and Risk of Sarcopenic Obesity in South Korean Populations: A Cross-Sectional Study
    Jieun Kim, Kyoungsik Jeong, Sueun Lim, Siwoo Lee, Younghwa Baek
    Metabolites.2024; 14(2): 130.     CrossRef
  • Association of Combining Diet and Physical Activity on Sarcopenia and Obesity in Elderly Koreans with Diabetes
    Sohye Kim, Soojeong Kim, Kyung Hee Hong
    Nutrients.2024; 16(7): 964.     CrossRef
  • Longitudinal association between soft drink consumption and handgrip strength in adults: a prospective analysis from the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) cohort study
    Tongfeng Liu, Shengxin Quan, Ge Meng, Hongmei Wu, Yeqing Gu, Shunming Zhang, Xuena Wang, Juanjuan Zhang, Qing Zhang, Li Liu, Shaomei Sun, Xing Wang, Ming Zhou, Qiyu Jia, Kun Song, Zhongze Fang, Kaijun Niu
    British Journal of Nutrition.2024; 131(12): 1997.     CrossRef
  • Sex-Specific Effects of Dietary Factors on Sarcopenic Obesity in Korean Elderly: A Nationwide Cross-Sectional Study
    Soojeong Kim, Kyung Hee Hong
    Nutrients.2024; 16(8): 1175.     CrossRef
Association between levels of physical activity and low handgrip strength: Korea National Health and Nutrition Examination Survey 2014-2019
Hyungsoon Ahn, Hwa Young Choi, Moran Ki
Epidemiol Health. 2022;44:e2022027.   Published online February 21, 2022
DOI: https://doi.org/10.4178/epih.e2022027
  • 12,891 View
  • 603 Download
  • 9 Web of Science
  • 10 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to investigate the association between levels of physical activity (PA) and low handgrip strength in Korean adults.
METHODS
Our cross-sectional study design included 24,109 Korean adults older than 19 years of age who participated in the Korea National Health and Nutrition Examination Survey 2014–2019. Low handgrip strength is described as hand strength less than the cut-off value of the 20th percentile of handgrip strength from a healthy population in each gender and age group. PA was categorized into three levels (inactive, active, and highly active) according to the World Health Organization’s global recommendations on PA for health. Multivariable logistic regression analysis was used to examine the association between levels of PA and low handgrip strength.
RESULTS
Odds ratios (ORs) for low handgrip strength were significantly higher in middle-aged women who were active (adjusted odds ratio [aOR], 1.40; 95% confidence interval [CI], 1.15 to 1.69) and inactive (aOR, 1.47; 95% CI, 1.23 to 1.76) than in those highly active in walking exercise. Most of older people had significantly higher ORs for low handgrip strength in active compared to highly active in the context of aerobic, muscle strengthening, and walking exercise.
CONCLUSIONS
Walking exercise was associated with a lower risk of sarcopenia in middle-aged women and older individuals. However, further studies are necessary to confirm the causal relationship between levels of PA and low handgrip strength.
Summary
Korean summary
본 연구는 국민건강영양조사 2014-2019년도 자료를 활용하여 한국인 만 19세 이상 건강한 성인을 대상으로 낮은 악력의 기준값을 성별 및 연령그룹별로 도출하고 유산소 운동, 근력 운동, 걷기 운동 수준과 낮은 악력의 연관성을 분석하였다. 분석 결과, 중년 여성과 노년층에서 걷기 운동이 근감소증 발생의 예방과 연관성이 있음을 알 수 있었다.
Key Message
The association between levels of physical activity and low handgrip strength was different by sex and age groups. For women, walking exercise was associated with low handgrip strength, but not for men. By age groups, muscle strengthening exercise could help prevent sarcopenia in the young population, aerobic exercise has the potential to prevent sarcopenia in middle-aged individuals, and walking exercise could reduce sarcopenia risk in older individuals.

Citations

Citations to this article as recorded by  
  • Examining factors contributing to the socioeconomic inequalities in handgrip strength among older adults in India: a decomposition analysis
    Manacy Pai, T. Muhammad
    Scientific Reports.2024;[Epub]     CrossRef
  • Relationship between Handgrip Strength and Incident Diabetes in Korean Adults According to Gender: A Population-Based Prospective Cohort Study
    Sung-Bum Lee, Min-Kyeung Jo, Ji-Eun Moon, Hui-Jeong Lee, Jong-Koo Kim
    Journal of Clinical Medicine.2024; 13(2): 627.     CrossRef
  • Association Between Dietary Fiber Intake and Low Muscle Strength Among Korean Adults
    Sunhye Shin
    Clinical Nutrition Research.2024; 13(1): 33.     CrossRef
  • Do age, gender, and subjective health-related factors influence health-related life satisfaction in people with disabilities who are physically active?: a secondary analysis
    Hyunseok Cho, Sukhee Ahn
    Women's Health Nursing.2024; 30(1): 56.     CrossRef
  • Association of adipose tissue inflammation and physical fitness in older adults
    Anna Tylutka, Barbara Morawin, Natalia Torz, Joanna Osmólska, Kacper Łuszczki, Paweł Jarmużek, Agnieszka Zembron-Lacny
    Immunity & Ageing.2024;[Epub]     CrossRef
  • Association between composite dietary antioxidant index and handgrip strength in American adults: Data from National Health and Nutrition Examination Survey (NHANES, 2011-2014)
    Dongzhe Wu, Hao Wang, Wendi Wang, Chang Qing, Weiqiang Zhang, Xiaolin Gao, Yongjin Shi, Yanbin Li, Zicheng Zheng
    Frontiers in Nutrition.2023;[Epub]     CrossRef
  • Assessment of dynapenia and undernutrition in primary care, a systematic screening study in community medicine
    Marie Treuil, Meliha Mahmutovic, Paolo Di Patrizio, Phi-Linh Nguyen-Thi, Didier Quilliot
    Clinical Nutrition ESPEN.2023; 57: 561.     CrossRef
  • Water Intake and Handgrip Strength in US Adults: A Cross-Sectional Study Based on NHANES 2011–2014 Data
    Dongzhe Wu, Chaoyi Qu, Peng Huang, Xue Geng, Jianhong Zhang, Yulin Shen, Zhijian Rao, Jiexiu Zhao
    Nutrients.2023; 15(20): 4477.     CrossRef
  • Hand Grip Strength, Osteoporosis, and Quality of Life in Middle-Aged and Older Adults
    Hyo Jin Park, Byoungduck Han, So-youn Chang, Seung Ho Kang, Dae Wook Lee, Seok Kang
    Medicina.2023; 59(12): 2148.     CrossRef
  • Lower grip strength and insufficient physical activity can increase depressive symptoms among middle-aged and older European adults: a longitudinal study
    Han Zheng, Qingwen He, Hongyan Xu, Xiaowei Zheng, Yanfang Gu
    BMC Geriatrics.2022;[Epub]     CrossRef
Association of appendicular skeletal muscle mass with carotid intima-media thickness according to body mass index in Korean adults
Ji Eun Heo, Hyeon Chang Kim, Jee-Seon Shim, Bo Mi Song, Hye Yoon Bae, Ho Jae Lee, Il Suh
Epidemiol Health. 2018;40:e2018049.   Published online October 7, 2018
DOI: https://doi.org/10.4178/epih.e2018049
  • 15,262 View
  • 203 Download
  • 17 Web of Science
  • 15 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The combined effects of obesity and appendicular skeletal muscle (ASM) on atherosclerosis, especially in middleaged populations, remain poorly understood. This cross-sectional study investigated the effects of ASM on carotid intima-media thickness (IMT) according to body mass index (BMI) in middle-aged Korean adults.
METHODS
Herein, 595 men and 1,274 women aged 30-64 years completed questionnaires and underwent health examinations as part of the Cardiovascular and Metabolic Disease Etiology Research Center cohort. ASM was measured via bioelectrical impedance analysis and adjusted for weight (ASM/Wt). IMT was assessed using B-mode ultrasonography; highest quartile of IMT was defined as gender-specific top quartile of the IMT values. Higher BMIs was defined as a BMI over 25.0 kg/m2 .
RESULTS
Compared to the highest ASM/Wt quartile, the lowest ASM/Wt quartile was significantly associated with highest quartile of IMT in men with lower BMIs (adjusted odds ratio [aOR], 2.78; 95% confidence interval [CI], 1.09 to 7.13), but not in those with higher BMIs (aOR, 0.59; 95% CI, 0.24 to 1.91). In women, there was no significant association of low skeletal muscle mass with highest quartile of IMT, regardless of BMI.
CONCLUSIONS
Low appendicular skeletal muscle mass is associated with carotid arterial wall thickening in men with lower BMIs, but not in men with higher BMIs. Our findings suggest that the risk of atherosclerosis may be low in middle-aged Korean men with appropriate body weight and skeletal muscle mass maintenance.
Summary
Korean summary
한국 중년 성인을 대상으로 사지근육양과 죽상경화증(경동맥 내중막 두께≥75 percentile)의 관련성을 체질량지수(≥25, <25 kg/m2)로 층화하여 평가하였다. 체질량지수 25 kg/m2 미만인 남자에서는, 사지근육양이 낮으면 죽상경화증의 위험이 유의하게 높았으나, 체질량지수 25 kg/m2 이상인 남자에서는 관련성이 없었다. 반면 여자에서는 체질량지수에 상관없이 사지근육양과 죽상경화증의 독립적인 관련성이 관찰되지 않았다.

Citations

Citations to this article as recorded by  
  • A multifaceted and inclusive methodology for the detection of sarcopenia in patients undergoing bariatric surgery: an in-depth analysis of current evidence
    Eunhye Seo, Yeongkeun Kwon, Ahmad ALRomi, Mohannad Eledreesi, Sungsoo Park
    Reviews in Endocrine and Metabolic Disorders.2024; 25(4): 677.     CrossRef
  • No association between vascular aging and sarcopenia in healthy participants
    Daniel Bunout, Gladys Barrera, Joselyn Arce, Raquel Burrows, Paulina Correa-Burrows, Sandra Hirsch
    Clinical Nutrition ESPEN.2024; 63: 384.     CrossRef
  • Contribution of low skeletal muscle mass in predicting cardiovascular events: A prospective cohort study
    Yiting Xu, Tingting Hu, Yun Shen, Yufei Wang, Yuqian Bao, Xiaojing Ma
    European Journal of Internal Medicine.2023; 114: 113.     CrossRef
  • Low appendicular skeletal muscle index increases the risk of carotid artery plaque in postmenopausal women with and without hypertension/hyperglycemia: a retrospective study
    Yayun Lu, Jianguang Tian, Liangyu Wu, Qing Xia, Qinzhong Zhu
    BMC Geriatrics.2023;[Epub]     CrossRef
  • Relationship between neck vessel abnormalities and sarcopenia: results of a study examining trends in health and aging in western China
    Huaying Ding, Xiaoyan Chen, Sha Huang, Birong Dong
    European Geriatric Medicine.2023; 15(1): 253.     CrossRef
  • A new paradigm in sarcopenia: Cognitive impairment caused by imbalanced myokine secretion and vascular dysfunction
    Danbi Jo, Gwangho Yoon, Oh Yoen Kim, Juhyun Song
    Biomedicine & Pharmacotherapy.2022; 147: 112636.     CrossRef
  • Low serum creatinine to cystatin C ratio is independently associated with sarcopenia and high carotid plaque score in patients with type 2 diabetes
    Jang Yel Shin
    Nutrition, Metabolism and Cardiovascular Diseases.2022; 32(6): 1454.     CrossRef
  • Association of High Muscle Mass with Carotid Atherosclerosis: A Community-Based Population Cohort Study
    Y. Xu, T. Hu, Y. Shen, Y. Wang, Xiaojing Ma, Yuqian Bao
    The Journal of nutrition, health and aging.2022; 26(12): 1087.     CrossRef
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    Ming-Feng Xia, Ling-Yan Chen, Li Wu, Hui Ma, Xiao-Ming Li, Qian Li, Qiqige Aleteng, Yu Hu, Wan-Yuan He, Jian Gao, Huan-Dong Lin, Xin Gao
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    Jang Yel Shin, Jung Soo Lim
    Nutrition, Metabolism and Cardiovascular Diseases.2021; 31(10): 2935.     CrossRef
  • Low muscle mass is associated with carotid atherosclerosis in patients with type 2 diabetes
    Da Hea Seo, Yong-ho Lee, Young Ju Suh, Seong Hee Ahn, Seongbin Hong, Young Ju Choi, Byoung Wook Huh, Seok Won Park, Eunjig Lee, So Hun Kim
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    Soon-Kyu Yoon, Ha-Na Kim, Sang-Wook Song
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  • Impact of sarcopenia on glycemic control and atherosclerosis in Japanese patients with type 2 diabetes: Cross‐sectional study using outpatient clinical data
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