Protein Supplements and Exercise for Sarcopenic Obesity: Benefits and Negative Effects
Main Article Content
Abstract
Background Protein supplements are commonly utilized by elderly persons who are suffering from sarcopenic obesity. Despite its popularity, however, there is currently a paucity of clear evidence on the possible benefits and negative effects of protein supplements and exercise on sarcopenic obesity (SO).
Objective Thus, we wanted to see how protein supplementation and exercise affected older persons with sarcopenic obesity. Method A thorough database search was carried out to look for randomised controlled trials, quasi experimental studies, and pre-post research designs addressing the effects of protein supplementation on reducing sarcopenic obesity in older persons. This scoping review was carried out via PubMed, Embase, Web of Science, and the Cochrane Library databases using PRISMA-Scr protocols. Two independent reviewers conducted a thorough systematic screening approach to determine record eligibility.
Results Seven papers met the inclusion criteria out of the 1,811 citations found. Six of the investigations were randomized controlled trials, while one was a pre-post test study. The majority of research addressed the usage of protein supplements as well as exercise training. The protein intake for the intervention group in the included trials ranged from 1.0 to 1.8 g/kg/BW/day, while the duration of exercise conducted ranged from 2 to 3 times per week, with each session lasting 1 hour. Whey protein supplementation has been demonstrated to improve sarcopenic symptoms and weight status in SO people. The combination of resistance training and protein supplementation produced additional benefits in terms of lean muscle mass as well as biomarkers. The study also discovered a lack of uniformity in exercise design among sarcopenic obesity therapies.
Conclusion Overall, the combination of resistance training and whey protein supplementation appears to be a good alternative for SO persons seeking to enhance their sarcopenic state and weight status. It does, however, underline the need for prudence when it comes to high protein consumption prescription. Given the scarcity of studies in this area, more research into the appropriate exercise plan for this demographic is necessary.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. United Nations. Population ageing and sustainable development. 2017. https://www.un.org/en/development/desa/population/publications/pdf/ popfacts/PopFacts_2017-1.pdf. Accessed 15 March 2023.
II. World Health Organization (WHO). Ageing and health. 2022. https://www. who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed 15 March 2023.
III. Sudharsanan N, Bloom DE. The demography of aging in low- and middle- income countries: chronological versus functional perspectives. https://www. ncbi.nlm.nih.gov/books/NBK513069/. Accessed 15 March 2023.
IV. Jaul E, Barron J. Age-related diseases and clinical and public health implications for the 85 years old and over population. Front Public Health. 2017;5:355. https://doi.org/10.3389/fpubh.2017.00335.
V. Papadopoulou SK. Sarcopenia: a contemporary health problem among older adult populations. Nutrients. 2020;12(5):1293. https://doi.org/10.3390/ nu12051293.
VI. Chew STH, Tey SL, Yalawar M, Liu Z, Baggs G, How CH, et al. Prevalence and associated factors of sarcopenia in community-dwelling older adults at risk of malnutrition. BMC Geriatr. 2022;22(1):997. https://doi.org/10.1186/ s12877-022-03704-1.
VII. Sri-on J, Fusakul Y, Kredarunsooksree T, Paksopis T, Ruangsiri R. The prevalence and risk factors of sarcopenia among thai community-dwelling older adults as defined by the asian working group for sarcopenia (awgs-2019) criteria: a cross-sectional study. BMC Geriatr. 2022;22(1):786. https://doi.org/10.1186/ s12877-022-03471-z.
VIII. Batsis JA, Villareal DT. Sarcopenic obesity in older adults: aetiology, epidemiol- ogy and treatment strategies. Nat Rev Endocrinol. 2018;14(9):513–37. https:// doi.org/10.1038/s41574-018-0062-9.
IX. Purcell SA, Mackenzie M, Barbosa-Silva TG, Dionne IJ, Ghosh S, Siervo M, et al. Prevalence of sarcopenic obesity using different definitions and the relation- ship with strength and physical performance in the canadian longitudinal study of aging. Front Physiol. 2021;11:583825. https://doi.org/10.3389/ fphys.2020.583825.
X. Pang BWJ, Wee S-L, Lau LK, Jabbar KA, Seah WT, Ng DHM, et al. Prevalence and associated factors of sarcopenia in singaporean adults—the yishun study. J Am Med Dir Assoc. 2021;22(4):885.e1-.e10 https://doi.org/10.1016/j. jamda.2020.05.029.
XI. Ranee R, Suzana S, You YY, Devinder KAS, Sakian NI. Prevalence and risk fac- tors of sarcopenia among community dwelling older adults in klang valley. Malaysian J Med Health Sci. 2022;18(1):177–86.
XII. Wagenaar CA, Dekker LH, Navis GJ. Prevalence of sarcopenic obesity and sarcopenic overweight in the general population: the lifelines cohort study. Clin Nutr. 2021;40(6):4422–9. https://doi.org/10.1016/j.clnu.2021.01.005.
XIII. Li CW, Yu KA-O, Shyh-Chang N, Jiang Z, Liu T, Ma S, et al. Pathogenesis of sarcopenia and the relationship with fat mass: descriptive review. J Cachexia Sarcopenia Muscle. 2022;13(2):781–94. https://doi.org/10.1002/jcsm.12901.
XIV. Su Y-C, Chang S-F, Tsai H-C. The relationship between sarcopenia and injury events: a systematic review and meta-analysis of 98,754 older adults. J Clin Med. 2022;11:6474. https://doi.org/10.3390/jcm11216474.
XV. Yuenyongchaiwat K, Boonsinsukh R. Sarcopenia and its relationships with depression, cognition, and physical activity in thai community-dwelling older adults. Curr Gerontol Geriatr Res. 2020;2020:8041489. https://doi. org/10.1155/2020/8041489.
XVI. Kelley GA, Kelley KS. Is sarcopenia associated with an increased risk of
XVII. all-cause mortality and functional disability? Exp. Gerontol. 2017;96:100–3. https://doi.org/10.1016/j.exger.2017.06.008.
XVIII. Stenholm S, Harris Tb Fau - Rantanen T, Rantanen T, Fau - Visser M, Visser M, Fau - Kritchevsky SB, Kritchevsky Sb Fau -, Ferrucci L, Ferrucci L. Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care. 2008;11(6):693–700. https://doi.org/10.1097/MCO.0b013e328312c37d.
XIX. Hong S-h, Choi KM. Sarcopenic obesity, insulin resistance, and their implications in cardiovascular and metabolic consequences. Int J Mol Sci. 2020;21(2):494. https://doi.org/10.3390/ijms21020494.
XX. Fruh SM, Obesity. Risk factors, complications, and strategies for sustainable long-term weight management. J Am Assoc Nurse Pract. 2017;29(S1):3–14. https://doi.org/10.1002/2327-6924.12510.
XXI. Morgan PT, Smeuninx B, Breen L. Exploring the impact of obesity on skeletal muscle function in older age. Front nutr. 2020;7:569904. https://doi. org/10.3389/fnut.2020.569904.
XXII. Bellanti F, Romano AD, Lo Buglio A, Castriotta V, Guglielmi G, Greco A, et al. Oxidative stress is increased in sarcopenia and associated with cardiovascu- lar disease risk in sarcopenic obesity. Maturitas. 2018;109:6–12. https://doi. org/10.1016/j.maturitas.2017.12.002.
XXIII. Chen L-K, Woo J, Assantachai P, Auyeung T-W, Chou M-Y, Iijima K, et al. Asian working group for sarcopenia: 2019 consensus update on sarcopenia diag- nosis and treatment. J Am Med Dir Assoc. 2020;21(3):300–7e2. https://doi. org/10.1016/j.jamda.2019.12.012.
XXIV. Roh E, Choi KM. Health consequences of sarcopenic obesity: a narra- tive review. Front Endocrinol. 2020;11:332. https://doi.org/10.3389/ fendo.2020.00332.
XXV. Verreijen AM, Verlaan S, Engberink MF, Swinkels S, de Vogel-van den Bosch J, Weijs PJ. A high whey protein-, leucine-, and vitamin D-enriched supplement preserves muscle mass during intentional weight loss in obese older adults: a double-blind randomized controlled trial. Am J Clin Nutr. 2015;101(2):279–86. https://doi.org/10.3945/ajcn.114.090290.
XXVI. Bauer JM, Mikušová L, Verlaan S, Bautmans I, Brandt K, Donini LM, et al. Safety and tolerability of 6-month supplementation with a vitamin D, calcium and leucine-enriched whey protein medical nutrition drink in sarcopenic older adults. Aging Clin Exp Res. 2020;32(8):1501–14. https://doi.org/10.1016/j. jamda.2013.05.021.
XXVII. Jang YJ. The effects of protein and supplements on sarcopenia in human clinical studies: how older adults should consume protein and supple- ments. J Microbiol Biotechnol. 2023;33:143–50. https://doi.org/10.4014/ jmb.2210.10014.
XXVIII. Kamińska MS, Rachubińska K, Grochans S, et al. The impact of whey protein supplementation on sarcopenia progression among the elderly: a systematic review and meta-analysis. Nutrients. 2023;15:2039. https://doi.org/10.3390/ nu15092039.
XXIX. Lee SY, Lee HJ, Lim J-Y. Effects of leucine-rich protein supplements in older adults with sarcopenia: a systematic review and meta-analysis of random- ized controlled trials. Arch Gerontol Geriatr. 2022;102:104758. https://doi. org/10.1016/j.archger.2022.104758.
XXX. Hita-Contreras F, Bueno-Notivol J, Martínez-Amat A, Cruz-Díaz D, Hernan- dez AV, Pérez-López FR. Effect of exercise alone or combined with dietary supplements on anthropometric and physical performance measures in community-dwelling elderly people with sarcopenic obesity: a meta-analysis of randomized controlled trials. Maturitas. 2018;116:24–35. https://doi. org/10.1016/j.maturitas.2018.07.007.
XXXI. Martone AM, Marzetti EA-O, Calvani R et al. Exercise and protein intake: a syn- ergistic approach against sarcopenia. BioMed Res. Int. 2017; 2017: 2672435. https://doi.org/10.1155/2017/2672435.
XXXII. Li L, He Y, Jin N, et al. Effects of protein supplementation and exercise on delaying sarcopenia in healthy older individuals in asian and non-asian coun- tries: a systematic review and meta-analysis. Food Chem: X. 2022;13:100210. https://doi.org/10.1016/j.fochx.2022.100210.
XXXIII. Hsu K-J, Liao C-D, Tsai M-W, Chen C-N. Effects of exercise and nutritional inter- vention on body composition, metabolic health, and physical performance in adults with sarcopenic obesity: a meta-analysis. Nutrients. 2019;11(9). https://doi.org/10.3390/nu11092163.
XXXIV. Eglseer D, Traxler M, Schoufour JD, Weijs PJM, Voortman T, Boirie Y, et al. Nutritional and exercise interventions in individuals with sarcopenic obesity around retirement age: a systematic review and meta-analysis. Nutr Rev. 2023;nuad007. https://doi.org/10.1093/nutrit/nuad007.
XXXV. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32. https://doi.org/10.1080/1364557032 000119616.
XXXVI. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (prisma-scr): checklist and explanation. Ann Intern Med. 2018;169(7):467–73. https://doi.org/10.7326/M18-0850.
XXXVII. Maltais ML, Perreault KF, Courchesne-Loyer A, Lagacé JC, Barsalani R, et al. Effect of resistance training and various sources of protein supplementation on body fat mass and metabolic profile in sarcopenic overweight older adult men: a pilot study. Int J Sport Nutr Exerc Metab. 2016;26(1):71–7. https://doi. org/10.1123/ijsnem.2015-0160.
XXXVIII. Kim H, Kim M, Kojima N, Fujino K, Hosoi E, Kobayashi H, et al. Exercise and nutritional supplementation on community-dwelling elderly japanese women with sarcopenic obesity: a randomized controlled trial. J Am Med Dir Assoc. 2016;17(11):1011–9. https://doi.org/10.1016/j.jamda.2016.06.016.
XXXIX. Sammarco R, Marra M, Di Guglielmo ML, Naccarato M, Contaldo F, et al. Evaluation of hypocaloric diet with protein supplementation in middle-aged sarcopenic obese women: a pilot study. Obes Facts. 2017;10(3):160–7. https:// doi.org/10.1159/000468153.
XL. Kemmler W, Weissenfels A, Teschler M, Willert S, Bebenek M, Shojaa M, et al. Whole-body electromyostimulation and protein supplementation favorably affect sarcopenic obesity in community-dwelling older men at risk: the randomized controlled FranSO study. Clin Interv Aging. 2017;12:1503–13. https://doi.org/10.2147/CIA.S137987.
XLI. Kemmler W, Kohl M, Freiberger E, Sieber C, von Stengel S. Effect of
XLII. whole-body electromyostimulation and / or protein supplementation on obesity and cardiometabolic risk in older men with sarcopenic obesity: the randomized controlled FranSO trial. BMC Geriatr. 2018;18(1):70. https://doi. org/10.1186/s12877-018-0759-6.
XLIII. Nabuco HCG, Tomeleri CM, Fernandes RR, Sugihara Junior P, Cavalcante EF, Cunha PM, et al. Effect of whey protein supplementation combined with resistance training on body composition, muscular strength, functional capacity, and plasma-metabolism biomarkers in older women with sarcope- nic obesity: a randomized, double-blind, placebo-controlled trial. Clin Nutr ESPEN. 2019;32:88–95. https://doi.org/10.1016/j.clnesp.2019.04.007.
XLIV. Camajani EA-O, Persichetti A, Watanabe MA-O, Contini S, Vari M, Di Bernardo S, et al. Whey protein, l-leucine and vitamin d supplementation for preserving lean mass during a low-calorie diet in sarcopenic obese women. Nutrients. 2022;14(9):1884. https://doi.org/10.3390/nu14091884.
XLV. Chen N, He X, Feng Y, et al. Effects of resistance training in healthy older peo- ple with sarcopenia: a systematic review and meta-analysis of randomized controlled trials. Eur Rev Aging Phys Act. 2021;18:23. https://doi.org/10.1186/ s11556-021-00277-7.
XLVI. Gilmartin S, O’Brien N, Giblin LA-O. Whey for sarcopenia: can whey peptides, hydrolysates or proteins play a beneficial role? Foods. 2020;9:750. https://doi. org/10.3390/foods9060750.
XLVII. Guo Y, Fu X, Hu Q, Chen L, Zuo H. The effect of leucine supplementation on sarcopenia-related measures in older adults: a systematic review and meta- analysis of 17 randomized controlled trials. Front Nutr. 2022;9:929891. https:// doi.org/10.3389/fnut.2022.929891.
XLVIII. Chang MA-O, Choo YA-O. Effects of whey protein, leucine, and vitamin d supplementation in patients with sarcopenia: a systematic review and meta- analysis. Nutrients. 2023;15(3):521. https://doi.org/10.3390/nu15030521.
XLIX. Otsuka Y, Yamada Y, Maeda A, et al. Effects of resistance training intensity on muscle quantity/quality in middle-aged and older people: a randomized controlled trial. J Cachexia Sarcopenia Muscle. 2022;13:894–908. https://doi. org/10.1002/jcsm.12941.
L. Hurst C, Robinson SM, Witham MD, Dodds RM, Granic A, Buckland C, et al. Resistance exercise as a treatment for sarcopenia: prescription and delivery. Age Ageing. 2022;51:afac003. https://doi.org/10.1093/ageing/afac003.
LI. Waters DL, Aguirre L, Gurney B, Sinacore DR, Fowler K, Gregori G, et al. Effect of aerobic or resistance exercise, or both, on intermuscular and visceral fat and physical and metabolic function in older adults with obesity while diet- ing. J Gerontol A Biol Sci Med Sci. 2022;77(1):131–9. https://doi.org/10.1093/ gerona/glab111.
LII. Kemmler W, Shojaa M, Steele J, Berger J, Fröhlich M, Schoene D, et al. Efficacy of whole-body electromyostimulation (wb-ems) on body composition
LIII. and muscle strength in non-athletic adults. A systematic review and meta-analysis. Front Physiol. 2021;26(12):640657. https://doi.org/10.3389/ fphys.2021.640657.
LIV. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, et al. Sarcopenia: european consensus on definition and diagnosis: report of the european working group on sarcopenia in older people. Age Ageing. 2010;39(4):412–
LV. 23. https://doi.org/10.1093/ageing/afq034.
LVI. Muscaritoli M, Anker SD, Argilés J, Aversa Z, Bauer JM, et al. Consensus defini- tion of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) cachexia-anorexia in chronic wasting diseases and nutrition in geriatrics. Clin Nutr. 2010;29(2):154–9. https://doi. org/10.1016/j.clnu.2009.12.004.
LVII. Morley JE, Abbatecola AM, Argiles JM, Baracos V, Bauer J, et al. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc. 2011;12(6):403–9. https://doi.org/10.1016/j.jamda.2011.04.014.
LVIII. Stojković M, Heinrich KM, Čvorović A, Jeknić V, Greco G, Kukić F. Accuracy of body mass index and obesity status in police trainees. Eur J Investig Health Psychol Educ. 2022;12(1):42–9. https://doi.org/10.3390/ejihpe12010004.
LIX. Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE study group. J Am Med Dir Assoc. 2013;14(8):542–59. https://doi.org/10.1016/j.jamda.2013.05.021.
LX. Deutz NEP, Bauer JM, Barazzoni R, Biolo G, Boirie Y, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN expert group. Clin Nutr. 2014;33:929–36. https://doi.org/10.1016/j. clnu.2014.04.007.
LXI. Morley JE, Argiles JM, Evans WJ, Bhasin S, Cella D, et al. Nutritional recom- mendations for the management of sarcopenia. J Am Med Dir Assoc. 2010;11(6):391–6. https://doi.org/10.1016/j.jamda.2010.04.014.
LXII. van Dronkelaar C, van Velzen A, Abdelrazek M, van der Steen A, Weijs PJM, Tieland M. Minerals and sarcopenia; the role of calcium, iron, magnesium, phosphorus, potassium, selenium, sodium, and zinc on muscle mass, muscle strength, and physical performance in older adults: a systematic review. J Am Med Dir Assoc. 2018;19:6–11e13. https://doi.org/10.1016/j.jamda.2017.05.026.
LXIII. Bhattacharya S, Bhadra R, Schols A, van Helvoort A, Sambashivaiah S. Nutrition in the prevention and management of sarcopenia - a special focus on asian Indians. Osteoporos Sarcopenia. 2022;8:135–44. https://doi. org/10.1016/j.afos.2022.12.002.