Role of insulin in the regulation of human skeletal muscle protein synthesis and breakdown: a systematic review and meta-analysis
Open accessAbstract
Aims/hypothesis We aimed to investigate the role of insulin in regulating human skeletal muscle metabolism in health and diabetes.Methods We conducted a systematic review and meta-analysis of published data that examined changes in skeletal muscle protein synthesis (MPS) and/or muscle protein breakdown (MPB) in response to insulin infusion. Random-effects models were used to calculate weighted mean differences (WMDs), 95% CIs and corresponding p values. Both MPS and MPB are reported in units of nmol (100 ml leg vol.)(-1) min(-1).Results A total of 104 articles were examined in detail. Of these, 44 and 25 studies (including a total of 173 individuals) were included in the systematic review and meta-analysis, respectively. In the overall estimate, insulin did not affect MPS (WMD 3.90 [95% CI -0.74, 8.55], p = 0.71), but significantly reduced MPB (WMD -15.46 [95% CI -19.74, -11.18], p < 0.001). Overall, insulin significantly increased net balance protein acquisition (WMD 20.09 [95% CI 15.93, 24.26], p < 0.001). Subgroup analysis of the effect of insulin on MPS according to amino acid (AA) delivery was performed using meta-regression analysis. The estimate size (WMD) was significantly different between subgroups based on AA availability (p = 0.001). An increase in MPS was observed when AA availability increased (WMD 13.44 [95% CI 4.07, 22.81], p < 0.01), but not when AA availability was reduced or unchanged. In individuals with diabetes and in the presence of maintained delivery of AA, there was a significant reduction in MPS in response to insulin (WMD -6.67 [95% CI -12.29, -0.66], p < 0.05).Conclusions/interpretation This study demonstrates the complex role of insulin in regulating skeletal muscle metabolism. Insulin appears to have a permissive role in MPS in the presence of elevated AAs, and plays a clear role in reducing MPB independent of AA availability.
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Insulin's impact on net protein balance operates most powerfully in an anti-catabolic manner on muscle.
“insulin’s impact on net protein balance seems to operate most powerfully in an anti-catabolic manner on muscle [102].”
From International Society of Sports Nutrition Position Stand: protein and exercise (2017) · cites this paper as [102]
Insulin promotes anti-catabolic effects in muscle, thereby shifting protein balance to favor anabolism.
“Specifically, insulin promotes anti-catabolic effects in muscle [101], thereby shifting protein balance to favor anabolism.”
From International society of sports nutrition position stand: nutrient timing (2017) · cites this paper as [101]
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- Authors
- Abdulla, H., Smith, K., Atherton, P. J., & Idris, I.
- Affiliations
- University of Nottingham (GB)
- Corresponding author
- Idris, Iskandar
- Venue
- Diabetologia
- Published
- 2015-09-24
- Volume
- 59
- Issue
- 1
- Pages
- 44-55
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2134934441
- Cited by
- 229
- References
- 55
- Citations by year
- 2026: 21 · 2025: 24 · 2024: 26 · 2023: 24 · 2022: 22 · 2021: 25 · 2020: 30 · 2019: 19 · 2018: 18 · 2017: 11 · 2016: 9
- FWCI
- 1.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (NIHR-INF-0274)
- Diabetes UK
- University of Nottingham
- Biotechnology and Biological Sciences Research Council (BB/K019104/1)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
- Keywords
- insulin, skeletal muscle protein synthesis, muscle protein degradation, net protein balance, amino acid availability, diabetes mellitus, muscle metabolism, insulin infusion
- MeSH terms
- Diabetes Mellitus, Type 2, Humans, Insulin, Insulin Resistance, Muscle Proteins, Phenylalanine, Signal Transduction, Muscle, Skeletal
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