Effects of protein supplementation on lean body mass, muscle strength, and physical performance in nonfrail community-dwelling older adults: a systematic review and meta-analysis
Open accessAbstract
Background Increasing protein intake has been suggested as an effective strategy to ameliorate age-related loss of muscle mass and strength. Current reviews assessing the effect of protein supplementation are strongly influenced by the inclusion of studies with frail older adults.Objectives We assessed the effect of protein supplementation on lean body mass, muscle strength, and physical performance in exclusively nonfrail community-dwelling older adults. Moreover, we assessed the superior effects of protein supplementation during concomitant resistance exercise training on muscle characteristics.Design A systematic literature search was conducted on PubMed, Embase, and Web of Science up to 15 May 2018. We included randomized controlled trials that assessed the effect of protein supplementation on lean body mass, muscle thigh cross-sectional area, muscle strength, gait speed, and chair-rise ability and performed random-effects meta-analyses.Results Data from 36 studies with 1682 participants showed no significant effects of protein supplementation on changes in lean body mass [standardized mean difference (SMD): 0.11; 95% CI: -0.06, 0.28], handgrip strength (SMD: 0.58; 95% CI: -0.08, 1.24), lower extremity muscle strength (SMD: 0.03; 95% CI: -0.20, 0.27), gait speed (SMD: 0.41; 95% CI: -0.04, 0.85), or chair-rise ability (SMD: 0.10; 95%: CI -0.08, 0.28) compared with a control condition in nonfrail community-dwelling older adults. Moreover, no superior effects of protein supplementation were found during concomitant resistance exercise training on muscle characteristics.Conclusions Protein supplementation in nonfrail community-dwelling older adults does not lead to increases in lean body mass, muscle cross-sectional area, muscle strength, or physical performance compared with control conditions; nor does it exert superior effects when added to resistance exercise training. Habitual protein intakes of most study participants were already sufficient, and protein interventions differed in terms of type of protein, amount, and timing. Future research should clarify what specific protein supplementation protocol is beneficial for nonfrail community-dwelling older adults with low habitual protein intake.
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The effects of protein ingestion independent of resistance exercise are not commonly explored.
“However, the effects of protein ingestion independent of RE are not commonly explored.”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [22]
The Selection of studies for the meta-analysis section (page unavailable) reports 11 studies assessing protein supplementation without concomitant resistance exercise, versus 18 assessing its additional effect during resistance exercise. This supports the narrower point that independent effects were studied less often in nonfrail community-dwelling older adults, but not the unqualified claim that they are uncommonly explored generally. (LLM, conf=0.83)
Experimental — accuracy not yet measuredProtein supplementation rarely substantially affects strength outcomes, which highlights that the extra LBM gain stimulated by protein supplementation may not be muscle, or at least not sufficient muscle that is contributing to increases in strength.
“This question is relevant as protein supplementation rarely substantially affects strength outcomes, 14 , 21 , 22 , 23 which highlights that the extra LBM gain stimulated by protein supplementation may not be muscle, 111 or at least not sufficient muscle that is contributing to increases in strength.”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [22]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe insertion of clinical trials testing multi-ingredient supplements, including energy-restricted weight-loss diets, or using different cut-off points for age sub-groups likely explains differences in main effects and conclusions when comparing studies.
“The insertion of clinical trials testing multi‐ingredient supplements, 106 including energy‐restricted weight‐loss diets, 13 or using different cut‐off points for age sub‐groups likely explain the differences in main effects and conclusions when comparing studies. 14 , 21 , 22 , 23”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [22]
The Study selection section defines older adults using an average age of at least 50 years, and the Limitations section says the review included protein-based multi-ingredient supplements and that varied supplementation strategies introduced heterogeneity. But Study selection explicitly excludes interventions with energy-intake restriction, and the cited passages do not establish that differing age cutoffs explain differences in conclusions between reviews. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSome particularities in the inclusion criteria in these two meta-analyses (i.e. aerobic exercise training or the cut-off point during age subgroup analysis) might cause such contrast compared with our findings.
“However, some particularities in the inclusion criteria in these two meta‐analyses (i.e. aerobic exercise training or the cut‐off point during age subgroup analysis) might cause such contrast compared with our findings.”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [22]
The Study selection section defines older adults as participants with an average age of at least 50 years, supporting the point about an age cutoff. It also includes studies with resistance training, but the passages do not establish that aerobic exercise training was an inclusion criterion. The proposed explanation for the contrast is the citing authors’ own inference, not a finding attributed to this review. (LLM, conf=0.78)
Experimental — accuracy not yet measuredAccording to previous meta-analyses, the effects of increasing daily protein ingestion on muscle strength are highly variable.
“According to previous meta‐analyses from our group and others, the effects of increasing daily protein ingestion on muscle strength are highly variable. 14 , 21 , 22 , 23”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [22]
The Muscle strength results (page unavailable) report significant heterogeneity in handgrip-strength effects, supporting variability for that outcome. But they report no heterogeneity for lower-extremity strength or for strength outcomes during resistance training; the Limitations section likewise says significant heterogeneity occurred in only two forest plots, just one of which concerned strength. Thus this source does not support describing muscle-strength effects generally as highly variable. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Haaf et al. 22 found no effect of additional protein supplementation on LBM in non-frail community-dwelling older adults (>50 years old), even when combined with resistance exercise (≥4 weeks).
“Conversely, Haaf et al. 22 found no effect of additional protein supplementation in LBM in non‐frail community‐dwelling older adults (>50 years old), even when combined with resistance exercise (≥4 weeks).”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [22]
Wirth et al. 21 and Haaf et al. 22 found no effect of additional protein ingestion and exercise on lower-body strength.
“In contrast, Wirth et al. 21 and Haaf et al. 22 found no effect of additional protein ingestion and exercise on lower‐body strength.”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [22]
Our results are in line with a previous meta-analysis 22 showing no significant effect of protein ingestion added to RE on gait speed or chair-rise time in healthy subjects.
“Our results are in line with a previous meta‐analysis 22 showing no significant effect of protein ingestion added to RE on gait speed or chair‐rise time in healthy subjects.”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [22]
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Aerobic training and postexercise protein in facioscapulohumeral muscular dystrophy
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Oral Amino Acids in Elderly Subjects: Effect on Myocardial Function and Walking Capacity
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Barazzoni, R., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Higashiguchi, T., Shi, H. P., Bischoff, S. C., Boirie, Y., Carrasco, F., Cruz-Jentoft, A., et al. (2022) · Clinical Nutrition · doi:10.1016/j.clnu.2022.02.001 · Cited by 406 · see citing works
Nunes, E. A., Colenso‐Semple, L., McKellar, S. R., Yau, T., Ali, M. U., Fitzpatrick‐Lewis, D., Sherifali, D., Gaudichon, C., Tomé, D., Atherton, P. J., et al. (2022) · Journal of Cachexia, Sarcopenia and Muscle · doi:10.1002/jcsm.12922 · Cited by 280 · see citing works
Morin, S. N., Feldman, S., Funnell, L., Giangregorio, L., Kim, S. S. Y., McDonald-Blumer, H., Santesso, N. A., Ridout, R., Ward, W. E., Ashe, M. C., et al. (2023) · Canadian Medical Association Journal · doi:10.1503/cmaj.221647 · Cited by 212 · see citing works
Strategies to Prevent Sarcopenia in the Aging Process: Role of Protein Intake and Exercise
Rogeri, P. S., Zanella, R., Martins, G. L., Garcia, M. D. A., Leite, G., Lugaresi, R., Gasparini, S. O., Sperandio, G. A., Ferreira, L. H. B., Souza-Junior, T. P., et al. (2021) · Nutrients · doi:10.3390/nu14010052 · Cited by 181 · see citing works
“Additionally, two meta-analyses corroborate the findings of these two studies, suggesting that protein supplementation alone may not be enough to promote positive changes in skeletal muscle mass in older adults [130,131].”
ResultWu, P.-Y., Huang, K.-S., Chen, K.-M., Chou, C.-P., & Tu, Y.-K. (2021) · Maturitas · doi:10.1016/j.maturitas.2020.12.009 · Cited by 168 · see citing works
Muscular Strength and Cardiovascular Disease
Carbone, S., Kirkman, D. L., Garten, R. S., Rodriguez‐Miguelez, P., Artero, E. G., Lee, D.-C., & Lavie, C. J. (2020) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000525 · Cited by 146 · see citing works
Compher, C., Cederholm, T., Correia, M. I. T. D., Gonzalez, M. C., Higashiguch, T., Shi, H. P., Bischoff, S. C., Boirie, Y., Carrasco, F., Cruz‐Jentoft, A., et al. (2022) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.2366 · Cited by 125 · see citing works
A word of caution against excessive protein intake
Mittendorfer, B., Klein, S., & Fontana, L. (2019) · Nature Reviews Endocrinology · doi:10.1038/s41574-019-0274-7 · Cited by 122 · see citing works
Tagawa, R., Watanabe, D., Ito, K., Ueda, K., Nakayama, K., Sanbongi, C., & Miyachi, M. (2021) · Nutrition Reviews · doi:10.1093/nutrit/nuaa104 · Cited by 118 · see citing works
“However, although some randomized controlled trials (RCTs) reported increased skeletal muscle mass following intake of more than the required amount of protein, no consistent results have been demonstrated.(12) A recent meta-analysis of RCTs reported the dose– response relationship between protein intake and increased…”
BackgroundThe role of nutrition in the prevention of sarcopenia
Robinson, S. M., Granic, A., Cruz-Jentoft, A. J., & Sayer, A. A. (2023) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2023.08.015 · Cited by 106 · see citing works
Nutrition in Menopausal Women: A Narrative Review
Silva, T. R., Oppermann, K., dos Reis, F. M., & Spritzer, P. M. (2021) · Nutrients · doi:10.3390/nu13072149 · Cited by 97 · see citing works
“A meta-analysis of 36 RCTs with 1682 participants concluded that protein supplementation, from 6 to 78 weeks, does not lead to increase in LBM in non-frail community-dwelling older adults [25].”
MethodNutrition and Muscle Strength, As the Key Component of Sarcopenia: An Overview of Current Evidence
Robinson, S. M., Granic, A., & Sayer, A. A. (2019) · Nutrients · doi:10.3390/nu11122942 · Cited by 93 · see citing works
“08), there were no differences in lower extremity strength [71].”
BackgroundKirwan, R., Mazidi, M., Rodríguez‐García, C., Lane, K. E., Jafari, A., Butler, T., de Heredia, F. P., & Davies, I. G. (2021) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqab355 · Cited by 93 · see citing works
Wirth, J., Hillesheim, E., & Brennan, L. (2020) · The Journal of Nutrition · doi:10.1093/jn/nxaa049 · Cited by 87 · see citing works
“Recent meta-analyses have suggested a positive effect of protein supplementation on muscle strength for frail (83) but not for nonfrail older subjects (5).”
BackgroundResultBai, G.-H., Tsai, M.-C., Tsai, H.-W., Chang, C., & Hou, W. (2021) · European Journal of Nutrition · doi:10.1007/s00394-021-02710-0 · Cited by 74 · see citing works
Roschel, H., Hayashi, A. P., Fernandes, A. L., Filho, J. C. J., Hevia-Larraín, V., de Capitani, M. D., de Santana, D. A., Gonçalves, L. D. S., de Sá‐Pinto, A. L., Lima, F. R., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.06.024 · Cited by 67 · see citing works
Optimizing Adult Protein Intake During Catabolic Health Conditions
Phillips, S. M., Paddon-Jones, D., & Layman, D. K. (2020) · Advances in Nutrition · doi:10.1093/advances/nmaa047 · Cited by 65 · see citing works
“Although observational evidence is interesting, interventional trials examining the efficacy of higher protein intakes alone in improving muscle mass or strength are less convincing with some meta-analyses showing no effect (53, 54), whereas others have observed improved physical function with protein supplementation…”
BackgroundPhase angle predicts physical function in older adults.
Matias, C., Nunes, C. L., Francisco, S., Tomeleri, C., Cyrino, E., Sardinha, L., & Silva, A. M. (2020) · Archives of gerontology and geriatrics (Print) · doi:10.1016/j.archger.2020.104151 · Cited by 55 · see citing works
Martin-Cantero, A., Reijnierse, E. M., Gill, B. M. T., & Maier, A. B. (2021) · Nutrition Reviews · doi:10.1093/nutrit/nuaa064 · Cited by 58 · see citing works
“Simultaneously, protein supplementation could augment the effects of resistance exercise training compared with exercise alone; however, results are contradictory.(8,73,77,78) All protein interventions contained a certain dose of AAs; however, the protein plus AA group had a greater improvement in muscle mass measures…”
BackgroundResultGranic, A., Dismore, L. L., Hurst, C., Robinson, S. M., & Sayer, A. A. (2020) · Nutrients · doi:10.3390/nu12082257 · Cited by 58 · see citing works
Kirk, B., Mooney, K., Cousins, R., Angell, P. J., Jackson, M. J., Pugh, J. N., Coyles, G., Amirabdollahian, F., & Alizadehkhaiyat, O. (2020) · European Journal of Applied Physiology · doi:10.1007/s00421-019-04293-5 · Cited by 58 · see citing works
Bjorkman, M. P., Suominen, M. H., Kautiainen, H., Jyväkorpi, S. K., Finne-Soveri, H. U., Strandberg, T. E., Pitkälä, K. H., & Tilvis, R. S. (2019) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2019.09.006 · Cited by 57 · see citing works
Whaikid, P., & Piaseu, N. (2024) · Epidemiology and Health · doi:10.4178/epih.e2024030 · Cited by 52 · see citing works
“A previous systematic review and meta-analysis found that adding protein supplementation to resistance exercise did not significantly outperform resistance exercise alone [53,54].”
BackgroundMendonça, N., Hengeveld, L. M., Visser, M., Presse, N., Canhão, H. M., Simonsick, E. M., Kritchevsky, S. B., Newman, A. B., Gaudreau, P., & Jagger, C. (2021) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqab051 · Cited by 51 · see citing works
“A later systematic review of 36 RCTs in nonfrail older adults concluded that walking speed tended to improve more with protein supplementation in combination with resistance exercise after 26 ± 26 wk compared with resistance exercise only (22).”
BackgroundOmura, T., & Araki, A. (2022) · Geriatrics & Gerontology International · doi:10.1111/ggi.14339 · Cited by 47 · see citing works
Mareschal, J., Genton, L., Collet, T., & Graf, C. E. (2020) · Nutrients · doi:10.3390/nu12092820 · Cited by 48 · see citing works
“A recent meta-analysis highlighted that protein supplementation combined with resistance training did not improve muscle mass, muscle strength and physical performance in non-frail community-dwelling older adults [56].”
BackgroundNishimura, Y., Højfeldt, G. W., Breen, L., Tetens, I., & Holm, L. (2021) · Nutrition Research Reviews · doi:10.1017/s0954422421000329 · Cited by 51 · see citing works
“This notion was highlighted previously(120) and is supported by a meta-analysis conducted by Ten Haaf et al.(121), where they assessed the impact of protein supplementation on lean body mass, muscle strength and physical performance in community-dwelling older individuals.”
ResultTagawa, R., Watanabe, D., Ito, K., Otsuyama, T., Nakayama, K., Sanbongi, C., & Miyachi, M. (2022) · Sports Medicine - Open · doi:10.1186/s40798-022-00508-w · Cited by 51 · see citing works
Formica, M., Gianoudis, J., Nowson, C. A., O’Connell, S. L., Milte, C. M., Ellis, K. A., & Daly, R. M. (2020) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqaa104 · Cited by 45 · see citing works
Tallis, J. A., Shelley, S. P., Degens, H., & Hill, C. (2021) · Biomolecules · doi:10.3390/biom11030372 · Cited by 44 · see citing works
Labata‐Lezaun, N., Llurda-Almuzara, L., López-de–Celis, C., Rodríguez‐Sanz, J., González-Rueda, V., Hidalgo-García, C., Muñiz-Pardos, B., & Pérez‐Bellmunt, A. (2020) · Nutrients · doi:10.3390/nu12092607 · Cited by 42 · see citing works
Al‐Ozairi, E., Alsaeed, D., Alroudhan, D., Voase, N., Hasan, A., Gill, J. M. R., Sattar, N. A., Welsh, P. I., Gray, C. M., Boonpor, J., et al. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa835 · Cited by 40 · see citing works
Huschtscha, Z., Parr, A., Porter, J. A., & Costa, R. J. S. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.644865 · Cited by 40 · see citing works
Eidam, A., Durga, J., Bauer, J. M., Zimmermann, S., Vey, J. A., Rapp, K., Schwenk, M., Cesari, M., & Benzinger, P. (2024) · European Geriatric Medicine · doi:10.1007/s41999-024-01013-x · Cited by 38 · see citing works
Elstgeest, L. E. M., Schaap, L. S., Heymans, M. W., Hengeveld, L. M., Naumann, E., Houston, D. K., Kritchevsky, S. B., Simonsick, E. M., Newman, A. B., Farsijani, S., et al. (2020) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqaa099 · Cited by 38 · see citing works
“However, evidence from randomized controlled trials (RCTs) is less conclusive: a meta-analysis of 36 RCTs on protein supplementation showed no effects on musculoskeletal outcomes in nonfrail older adults (12), whereas some recent trials found positive effects on LM (13), appendicular LM (aLM) (14), and gait speed (14).”
BackgroundGranic, A., Sayer, A. A., Cooper, R., & Robinson, S. M. (2024) · Proceedings of The Nutrition Society · doi:10.1017/s0029665124007432 · Cited by 38 · see citing works
Nichols, S., McGregor, G., Al‐Mohammad, A., Ali, A., Tew, G. A., & O’Doherty, A. F. (2019) · European Journal of Nutrition · doi:10.1007/s00394-019-02108-z · Cited by 35 · see citing works
Hengeveld, L. M., de Goede, J., Afman, L. A., Bakker, S. J. L., Beulens, J. W. J., Blaak, E. E., Boersma, E. H., Geleijnse, J. M., van Goudoever, J. B., Hopman, M. T. E., et al. (2021) · Advances in Nutrition · doi:10.1093/advances/nmab140 · Cited by 35 · see citing works
Self-citationNeil‐Sztramko, S., Teggart, K., Moore, C., Sherifali, D., Fitzpatrick‐Lewis, D., Coletta, G., Phillips, S. M., Newbold, K. B., Álvarez, E., Kuspinar, A., et al. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03170-9 · Cited by 29 · see citing works
Liu, M., Yu, D., Pan, Y., Ji, S., Han, N., Yang, C., & Sun, G. (2023) · The Journals of Gerontology Series A · doi:10.1093/gerona/glad191 · Cited by 28 · see citing works
Vieira, A. F., Santos, J. S., Costa, R. R., Cadore, E. L., & Macedo, R. C. O. (2022) · Sports Medicine · doi:10.1007/s40279-022-01704-0 · Cited by 25 · see citing works
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Reinders, I., Wijnhoven, H. A. H., Jyväkorpi, S. K., Suominen, M. H., Niskanen, R. T., Bosmans, J. E., Brouwer, I. A., Fluitman, K. S., Klein, M. C. A., Kuijper, L. D. J., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-040637 · Cited by 24 · see citing works
Pikosky, M. A., Cifelli, C. J., Agarwal, S., & Fulgoni, V. L. I. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.873512 · Cited by 24 · see citing works
Multi-directional nature of falls among older adults: A rationale for prevention and management
Smith, M. L., & Ory, M. G. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1117863 · Cited by 24 · see citing works
Li, H., Zhang, Q., Hao, Q., Li, Q., Yang, L., Yang, X., Wang, K., Teng, J., Gong, Z., & Jia, Y. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-05144-5 · Cited by 23 · see citing works
Reinders, I., Visser, M., Jyväkorpi, S. K., Niskanen, R. T., Bosmans, J. E., Ben, Â. J., Brouwer, I. A., Kuijper, L. D. J., Olthof, M. R., Pitkälä, K. H., et al. (2021) · European Journal of Nutrition · doi:10.1007/s00394-021-02675-0 · Cited by 23 · see citing works
Influences of Vitamin D and Iron Status on Skeletal Muscle Health: A Narrative Review
Shoemaker, M. E., Salmon, O. F., Smith, C. M., Duarte‐Gardea, M., & Cramer, J. T. (2022) · Nutrients · doi:10.3390/nu14132717 · Cited by 22 · see citing works
Koponen, S., Nykänen, I., Savela, R., Välimäki, T. H., Suominen, A. L., & Schwab, U. (2022) · European Journal of Nutrition · doi:10.1007/s00394-022-02908-w · Cited by 21 · see citing works
Protein intake in older people
Kiesswetter, E., Sieber, C. C., & Volkert, D. (2020) · Zeitschrift für Gerontologie und Geriatrie · doi:10.1007/s00391-020-01723-4 · Cited by 19 · see citing works
Li, L., He, Y., Jin, N., He, L., & Liu, X. (2022) · Food Chemistry X · doi:10.1016/j.fochx.2022.100210 · Cited by 18 · see citing works
Hawley, A., Liang, X., Børsheim, E., Wolfe, R., Salisbury, L., Hendy, E. B., Wu, H., Walker, S., Tacinelli, A. M., & Baum, J. (2022) · Meat Science · doi:10.1016/j.meatsci.2022.108830 · Cited by 17 · see citing works
Poggiogalle, E., Rossignon, F., Carayon, A., Capel, F., Rigaudière, J., Vincent, S. D. S., Bacquer, O. L., Salles, J., Giraudet, C., Patrac, V., et al. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2021.749049 · Cited by 18 · see citing works
Protein-Restricted Diets and Their Impact on Metabolic Health and Aging
Kim, S. Q., Spann, R. A., Hill, C. M., Berryman, C. E., Berthoud, H., McDougal, D. H., He, Y., Münzberg, H., Yu, S., & Morrison, C. D. (2025) · Annual Review of Nutrition · doi:10.1146/annurev-nutr-121624-114918 · Cited by 17 · see citing works
Kositsawat, J., Duque, G., & Kirk, B. (2021) · Experimental Gerontology · doi:10.1016/j.exger.2021.111521 · Cited by 16 · see citing works
Granic, A., Hurst, C., Dismore, L. L., Stevenson, E., Sayer, A. A., & Aspray, T. (2020) · PLoS ONE · doi:10.1371/journal.pone.0235952 · Cited by 17 · see citing works
“Previous studies have shown no additional anabolic effect of milk or extra protein supplements above those of RE in relatively healthy, active and well-nourished older adults [51,52].”
BackgroundHou, V., & Madden, K. M. (2022) · Canadian Geriatrics Journal · doi:10.5770/cgj.25.608 · Cited by 15 · see citing works
“(42,49,50) These findings may be due to differences in baseline protein intake, activity level, and adherence to the exercise and protein interventions.”
BackgroundResultCarbone, J. W., Phillips, S. M., Weaver, C. M., Hughes, J. M., & Pasiakos, S. M. (2024) · Advances in Nutrition · doi:10.1016/j.advnut.2024.100347 · Cited by 15 · see citing works
Bielecka-Dabrowa, A. M., Banach, M., Wittczak, A., Cicero, A. F. G., Kallel, A., Kubilius, R., Mikhailidis, D. P., Sahebkar, A., Stoian, A. P., Vinereanu, D., et al. (2023) · Archives of Medical Science · doi:10.5114/aoms/167799 · Cited by 14 · see citing works
Munekawa, C., Okamura, T., Majima, S., Budau, R., Kawai, S., Kobayashi, A., Nakajima, H., Kitagawa, N., Okada, H., Senmaru, T., et al. (2024) · Nutrients · doi:10.3390/nu16183084 · Cited by 13 · see citing works
Al-Rawhani, A. H., Adznam, S. N., Abu Zaid, Z., Md. Yusop, N. B., M. Sallehuddin, H., & Alshawsh, M. A. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.08.033 · Cited by 13 · see citing works
Spoelder, M., Koopmans, L., Hartman, Y., Bongers, C. C. W. G., Schoofs, M. C. A., Eijsvogels, T. M. H., & Hopman, M. T. E. (2023) · Nutrients · doi:10.3390/nu15020342 · Cited by 13 · see citing works
Self-citationReinders, I., Visser, M., & Wijnhoven, H. A. H. (2020) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2020.02.020 · Cited by 12 · see citing works
Mendonça, N., Hengeveld, L. M., Presse, N., Canhão, H. M., Simonsick, E. M., Kritchevsky, S. B., Farsijani, S., Gaudreau, P., Jagger, C., & Visser, M. (2022) · British Journal Of Nutrition · doi:10.1017/s0007114522002033 · Cited by 12 · see citing works
“A 2018 systematic review and meta-analysis of randomised controlled trials also failed to find a synergistic effect of protein supplementation and resistance exercise on muscle strength in non-frail community-dwelling older adults (14) .”
Kim, C., Jeon, Y.-B., Yoo, D.-G., Kim, K.-H., Jeong, H.-J., Kim, B.-K., Park, M.-H., Kim, K.-H., Hwang, J., Cho, G. H., et al. (2023) · Food Science of Animal Resources · doi:10.5851/kosfa.2023.e14 · Cited by 12 · see citing works
Amount of Protein Required to Improve Muscle Mass in Older Adults
Kim, D., & Park, Y. (2020) · Nutrients · doi:10.3390/nu12061700 · Cited by 12 · see citing works
Silva, T. R., Lago, S. C., Yavorivski, A., Ferreira, L. L., Fighera, T. M., & Spritzer, P. M. (2020) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000001692 · Cited by 11 · see citing works
“does not lead to increases in LBM in nonfrail communitydwelling older adults.(50) More recently, a secondary data analysis of a RCT performed to investigate a dose-dependent effect of whey protein supplementation in prefrail or frail participants aged 70 to 85 years, have shown that increased protein intake”
BackgroundTimmons, J. F., Hone, M., Cogan, K. E., Duffy, O., & Egan, B. (2021) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2021.653962 · Cited by 11 · see citing works
“…higher dietary protein intake rely on powdered protein supplements and oral nutrition solutions (Cermak et al., 2012; Liao et al., 2017; Ten Haaf et al., 2018; Labata-Lezaun et al., 2020), the present study is novel in the approach to employ an exclusively whole food-based dietary…”
BackgroundResultInfluentialHomes, R., Clark, D., Moridzadeh, S., Tosovic, D., van den Hoorn, W., Tucker, K. J., & Midwinter, M. J. (2023) · Sensors · doi:10.3390/s23010537 · Cited by 10 · see citing works
“These are commonly referred to as ‘major adverse events’ within the literature [20,21].”
BackgroundHoekstra, S. P., King, J. A., Fenton, J., Kirk, N., Willis, S. A., Phillips, S. M., Webborn, N., Tolfrey, K., den Bosch, J. D. V., & Goosey-Tolfrey, V. L. (2024) · Physiological Reports · doi:10.14814/phy2.70073 · Cited by 10 · see citing works
“Yarar-Fisher et al. (2018) showed that protein supplementation alone is not sufficient to alter SMM in persons with SCI, but similar findings have been observed in healthy adults without a disability after protein supplementation in the absence of RT (Ten Haaf et al., 2018).”
ResultMichel, J., Lievense, K., Norton, S., da Costa, J. A., Alphin, K. H., Bailey, L., & Miller, G. D. (2022) · Nutrients · doi:10.3390/nu14132739 · Cited by 10 · see citing works
“report in a recent meta-analysis that protein supplementation while undergoing concomitant RT produced no extra benefit to measures of DXA derived LBM in older adults [67].”
ResultJeong, H. Y., & Kwon, O. (2021) · Applied Biological Chemistry · doi:10.1186/s13765-021-00633-2 · Cited by 9 · see citing works
The Impact of Protein in Post-Menopausal Women on Muscle Mass and Strength: A Narrative Review
Black, K. E., & Matkin-Hussey, P. A. (2024) · Physiologia · doi:10.3390/physiologia4030016 · Cited by 10 · see citing works
Argyropoulou, D., Nomikos, T., Terzis, G. D., Tataki, S., Geladas, N. D., & Paschalis, V. (2025) · European Journal of Nutrition · doi:10.1007/s00394-024-03575-9 · Cited by 8 · see citing works
Are strategies to increase muscle mass and strength as effective in people with type 2 diabetes?
Al-Awadi, A. A., Gray, S. R., & Al‐Ozairi, E. (2025) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-025-09947-8 · Cited by 8 · see citing works
“…without T2D, evidence on the efficacy of protein supplements to increase muscle mass and strength is mixed, with no effect generally seen in the absence of concomitant resistance exercise [107] and a small increase in muscle mass and strength when taken alongside resistance exercise training [108].”
Wu, H., Quan, J., Wang, X., Gu, Y., Zhang, S., Meng, G., Zhang, Q., Liu, L., Wang, X., Sun, S., et al. (2023) · Nutrients · doi:10.3390/nu15020391 · Cited by 8 · see citing works
Schalla, J., Frommelt, S., Geisler, S., & Isenmann, E. (2024) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2024.1346637 · Cited by 7 · see citing works
Tian, H., Qiao, W., & Wen, X. (2025) · Journal of Nutrition · doi:10.1016/j.tjnut.2025.01.017 · Cited by 6 · see citing works
Chung, S. X., Shahar, S., Singh, D. K. A., Rivan, N. F. M., Karim, N. A., Fuad, N. F. N., Ong, Y. Q., Arifin, A., & Rahni, A. A. A. (2026) · European Journal of Nutrition · doi:10.1007/s00394-025-03845-0 · Cited by 6 · see citing works
Horner, K. M., Mullen, B., Quinn, A., Scheufele, P., Gola, S., Gonnelli, F., Bozzato, M., Pratt, J., Sala, W., Mullin, S. M., et al. (2024) · British Journal Of Nutrition · doi:10.1017/s0007114524002125 · Cited by 5 · see citing works
“Although previous studies have investigated the effects of protein supplementation, alone or with PA on sarcopenia-related outcomes (86,87) , nutritional outcomes, particularly appetite, have received little attention.”
Gehrmann, T., Beekman, M., Deelen, J., Partridge, L., van de Rest, O., Mei, L., Raz, Y., de Groot, C. P. G. M., van der Breggen, R., Reinders, M. J. T., et al. (2024) · doi:10.59368/agingbio.20240036 · Cited by 5 · see citing works
Liao, Y., Zhou, X., Xu, S., Meng, Z., Li, D., Yang, X., Liu, L., & Yang, W. Q. (2022) · The Journal of Nutritional Biochemistry · doi:10.1016/j.jnutbio.2022.108968 · Cited by 6 · see citing works
Yu, T., Oguma, Y., Asakura, K., Abe, Y., & Arai, Y. (2023) · Public Health Nutrition · doi:10.1017/s1368980023000113 · Cited by 6 · see citing works
“The association between PP and nutrition (such as protein and vitamin D) have been reported with inconsistent results(12,13).”
ResultEffects of nutritional guidance on frailty in older adults: A systematic review
Koyama, T., Nohara, J., & Nakamura, M. (2025) · The journal of nutrition health & aging · doi:10.1016/j.jnha.2025.100756 · Cited by 5 · see citing works
Adaptation and validation of a protein intake screening tool for a UK adult population
Tuttiett, E. R., Ioannou, E., Wijnhoven, H. A. H., Corfe, B. M., & Williams, E. A. (2022) · Journal of Nutritional Science · doi:10.1017/jns.2022.96 · Cited by 5 · see citing works
Validation of the German version of the Protein Screener 55+
Kiesswetter, E., Siebentritt, H. M., Schoene, D., Kob, R., Freiberger, E., Sieber, C. C., Visser, M., Wijnhoven, H. A. H., & Volkert, D. (2023) · European Journal of Clinical Nutrition · doi:10.1038/s41430-023-01266-y · Cited by 5 · see citing works
“However, intervention studies using protein supplements have often failed to improve muscle mass and function in older people, presumably caused by sufficiently high habitual protein intake [11, 12].”
BackgroundUkai, T., Yokoyama, K., & Watanabe, M. (2024) · Nutrients · doi:10.3390/nu16030386 · Cited by 4 · see citing works
“Lower PhA values indicate an increased quantity of extra water and decreased muscle mass [48,49].”
BackgroundSong, X., Wang, H., Su, C., Zhang, M., Zhang, L., Meng, J., & Zhang, B. (2024) · European Journal of Nutrition · doi:10.1007/s00394-024-03364-4 · Cited by 4 · see citing works
Kramer, C. S., Monsegue, A. P., Morwani‐Mangnani, J., Grootswagers, P., Beekman, M., Slagboom, P. E., Verdijk, L. B., & de Groot, C. P. G. M. (2024) · Mechanisms of Ageing and Development · doi:10.1016/j.mad.2024.112002 · Cited by 4 · see citing works
“It remains unknown whether increasing dietary protein intake alone may counteract anabolic resistance (Campbell et al., 2001; Houston et al., 2008; Volpi et al., 2013; Labata-Lezaun et al., 2020; Ten Haaf et al., 2018).”
BackgroundZou, Y., Xu, H., Cui, J., Wang, K., Feng, Y., Shi, H., Li, W., Song, C., & Investigation on Nutrition Status and Its Clinical Outcome of Common Cancers, I. P. (2023) · Nutrition and Cancer · doi:10.1080/01635581.2023.2165693 · Cited by 4 · see citing works
Arentson‐Lantz, E. J., & Kilroe, S. P. (2021) · Journal of Animal Science · doi:10.1093/jas/skab060 · Cited by 5 · see citing works
Stable isotope approaches to study muscle mass outcomes in clinical populations
Chapple, L. S., Dirks, M. L., & Kouw, I. W. K. (2021) · Clinical Nutrition Open Science · doi:10.1016/j.nutos.2021.01.004 · Cited by 4 · see citing works
Dietary protein and muscle wasting in chronic kidney disease: new insights
Güngör, Ö., Kara, A. V., Hasbal, N. B., & Kalantar‐Zadeh, K. (2023) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000903 · Cited by 5 · see citing works
“It was seen that the daily protein intake was already sufficient in most of the study participants [30].”
BackgroundKanter, M. M., Aaron, S., Austad, S. N., Brown, A. W., Burd, N. A., Campbell, W. W., Cope, M. B., Davis, T. A., Erdman, J. W., Freitas, M., et al. (2026) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2026.2658728 · Cited by 3 · see citing works
“…several meta-analyses published since 2018 examining the effects of diet and supplemental protein on body composition or functional outcomes report much smaller sample sizes (Morton et al. 2018; Ten Haaf et al. 2018; Liao et al. 2020; Tagawa et al. 2020; Nunes et al. 2022; Kokura et al. 2024).”
Miyazaki, R., Abe, T., Sakane, N., Ando, H., Yano, S., Okuyama, K., Isomura, M., Yamasaki, M., & Nabika, T. (2023) · Geriatric Nursing · doi:10.1016/j.gerinurse.2023.06.014 · Cited by 3 · see citing works
Huang, J., Shanmugam, A., Huang, X., van Dam, R. M., & Hilal, S. (2023) · British Journal Of Nutrition · doi:10.1017/s0007114523002647 · Cited by 3 · see citing works
“M ode l 2 : ad j u s t ed f o r age ( y ea r s ) , s e x , e t hn i c i t y , t o t a l M VPA ( M E T - h / d ) and s m o k i ng s t a t u s . observational and intervention studies (32,33) .”
BackgroundLi, G., Kawakami-Shinoda, Y., ALIMA, Takiwaki, M., Abe, K., Hosaka, T., Goda, T., & Arai, H. (2025) · The Journal of Medical Investigation · doi:10.2152/jmi.72.76 · Cited by 2 · see citing works
“A previous meta-analysis reported that if subjects had adequate dietary protein intake (1.1-1.2 g / kg BW / day), additional dietary protein intake did not increase muscle mass (34).”
InfluentialMolecular Mechanisms and Nutritional Modulation in Sarcopenia: A Narrative Review
Chin, H. S., Liu, L., Liao, P.-J., Wee, A. L. R. M., Kwek, X.-Y., Teh, B. T., & Koh, F. H.-X. (2026) · Nutrients · doi:10.3390/nu18071161 · Cited by 2 · see citing works
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Park, J. H., Oh, J., & Park, S. (2022) · Exercise Science · doi:10.15857/ksep.2022.00024 · Cited by 2 · see citing works
- Authors
- ten Haaf, D. S. M., Nuijten, M. A. H., Maessen, M. F. H., Horstman, A. M. H., Eijsvogels, T. M. H., & Hopman, M. T.
- Affiliations
- Radboud University Medical Center (NL)
- FrieslandCampina (Netherlands) (NL)
- Corresponding author
- Hopman, Maria TE
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2018-11
- Volume
- 108
- Issue
- 5
- Pages
- 1043-1059
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2901144022
- Cited by
- 152
- References
- 94
- Citations by year
- 2026: 11 · 2025: 9 · 2024: 24 · 2023: 18 · 2022: 40 · 2021: 19 · 2020: 24 · 2019: 7
- FWCI
- 1.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Socio-Environmental Systems Modeling (acceptedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
- Keywords
- protein supplementation, lean body mass, muscle strength, physical performance, community-dwelling older adults, resistance training, grip strength, walking speed, muscle cross-sectional area, sarcopenia
- MeSH terms
- Physical Functional Performance, Aged, Aged, 80 and over, Body Fluid Compartments, Dietary Proteins, Female, Gait, Humans, Male, Middle Aged, Movement, Exercise, Geriatric Assessment, Muscle, Skeletal, Dietary Supplements, Muscle Strength, Resistance Training, Independent Living
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