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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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“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]
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“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]
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“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]
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“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]
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“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]
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“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]
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“In contrast, Wirth et al. 21 and Haaf et al. 22 found no effect of additional protein ingestion and exercise on lower‐body strength.”
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“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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“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 15
Amount of Protein Required to Improve Muscle Mass in Older Adults
Kim, D., & Park, Y. (2020) · Nutrients · doi:10.3390/nu12061700 · Cited by 12
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
“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
“…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
“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
“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
“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 10
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
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 9
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
“…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 9
Schalla, J., Frommelt, S., Geisler, S., & Isenmann, E. (2024) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2024.1346637 · Cited by 7
Tian, H., Qiao, W., & Wen, X. (2025) · Journal of Nutrition · doi:10.1016/j.tjnut.2025.01.017 · Cited by 7
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 9
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 7
“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
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
Yu, T., Oguma, Y., Asakura, K., Abe, Y., & Arai, Y. (2023) · Public Health Nutrition · doi:10.1017/s1368980023000113 · Cited by 6
“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
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
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
“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
“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
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 5
“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
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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
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
“It was seen that the daily protein intake was already sufficient in most of the study participants [30].”
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“…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).”
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“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 3
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Metadata
- 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 (medical) › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › 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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