Cited by 193Nutrition and Health in AgingMuscle metabolism and nutritionFrailty in Older Adults

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Protein supplementation improves muscle mass and physical performance in undernourished prefrail and frail elderly subjects: a randomized, double-blind, placebo-controlled trial

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Park, Yongsoon, Choi, Jeong-Eun, Hwang, Hwan-Sik·2018·The American Journal of Clinical Nutrition

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Abstract

Background Age-related loss of muscle mass and function is a major component of frailty. Nutrition supplementation with exercise is an effective strategy to decrease frailty by preventing sarcopenia, but the effect of protein alone is controversial.Objective The present study was performed to investigate a dose-dependent effect of protein supplementation on muscle mass and frailty in prefrail or frail malnourished elderly people.Design A 12-wk double-blind randomized controlled trial was conducted in elderly subjects aged 70-85 y with ≥1 of the Cardiovascular Health Study frailty criteria and a Mini Nutritional Assessment score ≤23.5 (n = 120). Participants were randomly assigned to 1 of 3 groups: 0.8, 1.2, or 1.5 g protein · kg-1 · d-1, with concealed allocation and intention-to-treat analysis. Primary outcomes were appendicular skeletal muscle mass (ASM) and skeletal muscle mass index (SMI) measured by dual-energy X-ray absorptiometry.Results After the 12-wk intervention, the 1.5-g protein · kg-1 · d-1 group had higher ASM (mean ± SD: 0.52 ± 0.64 compared with 0.08 ± 0.68 kg, P = 0.036) and SMI (ASM/weight: 0.87% ± 0.69% compared with 0.15% ± 0.89%, P = 0.039; ASM/BMI: 0.02 ± 0.03 compared with 0.00 ± 0.04, P = 0.033; ASM:fat ratio: 0.04 ± 0.11 compared with -0.02 ± 0.10, P = 0.025) than the 0.8-g protein · kg-1 · d-1 group. In addition, gait speed was improved in the 1.5-g protein · kg-1 · d-1 group compared with the 0.8-g protein · kg-1 · d-1 group (0.09 ± 0.07 compared with 0.04 ± 0.07 m/s, P = 0.039). There were no significant differences between the 1.2- and 0.8-g protein · kg-1 · d-1 groups in muscle mass and physical performance. No harmful adverse effects were observed.Conclusions The present study indicates that protein intake of 1.5 g · kg-1 · d-1 has the most beneficial effects in regard to preventing sarcopenia and frailty compared with protein intakes of 0.8 and 1.2 g · kg-1 · d-1 in prefrail or frail elderly subjects at risk of malnutrition. This trial was registered at cris.nih.go.kr as KCT0001923.

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“Meanwhile, the inverse relationship between protein intake per ABW and frailty showed a gradual decrease at 1.4 g/kg ABW/day for protein; the pattern of association was a weak L-shape.”
Influential
Association between masseter muscle volume, nutritional status, and cognitive status in older people
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BackgroundMethodInfluential
Polypharmacy and Lack of Joy Are Related to Physical Frailty among Northern Japanese Community-Dwellers from the ORANGE Cohort Study
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Background
Muscle-Related Effect of Whey Protein and Vitamin D3 Supplementation Provided before or after Bedtime in Males Undergoing Resistance Training
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Modulation of frailty syndrome by diet: A review of evidence from mouse studies
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BackgroundInfluentialSelf-citation
Oral Protein Supplements Might Improve Nutritional Status and Quality of Life in Elderly Patients after Standard Pancreatic Resection
Lee, N. R., Hwang, H. K., Lee, H., & Kang, C. M. (2024) · Nutrients · doi:10.3390/nu16172988 · Cited by 15
“…Korea, which discovered that the group that consumed more than 1.2 g/kg of protein suffered less sarcopenia compared with the group that consumed less than 0.8 g/kg of protein [22], or the meta-analysis which suggested that inadequate protein intake may be related to sarcopenia in the elderly [23].”
BackgroundInfluentialSelf-citation
Two dietary advice strategies to increase protein intake among community-dwelling older adults: A feasibility study
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“Vitamin D and protein have protective effects against the muscular loss and functional impairment associated with aging, including sarcopenia [19,20].”
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Amount of Protein Required to Improve Muscle Mass in Older Adults
Kim, D., & Park, Y. (2020) · Nutrients · doi:10.3390/nu12061700 · Cited by 12
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A review of recent evidence of dietary protein intake and health
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BackgroundSelf-citation
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Effectiveness of Protein-Enriched Oral Nutritional Supplements on Muscle Function in Middle-Aged and Elderly Women: A Randomized Controlled Trial
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Association between Sarcopenia and Energy and Protein Intakes in Community-dwelling Elderly
Na, W., Oh, D., Hwang, S., Chung, B., & Sohn, C. (2022) · 대한지역사회영양학회지 · doi:10.5720/kjcn.2022.27.4.286 · Cited by 10
Clinical Practice Guideline for Frailty Applicable in Primary Care Setting
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Self-citation
Evaluating the Effect of a Home-Delivered Meals Service on the Physical and Psychological Wellbeing of a UK Population of Older Adults – A Pilot and Feasibility Study
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“2 g/kg/d are safe and are likely to preserve skeletal muscle mass and strength in the older adults.(29,30) The average daily protein provision to participants in this study represents a protein intake of 0.”
Background
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Kirk, B., Iuliano, S., Daly, R. M., & Duque, G. (2020) · Australian Journal on Ageing · doi:10.1111/ajag.12853 · Cited by 9
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Kim, C.-O., Jeong, Y.-H., Park, Y., Bae, J.-S., Kwon, Y., Cho, M. H., Yoo, C. H., & Lee, K. (2021) · Gerontology · doi:10.1159/000514676 · Cited by 9
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Effectiveness of a Per-Meal Protein Prescription and Nutrition Education with versus without Diet Coaching on Dietary Protein Intake and Muscle Health in Middle-Aged Women
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Method
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“While research has been conducted on protein intake levels for sarcopenia prevention [14,15] and socioeconomic factors related to protein intake [18,25], studies on regional differences in protein intake among older adults are lacking.”
Influential
Sarcopenia: an Aging Perspective and Management Options
Teixeira, A. M., Nosrani, S. E., Parvani, M., Viola, J., & Mohammadi, S. (2025) · International Journal of Sports Medicine · doi:10.1055/a-2577-2577 · Cited by 10
Effects of 12-Week Dietary Inflammatory Index-Based Dietary Education on Frailty Status in Frail Patients with Colorectal Cancer: A Randomized Controlled Trial
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Combined Protein, Probiotics, and Exercise Therapy for Sarcopenia: A Comprehensive Review
Kwon, R. J., Mijan, M. A., Son, S. M., Yoo, W., & Kim, T. (2025) · Cells · doi:10.3390/cells14171375 · Cited by 7
Dietary factors and nutritional guidelines for sarcopenia in older adults: a narrative review
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The feasibility of a 6‐month dietary intervention aiming to increase protein intake among community‐dwelling older adults with low habitual protein intake: A secondary analysis of the PROMISS randomised controlled trial
Niskanen, R. T., Reinders, I., Wijnhoven, H. A. H., Hyvönen, A., Pols‐Vrijmoeth, M., Trommel‐Bout, M., Visser, M., Pitkälä, K. H., Suominen, M. H., Öhman, H., et al. (2023) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.13197 · Cited by 7
Daily supplementation of lesser mealworm protein for 11-weeks increases skeletal muscle mass in physically active older adults
Koopmans, L., Spoelder, M., Bongers, C. C. W. G., Eijsvogels, T. M. H., & Hopman, M. T. E. (2024) · The journal of nutrition health & aging · doi:10.1016/j.jnha.2024.100364 · Cited by 8
“Several randomized controlled trails have shown positive effects of whey and milk-based protein supplements, with or without concurrent resistance training, on muscle characteristics in older adults [6 – 8].”
Uso de suplementos alimentares no manejo nutricional em idosos com Sarcopenia
de Moura, G. V. (2021) · Saúde com · doi:10.22481/rsc.v17i3.8142 · Cited by 10

Authors: Park, Y., Choi, J.-E., & Hwang, H.-S.
Affiliations: Hanyang University (KR)
Corresponding author: Park, Yongsoon
ORCID: Park, Yongsoon
Hwang, Hwan-Sik
Venue: The American Journal of Clinical Nutrition
Publisher: Elsevier BV
Published: 2018-11
Volume: 108
Issue: 5
Pages: 1026-1033
ISSN: 0002-9165 (ISSN-L)
DOI: 10.1093/ajcn/nqy214
OpenAlex: W2900982893
Cited by: 193
References: 33
Citations by year: 2026: 18 · 2025: 29 · 2024: 30 · 2023: 29 · 2022: 25 · 2021: 28 · 2020: 26 · 2019: 6 · 2018: 2
FWCI: 10.70
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 1556 d)
Locations: American Journal of Clinical Nutrition (publishedVersion)
PubMed (publishedVersion)
Funders: Ministry of Health & Welfare, Republic of Korea (HI15C3207)
Topics: Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
Health Sciences › Nursing › Nutrition and Dietetics › Muscle metabolism and nutrition
Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Keywords: protein supplementation, frailty, pre-frailty, sarcopenia, muscle mass, skeletal muscle index, malnutrition, older adults, walking speed, physical performance, dose-response relationship, appendicular skeletal muscle mass, Mini Nutritional Assessment, dietary intervention, exercise training, functional capacity, quality of life, body composition
MeSH terms: Frailty, Physical Functional Performance, Aged, Aged, 80 and over, Body Composition, Dietary Proteins, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Male, Nutritional Status, Nutrition Assessment, Frail Elderly, Muscle, Skeletal, Dietary Supplements, Malnutrition, Sarcopenia

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Protein supplementation improves muscle mass and physical performance in undernourished prefrail and frail elderly subjects: a randomized, double-blind, placebo-controlled trial

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