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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“…of plant foods) might have adverse effects on cognitive function and chronic diseases in older adults [35, 44], animal-based dietary components were typically sources of protein, and consuming protein can help prevent frailty and delay the decline in muscle function in elderly individuals [59, 65].”
Nutritional interventions in frailty in older adults: a narrative review on the current evidence
Catarina, V., Guerra, R. S., & Sousa, A. S. (2023) · Acta Portuguesa de Nutrição · doi:10.21011/apn.2023.3506
Different Effects of Functional Food and Music Aerobic Exercise on Complete Blood Counts, Blood Biochemistry and Frailty of the ElderlyPreprint
Yeh, S., Lee, C.-H., Lee, M.-T., Wang, J.-H., Pan, M.-H., Sung, W., & Yang, K. D. (2023) · Preprints.org · doi:10.20944/preprints202307.0893.v1 · Cited by 1
Mechanism of Malignancy Development When the Metabolism of the Human Body DeterioratesPreprint
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Mechanism of Malignancy Development When the Metabolism of the Human Body DeterioratesPreprint
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An 8-Week Oral Therapy with Ashwagandha ( Withania Somnifera ) Root Extract (600 mg/day) Improves Frailty and Quality of Life in Elderly: A Prospective, Randomized, Placebo-Controlled, Efficacy and Safety StudyPreprint
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“[21] However, as reported by Vasconcelos QDJS et al. (2021), long term consumption of excess protein supplementation may have some adverse effects on the body, which can further be aggravated by sedentary lifestyle.”
Background
Nutritional Therapy in the Management of Physical Frailty and Sarcopenia
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Nutritional Approaches to Treat Sarcopenia
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Aging
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Polypharmacy and lack of joy predict physical frailty among northern Japanese community-dwellers from the ORANGE cohort studyPreprint
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Resistance training with progressive load associated with nutritional advice reduces the frequency of sarcopenia in older peoplePreprint
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A INFLUÊNCIA DO CONSUMO DE PROTEÍNA NA PREVENÇÃO DE SARCOPENIA NO IDOSO
Melo, L. A., dos Santos, M. V., & Silva, V. (2023) · RECIMA21 - Revista Científica Multidisciplinar · doi:10.47820/recima21.v4i12.4611
Frailty: Assessment and Intervention
Moon, H., Lee, G. H., & Kim, D. H. (2024) · Gyemyeong uidae haksulji · doi:10.46308/kmj.2024.00108
“Older individuals with malnutrition should consume 1.5 g of protein per kilogram of body weight per day [22].”
BackgroundInfluential
Assessment of the impact of an innovative nutraceutical on blood biomarkers: essential aminoacids, antioxidants, lipid profile and REDOX status
Orozco‐Levi, M., Pabón-Quezada, A., Quintero-Lesmes, D. C., Vélez, A. R., López, J. C. J., Serrano, N. C., Castillo, V. R., García, A. Y. S., & Ramírez-Sarmiento, A. (2025) · Nutrition & Food Science · doi:10.1108/nfs-07-2024-0252
Comparación de los efectos de los cereales sobre la composición corporal en un modelo murinométrico
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Direct and Indirect Effects of Nutritional Status on Subjective Well-Being in Community-Dwelling Older Adults—the Yilan Study, Taiwan
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“Good nutrition among older adults can enhance physiological factors, such as body composition (Park et al., 2018), physical function (Ge et al., 2020; Kaburagi et al., 2011), and physical activity (Timpini et al., 2011), which have been individually validated to be related to SWB (Taani et al.,…”
Effects of exercise and supplement interventions on body composition and physical fitness in older adults: A systematic review and meta-analysis of randomized controlled trials
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Association Between Protein Intake and Sarcopenia-Related Indicators Among Korean Older Adults: A Scoping Review
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Additional file 2 of Association of frailty with the incidence risk of cardiovascular disease and type 2 diabetes mellitus in long-term cancer survivors: a prospective cohort study
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Additional file 3 of Association of frailty with the incidence risk of cardiovascular disease and type 2 diabetes mellitus in long-term cancer survivors: a prospective cohort study
Cao, X., Yang, Z., Li, X., Chen, C., Hoogendijk, E. O., Zhang, J., Yao, N. A., Ma, L., Zhang, Y., Zhu, Y. L., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26571331
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“…have been conducted in older or frail adult populations, in whom age-related muscle decline and insufficient protein intake are common [27 – 29], while other studies have reported no positive association between protein intake and muscle strength in different research contexts, including…”
SUPLEMENTAÇÃO DA PROTEÍNA DO SORO DO LEITE EM IDOSOS: ESTRATÉGIA PARA PREVENÇÃO E TRATAMENTO DA SARCOPENIA
Bernardo, L. R., & Dimer, N. W. (2025) · Revista Multidisciplinar do Nordeste Mineiro · doi:10.61164/xb2tsw82
Enzymatic modification of pumpkin and groundnut seed proteins for enhanced digestibility: BCAA-enriched peptide profiling and structural-functional characterization.
Rani, M., Shivappa, G. K. B., & A., J. (2026) · Food Research International · doi:10.1016/j.foodres.2026.118738
Hand grip strength and loss of independence in Indigenous and non-Indigenous New Zealand octogenarians—the LiLACS NZ cohort study
Moyes, S. A., Selak, V., Plank, L. D., Hikaka, J., Teh, R., & Kerse, N. M. (2026) · The Journals of Gerontology Series A · doi:10.1093/gerona/glag066
Feasibility and physiological effects of a combined exercise and nutritional intervention in older adults with cancer under catabolic stress
Park, S. E., Choi, J. H., Kim, D. H., Kim, D., Park, Y., Ha, Y. C., & Hwang, I. G. (2026) · Frontiers in Physiology · doi:10.3389/fphys.2026.1779559
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Self-citation
Developing and assessing fortified foods to enable older people to fulfil their nutritional needs while maintaining pleasure to eat
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Association of serum albumin redox state with dietary protein intake and frailty in older adults: A cross-sectional study
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Eating Behavior Patterns, Food Group Intake Frequency, and Sarcopenia in Community‐Dwelling Older Adults: A Cross‐Sectional Study From the Kashiwa Study
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Integrating exercise and nutrition to combat frailty: a systematic review of multidomain interventions in aging populations
Ren, G., Zhang, Z., & Nan, B. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1883888 · Cited by 1
“Tieland et al. (39) showed that protein supplementation augmented lean mass gains during resistance training, while Park et al. (12) demonstrated dose-dependent improvements in appendicular muscle mass and gait speed with higher protein intake.”
Influential
Frailty and enhanced recovery after surgery: Who benefits most following colorectal resection?
Le, S., Fumagalli, I. A., Kipnis, P., Liu, V. X., Escobar, G., Peng, P. D., Beg, M. F., Popuri, K., & Feliciano, E. M. C. (2026) · Surgery · doi:10.1016/j.surg.2026.110534
Targeting pyroptosis for skeletal muscle atrophy: mechanistic insights and therapeutic perspectives
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“Furthermore, protein/amino acid supplementation (whey protein and leucine) may indirectly alleviate the in ﬂ ammatory response by improving the metabolic microenvironment and promoting anabolic processes, with enhanced ef ﬁ cacy when combined with exercise (97).”
Mediating Effect of Protein Intake on the Association Between Number of Remaining Teeth and Functional Decline
Taguchi, U., Ono, S., Sugimoto, M., Aida, J., Hikichi, H., Sasaki, S., Kawachi, I. I., & Hoshi, K. (2026) · Gerodontology · doi:10.1111/ger.70127
Comparative Effectiveness of Nutritional Strategies for Sarcopenia-Related Outcomes in Older Adults: A Systematic Review and Network Meta-Analysis
Zhang, X., Fan, S., Zan, J., Chen, M., & Chen, X. (2026) · Nutrients · doi:10.3390/nu18203368

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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