Effects of protein supplementation combined with resistance exercise on body composition and physical function in older adults: a systematic review and meta-analysis
Open accessAbstract
Background: Overweight and obese older people face a high risk of muscle loss and impaired physical function, which may contribute to sarcopenic obesity. Resistance exercise training (RET) has a beneficial effect on muscle protein synthesis and can be augmented by protein supplementation (PS). However, whether body weight affects the augmentation of muscular and functional performance in response to PS in older people undergoing RET remains unclear.Objective: This study was conducted to identify the effects of PS on the body composition and physical function of older people undergoing RET.Design: We performed a comprehensive search of online databases to identify randomized controlled trials (RCTs) reporting the efficacy of PS for lean mass gain, strength gain, and physical mobility improvements in older people undergoing RET.Results: We included 17 RCTs; the overall mean ± SD age and body mass index (BMI; in kg/m 2) in these RCTs were 73.4 ± 8.1 y and 29.7 ± 5.5, respectively. The participants had substantially greater lean mass and leg strength gains when PS and RET were used than with RET alone, with the standard mean differences (SMDs) being 0.58 (95% CI: 0.32, 0.84) and 0.69 (95% CI: 0.39, 0.98), respectively. The subgroup of studies with a mean BMI ≥30 exhibited substantially greater lean mass (SMD: 0.53; 95% CI: 0.19, 0.87) and leg strength (SMD: 0.88; 95% CI: 0.42, 1.34) gains in response to PS. The subgroup of studies with a mean BMI <30 also exhibited relevant gains in response to PS.Conclusions: Compared with RET alone, PS combined with RET may have a stronger effect in preventing aging-related muscle mass attenuation and leg strength loss in older people, which was found in studies with a mean BMI ≥30 and in studies with a mean BMI <30. Clinicians could use nutrition supplement and exercise strategies, especially PS plus RET, to effectively improve the physical activity and health status of all older patients.
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Liao et al. 106 compared the effect of additional protein ingestion and RE with no intervention as a control group; therefore, it is reasonable to suggest that the RE was the primary intervention leading to the main findings.
“Of note, Liao et al. 106 compared the effect of additional protein ingestion and RE with no intervention as a control group; therefore, it is reasonable to suggest that the RE was the primary intervention leading to the main findings.”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [106]
The PS characteristics section reports that control participants received either a placebo supplement or no supplement, but they still performed resistance exercise training. The Outcome measures section compares protein supplementation plus resistance exercise with control groups that also exercised. This contradicts the claimed no-intervention comparison and does not support the inference that exercise, rather than supplementation, produced the between-group findings. Page numbers are unavailable in our copy. (LLM, conf=0.92)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe claimed superior effects of multi-ingredients compared to the intake of each ingredient in isolation are based on their synergistic interaction or amplification effect once the included ingredients are ingested as a component of a special formulation.
“The claimed superior effects of multi-ingredients compared to the intake of each ingredient in isolation are based on their synergistic interaction or amplification effect once the included ingredients are ingested as a component of a special formulation (Liao et al. 2017).”
From Effect of a Multi-Ingredient Post-Workout Dietary Supplement on Body Composition and Muscle Strength – A Randomized Controlled Trial (2025) · cites this paper as Liao et al. 2017
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 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 [106]
The Discussion notes a discrepancy between this review and earlier studies, and the Study selection criteria specify a mean-age threshold of 60 years and allow protein combined with other nutrients. Neither passage says that different age cut-offs or the inclusion of multi-ingredient trials caused the differing conclusions; our copy also does not establish the proposed role of energy-restricted diets. (LLM, conf=0.76)
Experimental — accuracy not yet measuredLiao et al. 106 found additive significant main effects for additional protein (but included numerous other supplement ingredients) ingestion and RE in the performance of physical function tests in older overweight or obese subjects.
“In contrast, Liao et al. 106 found additive significant main effects for additional protein (but included numerous other supplement ingredients) ingestion and RE in the performance of physical function tests in older overweight or obese subjects.”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [106]
The Effects on physical mobility outcome section reports significant improvements with protein supplementation plus resistance exercise in the short physical performance battery and some other tests, but nonsignificant effects on gait speed, physical activity, timed up-and-go, and chair rise. The Outcome measures section compares supplementation plus exercise with control groups generally also doing exercise; it does not establish separate, additive main effects of protein and exercise on physical function. The reported physical-function findings are not specifically for the overweight or obese subgroup, although the Study characteristics section shows that the included trials largely enrolled people with mean BMIs in those ranges. (LLM, conf=0.88)
Experimental — accuracy not yet measuredProtein supplementation mainly induces muscular adaptations such as muscle hypertrophy.
“Because protein supplementation mainly induces muscular adaptations such as muscle hypertrophy, contributions of neural and muscular factors to training-induced adaptation would not be coincidence between resistance training interventions with and without protein supplementation.”
From Modulation of Neural and Muscular Adaptation Processes During Resistance Training by Fish Protein Ingestions in Older Adults (2020) · cites this paper as [11]
The Effects on muscle volume section (page unavailable) reports greater muscle-volume gains when protein supplementation was added to resistance training in older adults, supporting the hypertrophy aspect. The paper does not establish that supplementation mainly induces muscular rather than neural adaptations; that comparison goes beyond the outcomes reported. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Increases in muscle mass and strength following resistance training are elicited by protein supplementation in older adults.
“There has been growing recognition that increases in muscle mass and strength following resistance training is elicited by protein supplementation in older adults (10,11).”
From Modulation of Neural and Muscular Adaptation Processes During Resistance Training by Fish Protein Ingestions in Older Adults (2020) · cites this paper as [11]
The Effects on LBM section (page not available) reports greater lean-mass gains with protein supplementation during resistance training. The Effects on muscle strength section (page not available) reports greater leg-strength gains, but no significant additional gain in handgrip or upper-body strength. The claim omits that distinction and states the effect more categorically than the paper’s qualified conclusion. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIn most previous studies, casein, whey, and/or milk protein have been used as protein supplementations to test the effect of their combination with resistance training.
“In most of the previous studies, casein, whey, and/or milk protein have been used as protein supplementations to test the effect of its combination with resistance training (10,11)”
From Modulation of Neural and Muscular Adaptation Processes During Resistance Training by Fish Protein Ingestions in Older Adults (2020) · cites this paper as [11]
The PS characteristics section (page not available) says the reviewed resistance-training trials used whey, casein, and milk-protein supplements. It also lists leucine, other essential amino acids, and other supplements; its count of 15 of 17 trials combines these types, so it does not establish that most used casein, whey, and/or milk protein specifically. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe amount of CAS supplementation used in this study is relatively low compared with those used in previous studies (10-63 g/d or 0.3 g/kg/d).
“On the other hand, amount of CAS supplementation used in this study is relatively low in comparison with those used in the previous studies (10–63 g/d or 0.3 g/kg/d) (10,11).”
From Modulation of Neural and Muscular Adaptation Processes During Resistance Training by Fish Protein Ingestions in Older Adults (2020) · cites this paper as [11]
The PS characteristics section reports doses of 0.3 g/kg/d in two trials and fixed doses of 10–35 g/d in the other 15. It supports the 0.3 g/kg/d figure and the 10 g/d lower bound, but not the claimed upper bound of 63 g/d. The source does not assess the citing study’s CAS dose, so it cannot itself establish the comparison. (LLM, conf=0.88)
Experimental — accuracy not yet measuredProtein supplementation in combination with resistance-type muscle strengthening exercise is an efficient intervention for lean mass and strength gain in elderly individuals.
“PS in combination with resistance-type MSE has been identified as an efficient intervention for LM and strength gain in elderly individuals [11,13,15,19,59,64].”
Previous systematic reviews found nonsignificant effects on physical mobility in response to PS + MSE for elderly adults who were mostly healthy or not frail.
“Previous systemic reviews have shown nonsignificant effects on changes in muscle mass [20,69], muscle strength [20], and physical mobility [19] in response to PS + MSE for elderly adults who mostly were healthy or not frail.”
The increase of >2.0% to 3.0% in muscle mass may explain the inconsistencies with other authors who reported conflicting results of synergetic improvements in muscle mass and function.
“Furthermore, we identified that an increase of >2.0% to 3.0% in muscle mass predicts a positive effect of PS + MSE on leg strength and walking capability, which may explain the inconsistencies with other authors who reported conflicting results of such synergetic improvements in muscle mass and function [13,17,18,19,20].”
Recent systematic reviews summarized synergistic effects of PS and ET on body composition and strength in older individuals, most of which included healthy participants and trials using RET only.
“Recent systematic reviews have summarized the synergistic effects of PS and ET on body composition and strength in older individuals [15,17,18,19,20], most of which included healthy participants [18,19,20,21] and included trials using RET only [18,19,20,21].”
From Effects of Protein Supplementation Combined with Exercise Intervention on Frailty Indices, Body Composition, and Physical Function in Frail Older Adults (2018) · cites this paper as [20]
There may have been sex differences for changes in body composition in response to PS plus exercise training.
“there may have been sex differences for changes in body composition in response to PS plus exercise training [20,91,92,93]”
From Effects of Protein Supplementation Combined with Exercise Intervention on Frailty Indices, Body Composition, and Physical Function in Frail Older Adults (2018) · cites this paper as [20]
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Pacifico, J., Geerlings, M. A. J., Reijnierse, E. M., Phassouliotis, C., Lim, W. K., & Maier, A. B. (2019) · Experimental Gerontology · doi:10.1016/j.exger.2019.110801 · Cited by 339 · see citing works
“, 2019) and combined RET and protein supplementation have been shown to enhance the effectiveness in increasing muscle mass and muscle strength (Liao et al., 2017).”
BackgroundSarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss
Kirwan, R., McCullough, D., Butler, T., de Heredia, F. P., Davies, I. G., & Stewart, C. E. (2020) · GeroScience · doi:10.1007/s11357-020-00272-3 · Cited by 331 · see citing works
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Self-citationCoronary Artery Disease in Patients ≥80 Years of Age
Madhavan, M. V., Gersh, B. J., Alexander, K. P., Granger, C. B., & Stone, G. W. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.12.068 · Cited by 322 · 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
“Of note, Liao et al.106 compared the effect of additional protein ingestion and RE with no intervention as a control group; therefore, it is reasonable to suggest that the RE was the primary intervention leading to the main findings.”
BackgroundInfluentialGielen, E., Beckwée, D., Delaere, A., De Breucker, S., Vandewoude, M., Bautmans, I., the Sarcopenia Guidelines Development Group of the Belgian Society of Gerontology and Geriatrics (BSGG), Bautmans, I., Beaudart, C., Beckwée, D., et al. (2021) · Nutrition Reviews · doi:10.1093/nutrit/nuaa011 · Cited by 269 · see citing works
Exercise interventions for older adults: A systematic review of meta-analyses
Lorito, C. D., Long, A., Byrne, A., Harwood, R., Gladman, J. R. F., Schneider, S., Logan, P., Bosco, A., & van der Wardt, V. (2020) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2020.06.003 · Cited by 285 · see citing works
“One review (2%) scored 4 points,(29) 4 reviews (7%) scored 6 points,(13,25,40,44) 9 reviews (16%) scored 8 points,(20) 22,30 32,36,45,46 19 reviews (34%) scored 9 points,(14) 16,18,19,23,26,28,34,35,37,38,41,43,47,48,56 58 and 23 (41%) scored 10 points.(17,27,33,39,42,59) 75 The items with the highest scores had clari…”
BackgroundInfluentialHsu, K.-J., Liao, C.-D., Tsai, M.-W., & Chen, C.-N. (2019) · Nutrients · doi:10.3390/nu11092163 · Cited by 258 · see citing works
“Previous studies showed that protein supplementation provided additional beneficial effects on TSM and muscle strength compared to exercise alone in older adults [45, 46].”
BackgroundSelf-citationPolyzos, S. A., & Margioris, A. N. (2018) · Hormones · doi:10.1007/s42000-018-0049-x · Cited by 212 · see citing works
Liao, C.-D., Chen, H.-C., Huang, S.-W., & Liou, T.-H. (2019) · Nutrients · doi:10.3390/nu11081713 · Cited by 189 · see citing works
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Strasser, B., Wolters, M., Weyh, C., Krüger, K., & Ticinesi, A. (2021) · Nutrients · doi:10.3390/nu13062045 · Cited by 181 · see citing works
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Kemmler, W., Kohl, M., Fröhlich, M., Jakob, F., Engelke, K., von Stengel, S., & Schoene, D. (2020) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.4027 · Cited by 139 · see citing works
“In parallel, evidence for an additional effect of protein or EAA to exercise on muscle mass or function for older people((48,49,68,69)) or people with sarcopenia is reported to be still inconsistent and overall low at best.”
BackgroundMehra, R., Kumar, H., Kumar, N., Ranvir, S., Jana, A., Buttar, H., Télessy, I., Awuchi, C. G., Okpala, C., Korzeniowska, M., et al. (2021) · Journal of Functional Foods · doi:10.1016/j.jff.2021.104760 · Cited by 120 · see citing works
Dietary and policy priorities to reduce the global crises of obesity and diabetes
Mozaffarian, D. (2020) · Nature Food · doi:10.1038/s43016-019-0013-1 · Cited by 133 · see citing works
Nabuco, H. C. G., Tomeleri, C. M., Fernandes, R. R., Sugihara Junior, P., Cavalcante, E. F., Cunha, P. M., Antunes, M., Nunes, J. P., Venturini, D., Barbosa, D. S., et al. (2019) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2019.04.007 · Cited by 125 · see citing works
Sarcopenic obesity in cirrhosis—The confluence of 2 prognostic titans
Eslamparast, T., Montaño‐Loza, A. J., Raman, M., & Tandon, P. (2018) · Liver International · doi:10.1111/liv.13876 · Cited by 124 · 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
Falls among Older Adults: Screening, Identification, Rehabilitation, and Management
Giovannini, S., Brau, F., Galluzzo, V., Santagada, D. A., Loreti, C., Biscotti, L., Laudisio, A., Zuccalà, G., & Bernabei, R. (2022) · Applied Sciences · doi:10.3390/app12157934 · Cited by 108 · see citing works
Eglseer, D., Traxler, M., Embacher, S., Reiter, L., Schoufour, J. D., Weijs, P. J. M., Voortman, T., Boirie, Y., Cruz-Jentoft, A., & Bauer, S. (2023) · Advances in Nutrition · doi:10.1016/j.advnut.2023.04.001 · Cited by 102 · see citing works
Liao, C.-D., Lee, P.-H., Hsiao, D.-J., Huang, S.-W., Tsauo, J.-Y., Chen, H.-C., & Liou, T.-H. (2018) · Nutrients · doi:10.3390/nu10121916 · Cited by 94 · see citing works
“Previous systematic reviews have demonstrated nonsignificant effects on changes in body weight [21,71,87], muscle mass [19,87], muscle strength [19], and physical mobility [20] in response to PS plus RET among older adults who mostly were healthy or nonfrail.”
BackgroundResultSelf-citationLichtenberg, T., von Stengel, S., Sieber, C. C., & KEMMLER, W. K. (2019) · Clinical Interventions in Aging · doi:10.2147/cia.s225618 · Cited by 95 · see citing works
Kirwan, 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
Hou, L., Lei, Y., Li, X., Huo, C., Jia, X.-M., Yang, J., Xu, R., & Wang, X. (2019) · The journal of nutrition health & aging · doi:10.1007/s12603-019-1181-2 · Cited by 88 · 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).”
BackgroundNabuco, H. C. G., Tomeleri, C. M., Sugihara, P., Fernandes, R. R., Cavalcante, E. F., Antunes, M., Ribeiro, A. S., Teixeira, D. D. C., Silva, A. M., Sardinha, L. B., et al. (2018) · Nutrients · doi:10.3390/nu10050563 · Cited by 88 · see citing works
“However, the effect on strength gain was not associated with improvements in most components of physical mobility [44].”
BackgroundResultHita-Contreras, F., Bueno-Notivol, J., Martínez-Amat, A., Cruz-Díaz, D., Hernandez, A. V., & Pérez-López, F. R. (2018) · Maturitas · doi:10.1016/j.maturitas.2018.07.007 · Cited by 86 · see citing works
KEMMLER, W. K., Kohl, M., Jakob, F. J., Engelke, K., & von Stengel, S. (2020) · Nutrients · doi:10.3390/nu12082341 · Cited by 81 · see citing works
“On the other hand, the additional effect of protein supplementation to resistance exercise on muscle mass and/or function in older people with [49,84,85] or without sarcopenia/SO [69,85] is still under discussion.”
BackgroundRehabilitation Nutrition for Iatrogenic Sarcopenia and Sarcopenic Dysphagia
Nagano, A., Nishioka, S., & Wakabayashi, H. (2018) · The journal of nutrition health & aging · doi:10.1007/s12603-018-1150-1 · Cited by 75 · see citing works
“In this respect, rehabilitation nutrition can offer better effects (11, 50-59).”
Planella-Farrugia, C., Comas, F., Sabater, M., Moreno, M., Moreno‐Navarrete, J. M., Rovira, O., Ricart, W., & Fernández‐Real, J. M. (2019) · Frontiers in Physiology · doi:10.3389/fphys.2019.00871 · Cited by 74 · see citing works
van Dongen, E. J. I., Haveman‐Nies, A., Doets, E. L., Dorhout, B. G., & de Groot, C. P. G. M. (2020) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2019.11.026 · Cited by 74 · see citing works
Orsso, C. E., Montes‐Ibarra, M., Findlay, M., van der Meij, B. S., de van der Schueren, M. A. E., Landi, F., Laviano, A., & Prado, C. M. (2022) · Journal of Cachexia, Sarcopenia and Muscle · doi:10.1002/jcsm.12954 · Cited by 73 · see citing works
Prospective views for whey protein and/or resistance training against age-related sarcopenia
Liao, Y., Peng, Z., Chen, L., Zhang, Y., Cheng, Q., Nüssler, A. K., Bao, W., Liu, L., & Yang, W. (2019) · Aging and Disease · doi:10.14336/ad.2018.0325 · Cited by 68 · see citing works
“compared with RT alone, protein supplement combined with RT may have a stronger effect in preventing agingrelated muscle mass attenuation and leg strength loss in overweight and obese older people [107].”
MethodMartínez-Amat, A., Aibar-Almazán, A., Fábrega-Cuadros, R., Cruz-Díaz, D., Jiménez-García, J. D., Pérez-López, F. R., Achalandabaso, A., Barranco-Zafra, R., & Hita-Contreras, F. (2018) · Maturitas · doi:10.1016/j.maturitas.2018.02.005 · Cited by 65 · see citing works
Effects of progressive elastic band resistance exercise for aged osteosarcopenic adiposity women
Lee, Y.-H., Lee, P.-H., Lin, L.-F., Liao, C.-D., Liou, T.-H., & Huang, S.-W. (2021) · Experimental Gerontology · doi:10.1016/j.exger.2021.111272 · Cited by 62 · see citing works
McCullough, D., Webb, R., Enright, K. J., Lane, K. E., McVeigh, J., Stewart, C. E., & Davies, I. G. (2021) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-020-09616-y · Cited by 62 · see citing works
“Although resistance exercise has shown to reduce the severity of sarcopenia [72, 73], serum testosterone levels decline with age in males which may lead to testosterone deficiency and attribute to sarcopenia and frailty; therefore, low dose testosterone supplementation may attenuate this decline and even improvemuscle…”
BackgroundEvans, K., Abdelhafiz, D., & Abdelhafiz, A. H. (2021) · Postgraduate Medicine · doi:10.1080/00325481.2021.1942934 · Cited by 58 · see citing works
Koya, S., Kawaguchi, T., Hashida, R., Hirota, K., Bekki, M., Goto, E., Yamada, M., Sugimoto, M., Hayashi, S., Goshima, N., et al. (2018) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.14538 · Cited by 61 · see citing works
Therapeutic approaches to osteosarcopenia: insights for the clinician
Fatima, M., Brennan-Olsen, S. L., & Duque, G. (2019) · Therapeutic Advances in Musculoskeletal Disease · doi:10.1177/1759720x19867009 · Cited by 61 · see citing works
Lee, S. Y., Lee, H. J., & Lim, J. (2022) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2022.104758 · Cited by 60 · 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…”
ResultMalandrino, N., Bhat, S. Z., Alfaraidhy, M., Grewal, R. S., & Kalyani, R. R. (2023) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2022.10.001 · Cited by 61 · see citing works
Liao, C., Chen, H., Kuo, Y., Tsauo, J., Huang, S., & Liou, T. (2019) · Arthritis Care & Research · doi:10.1002/acr.24097 · Cited by 58 · see citing works
Self-citationDietary Protein Sources and Muscle Mass over the Life Course: The Lifelines Cohort Study
Alexandrov, N. V., Eelderink, C., Singh-Povel, C. M., Navis, G. J., Bakker, S. J. L., & Corpeleijn, E. (2018) · Nutrients · doi:10.3390/nu10101471 · Cited by 56 · see citing works
“Intervention studies [15,25] have clearly demonstrated that combining physical exercise with protein intake has a positive synergistic effect on muscle protein synthesis.”
BackgroundJyväkorpi, S. K., Ramel, A., Strandberg, T. E., Piotrowicz, K., Błaszczyk-Bębenek, E., Urtamo, A., Rempe, H. M., Geirsdóttir, Ó. G., Vágnerová, T., Billot, M., et al. (2021) · European Geriatric Medicine · doi:10.1007/s41999-020-00438-4 · Cited by 55 · see citing works
Liao, C., Wu, Y., Tsauo, J., Chen, P., Tu, Y., Chen, H., & Liou, T. (2020) · Nutrients · doi:10.3390/nu12082422 · Cited by 57 · see citing works
“This finding is consistent with those of previous systematic reviews on the effectiveness of PS + ET in sarcopenic or frail older adults [38,68], regardless of exercise type.”
BackgroundResultSelf-citationGriffen, C., Duncan, M. J., Hattersley, J. G., Weickert, M. O., Dallaway, A., & Renshaw, D. W. (2021) · Experimental Gerontology · doi:10.1016/j.exger.2021.111651 · Cited by 57 · see citing works
Couderc, A., Liuu, É., Boudou, P., Poisson, J., Frélaut, M., Montégut, C., Mebarki, S., Geiss, R., Thomas, Z. A., Noret, A., et al. (2023) · Nutrients · doi:10.3390/nu15051193 · Cited by 54 · see citing works
Awuchi, C. G., & Okpala, C. O. R. (2022) · Journal of Food Bioactives · doi:10.31665/jfb.2022.18317 · Cited by 52 · see citing works
“Dietary supplements - nutrients derived from foods or other safe sources, are usually concentrated in form of a pill, powder, liquid, capsule, gel caps, or soft gels, taken orally to supplement the diet (Liao et al., 2017; Hofmeyr et al., 2019).”
BackgroundWhaikid, P., & Piaseu, N. (2024) · Epidemiology and Health · doi:10.4178/epih.e2024030 · Cited by 52 · see citing works
“Existing worldwide systematic reviews often lack specificity, particularly when it comes to targeting community-dwelling older adults with sarcopenia [25,26].”
BackgroundResultvan den Helder, J., Mehra, S., van Dronkelaar, C., ter Riet, G., Tieland, M., Visser, B., Kröse, B. J. A., Engelbert, R. H. H., & Weijs, P. J. M. (2020) · Journal of Cachexia, Sarcopenia and Muscle · doi:10.1002/jcsm.12634 · Cited by 51 · see citing works
Cardiovascular care of older adults
O’Neill, D. E., & Forman, D. E. (2021) · BMJ · doi:10.1136/bmj.n1593 · Cited by 54 · see citing works
The Effect of Aging Physiology on Critical Care
Darden, D. B., Moore, F. A., Brakenridge, S. C., Navarro, E., Anton, S. D., Leeuwenburgh, C., Moldawer, L. L., Mohr, A. M., Efron, P. A., & Mankowski, R. T. (2020) · Critical Care Clinics · doi:10.1016/j.ccc.2020.08.006 · Cited by 52 · see citing works
Amasene, M., Besga, A., Echeverria, I., Urquiza, M., Ruiz, J. R., Rodriguez‐Larrad, A., Aldámiz, M., Anaut, P., Irazusta, J., & Labayen, I. (2019) · Nutrients · doi:10.3390/nu11102337 · Cited by 51 · see citing works
“There is still much controversy regarding protein supplementation in the elderly population due to poor compliance, high heterogeneity and underpowered studies evident from meta-analysis and systematic reviews [17,18,45].”
BackgroundMemelink, R. G., Pasman, W. J., Bongers, A., Tump, A. C., van Ginkel, A., Tromp, W., Wopereis, S., Verlaan, S., den Bosch, J. D. V., & Weijs, P. J. M. (2020) · Nutrients · doi:10.3390/nu13010064 · Cited by 51 · see citing works
“[42] who showed that overweight or obese older adults had substantially greater leg strength gain, in addition to greater lean mass gain, when protein supplementation was combined with resistance exercise, compared to resistance exercise alone.”
BackgroundMou, K., Chan, S. M. H., & Vlahos, R. (2024) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2024.108635 · Cited by 50 · see citing works
Development of Pharmacotherapies for the Treatment of Sarcopenia
Rooks, D., & Roubenoff, R. (2019) · The Journal of Frailty & Aging · doi:10.14283/jfa.2019.11 · Cited by 49 · see citing works
“The topics of exercise and nutrition for improved health and function and as contributors to and potential treatment for sarcopenia in older adults have been reviewed recently (3, 25-27).”
Lin, Y.-N., Tseng, T.-T., Knuiman, P., Chan, W. P., Wu, S.-H., Tsai, C.-L., & Hsu, C. (2020) · Clinical Nutrition · doi:10.1016/j.clnu.2020.12.012 · Cited by 47 · see citing works
O’Bryan, K. R., Doering, T. M., Morton, R. W., Coffey, V. G., Phillips, S. M., & Cox, G. R. (2019) · British Journal of Sports Medicine · doi:10.1136/bjsports-2018-099889 · Cited by 47 · see citing works
Conforto, R., Rizzo, V., Russo, R., Mazza, E., Maurotti, S., Pujia, C., Succurro, E., Arturi, F., Ferro, Y., Sciacqua, A., et al. (2024) · Metabolism · doi:10.1016/j.metabol.2024.156052 · Cited by 45 · see citing works
Verreijen, A. M., Engberink, M. F., Houston, D. K., Brouwer, I. A., Cawthon, P. M., Newman, A. B., Tylavsky, F. A., Harris, T. B., Weijs, P. J. M., & Visser, M. (2019) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqy341 · Cited by 45 · see citing works
Liao, C.-D., Huang, S.-W., Chen, H.-C., Huang, M.-H., Liou, T.-H., & Lin, C.-L. (2024) · Nutrients · doi:10.3390/nu16070941 · Cited by 45 · see citing works
“Especially, a high-protein diet or protein supplementation is believed to have surplus benefits in augmenting efficacy of RT for healthy older people [42–45], as well as those who have high risks of sarcopenia [41,43–51].”
BackgroundSelf-citationRehabilitative Good Practices in the Treatment of Sarcopenia
Agostini, F., Bernetti, A., Giacomo, G. D., Viva, M. G., Paoloni, M., Mangone, M., Santilli, V., & Masiero, S. (2020) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000001572 · Cited by 43 · see citing works
Li, C., Meng, H., Wu, S., Fang, A., Liao, G., Tan, X., Chen, P., Wang, X., Chen, S., & Zhu, H. (2021) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2021.01.006 · Cited by 43 · see citing works
Webster, J., Via, J. D., Langley, C. K., Smith, C., Sale, C., & Sim, M. (2023) · Bone Reports · doi:10.1016/j.bonr.2023.101684 · Cited by 47 · see citing works
“…0.3 kg (Morton et al., 2018); standardised mean difference 0.6 (Liao et al., 2017) and one-repetition maximum strength (mean difference 2.5 kg (Morton et al., 2018); standardised mean difference 0.7) among healthy adults (Morton et al., 2018) or older adults specifically (Liao et al., 2017).”
BackgroundInfluentialTallis, J. A., Shelley, S. P., Degens, H., & Hill, C. (2021) · Biomolecules · doi:10.3390/biom11030372 · Cited by 44 · see citing works
“[223], was equivalent in a high BMI (>30 kg/m2) group.”
BackgroundSmith, G. I., Commean, P. K., Reeds, D. N., Klein, S., & Mittendorfer, B. (2018) · Obesity · doi:10.1002/oby.22169 · Cited by 42 · see citing works
“However, the data from several recent systematic reviews and meta-analyses have shown little or no effect of increased protein and/or amino acid intake on exercise-training-induced muscle hypertrophy in weight-stable middle-aged and older adults (36-41).”
BackgroundLabata‐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
Reijnierse, E. M., Verlaan, S., Pham, V. K., Lim, W. K., Meskers, C. G. M., & Maier, A. B. (2018) · The Journals of Gerontology Series A · doi:10.1093/gerona/gly281 · Cited by 41 · see citing works
“The appealing trait of skeletal muscle is its capacity to be modifiable in volume by nutritional and exercise interventions (33).”
BackgroundLiao, C., Liao, Y., Liou, T., Hsieh, C.-Y., Kuo, Y., & Chen, H. (2021) · Nutrients · doi:10.3390/nu13082487 · Cited by 41 · see citing works
“A number of systematic review studies have investigated the effects of additional PS applied during exercise on physical mobility and global function for sarcopenic or frail elderly people [94,95,115,121,122], and the evidence remains inconclusive.”
BackgroundResultInfluentialSelf-citationLiao, C., Tsauo, J., Chiu, Y., Ku, J.-W., Huang, S., & Liou, T. (2019) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000001344 · Cited by 42 · see citing works
“Diet patterns or nutrition supplements, such as protein supplements, may cause changes in whole-body weight or muscle mass during RET.58 In conclusion, this study revealed that 12 wks of elastic RET after TKR had benefits for muscle mass gain and functional recovery in relation to walk capability, balance, and lower-l…”
BackgroundInfluentialSelf-citationPlasma Amino Acid Concentrations Are Associated with Muscle Function in Older Japanese Women
Yamada, M., Kimura, Y., Ishiyama, D., Nishio, N., Tanaka, T., Ohji, S., Otobe, Y., Koyama, S., Sato, A., Suzuki, M., et al. (2018) · The journal of nutrition health & aging · doi:10.1007/s12603-018-1014-8 · Cited by 39 · see citing works
“Therefore, numerous studies have examined the effects of various programs on skeletal muscle function and have found beneficial effects of physical exercise and nutritional supplementation in sarcopenic older adults (3).”
Reidy, P. T., Mahmassani, Z. S., McKenzie, A. I., Petrocelli, J. J., Summers, S. A., & Drummond, M. J. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21041514 · Cited by 39 · see citing works
“, cardiovascular disease, peripheral vascular disease, and neuropathy), leading to enormous healthcare cost and decreased quality of life [3,4].”
BackgroundChang, K. C., Wu, W., Huang, K., & Han, D. (2020) · Clinical Nutrition · doi:10.1016/j.clnu.2020.06.037 · Cited by 41 · see citing works
Yang, Y., Zhang, Q., He, C., Chen, J., Deng, D., Lu, W., & Wang, Y. (2022) · PeerJ · doi:10.7717/peerj.13678 · Cited by 37 · see citing works
Ransdell, L. B., Wayment, H. A., Lopez, N. V., Lorts, C., Schwartz, A. L., Pugliesi, K. L., Pohl, P. S., Bycura, D. K., & Camplain, R. L. (2021) · Women · doi:10.3390/women1030014 · Cited by 35 · see citing works
“…and leg strength gains than RT alone (standard mean differences of 0.58 and 0.69, respectivelyear), and that gains in lean mass and leg strength were greater in those with a BMI ≥ 30 kg · m − 2 than in those with a BMI 30 kg · m − 2 (standard mean difference of 0.53 and 0.88, respectively [17].”
BackgroundInfluentialDorhout, B. G., Haveman‐Nies, A., van Dongen, E. J. I., Wezenbeek, N. L. W., Doets, E. L., Bulten, A., de Wit, G. A., & de Groot, C. P. G. M. (2021) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2020.12.036 · Cited by 34 · see citing works
“Rehabilitation care treatment 157 per hour (178) 3 18 (3 20) 11 (13) 1 2 (1 2) 4 (5) Consultations outpatient clinic 93 per hour (106) 212 242 (240 274) 55 (67) 164 197 (186 223) 51 (59) Medication use Individualized 174 153 (197 173) 76 (93) 356 1347 (403 1524) 76 (88) Subtotal 1336 1466 (1510 1656) 1697 2656 (1917 3…”
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
Han, M., Woo, K.-S., & Kim, K. (2024) · Nutrients · doi:10.3390/nu16244350 · Cited by 31 · see citing works
“Similarly, a meta-analysis examining the effects of protein supplementation combined with resistance exercise on physical function in older adults reported significant improvements in SPPB scores [66].”
van Wijngaarden, J. P., Wojzischke, J., van den Berg, C., Cetinyurek‐Yavuz, A., Diekmann, R., Luiking, Y. C., & Bauer, J. M. (2020) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2020.04.012 · Cited by 31 · see citing works
Kamińska, M. S., Rachubińska, K., Grochans, S., Skonieczna‐Żydecka, K., Cybulska, A. M., Grochans, E., & Karakiewicz, B. (2023) · Nutrients · doi:10.3390/nu15092039 · Cited by 31 · see citing works
Hsu, K., Chien, K., Tsai, S.-C., Tsai, Y.-S., Liao, Y. H., Chen, J. J., Chen, Y.-R., & Chen, C. (2021) · The journal of nutrition health & aging · doi:10.1007/s12603-021-1599-1 · Cited by 30 · see citing works
Chew, S. T. H., Kayambu, G., Lew, C. C. H., Ng, T. P., Ong, F., Tan, J. J., Tan, N. C., & Tham, S.-L. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02240-8 · Cited by 30 · see citing works
“A meta-analysis found that protein supplementation has a stronger effect in preventing loss of muscle mass and leg strength in older adults at risk of sarcopenia and frailty compared with RET alone [129].”
BackgroundHonaga, K., Mori, N., Akimoto, T., Tsujikawa, M., Kawakami, M., Okamoto, T., Sakata, Y., Hamano, H., Takeda, Y., & Kondo, K. (2022) · Nutrients · doi:10.3390/nu14030685 · Cited by 30 · see citing works
“Regarding the effects of nutritional supplementation combined with exercise, not only specific amino acid mixture, but also dietary proteins, including cow’s milk whey protein, are known to improve muscle mass and function in the elderly [17,18].”
BackgroundDietary Protein, Exercise, and Frailty Domains
Schoufour, J. D., Overdevest, E., Weijs, P. J. M., & Tieland, M. (2019) · Nutrients · doi:10.3390/nu11102399 · Cited by 29 · see citing works
Bailey, R. L., Sahni, S., Chocano-Bedoya, P. O., Daly, R. M., Welch, A. A., Bischoff-Ferrari, H. A., & Weaver, C. M. (2018) · Advances in Nutrition · doi:10.1093/advances/nmy111 · Cited by 28 · see citing works
“Others have reported that the provision of additional protein can lead to greater resistance training–induced gains in muscle mass and/or strength compared to resistance training alone in older adults (154), particularly in those with inadequate basal protein intakes or those who are institutionalized or sarcopenic (1…”
BackgroundMung Bean Protein Supplement Improves Muscular Strength in Healthy, Underactive Vegetarian Adults
Bartholomae, E. M., Incollingo, A., Vizcaíno, M., Wharton, C. M., & Johnston, C. S. (2019) · Nutrients · doi:10.3390/nu11102423 · Cited by 27 · see citing works
Protein and amino acids for skeletal muscle health in aging
Thalacker‐Mercer, A. E., Riddle, E. S., & Barré, L. K. (2020) · Advances in food and nutrition research · doi:10.1016/bs.afnr.2019.08.002 · Cited by 26 · see citing works
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“Other interventions with evidence in increasing muscle mass are protein supplementation combined with resistance training [48], especially in the obese population, and creatine supplementation combined with resistance training [49].”
BackgroundLee, E.-L., Jang, M. H., Lee, B., Han, S. H., Lee, H., Choi, S. U., & Shin, M. (2023) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2023.08.013 · Cited by 25 · see citing works
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“In most of the previous studies, casein, whey, and/or milk protein have been used as protein supplementations to test the effect of its combination with resistance training (10,11), and these are widely developed as commercial protein supplements.”
BackgroundMethodReinders, 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
Abiri, B., Hosseinpanah, F., Seifi, Z., Amini, S., & Valizadeh, M. (2023) · The journal of nutrition health & aging · doi:10.1007/s12603-023-1986-x · Cited by 27 · see citing works
“Another systematic review (42) found that combining protein supplements with resistance training effectively increased muscle mass and strength in older individuals irrespective of their body weight.”
Dietary supplement intake among the elderly
Walrand, S. (2018) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000512 · Cited by 24 · see citing works
Linking epidemiology and molecular mechanisms in sarcopenic obesity in populations
El Bizri, I., & Batsis, J. A. (2020) · Proceedings of the Nutrition Society · doi:10.1017/s0029665120000075 · Cited by 23 · see citing works
“Compared with resistance training alone, protein supplementation combined with resistance training may have a stronger effect in preventing ageing-related muscle mass attenuation and leg strength loss in older people (85) .”
Zhou, H., Liao, Y., Zhou, X., Peng, Z., Xu, S., Shi, S., Liu, L., Hao, L., & Yang, W. Q. (2023) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2023-0118 · Cited by 24 · see citing works
- Authors
- Liao, C.-D., Tsauo, J.-Y., Wu, Y.-T., Cheng, C.-P., Chen, H.-C., Huang, Y.-C., Chen, H.-C., & Liou, T.-H.
- Affiliations
- National Taiwan University (TW)
- National Taiwan University Hospital (TW)
- National Taipei University of Nursing and Health Science (TW)
- Taipei Medical University (TW)
- Corresponding author
- Liou, Tsan-Hon
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 106
- Issue
- 4
- Pages
- 1078-1091
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2747357561
- Cited by
- 317
- References
- 63
- Citations by year
- 2026: 21 · 2025: 35 · 2024: 28 · 2023: 32 · 2022: 40 · 2021: 37 · 2020: 49 · 2019: 38 · 2018: 35 · 2017: 1
- FWCI
- 4.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ministry of Health and Welfare
- National Science Council
- Ministry of Science and Technology, Taiwan (053-MY3, 2314-B-038)
- Health Promotion Administration, Ministry of Health and Welfare
- 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, resistance training, older adults, sarcopenic obesity, body composition, lean mass gain, leg strength, physical function, physical mobility, body mass index, muscle protein synthesis, muscle mass loss
- MeSH terms
- Aged, Aged, 80 and over, Body Composition, Dietary Proteins, Female, Humans, Male, Middle Aged, Muscles, Obesity, Physical Fitness, Dietary Supplements, Muscle Strength, Resistance Training, Sarcopenia
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