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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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“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]
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In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
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In the citing paper
“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]
Experimental — accuracy not yet measuredIn the citing paper
“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].”
In the citing paper
“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.”
In the citing paper
“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].”
In the citing paper
“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]
In the citing paper
“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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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 54
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
“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 56
“[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 53
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 51
“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 48
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 52
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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 48
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
“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 46
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 47
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 49
“…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 46
“[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 45
“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 46
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
“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
“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
“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
“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 43
“, 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 44
Yang, Y., Zhang, Q., He, C., Chen, J., Deng, D., Lu, W., & Wang, Y. (2022) · PeerJ · doi:10.7717/peerj.13678 · Cited by 41
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
“…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 33
“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
Han, M., Woo, K.-S., & Kim, K. (2024) · Nutrients · doi:10.3390/nu16244350 · Cited by 35
“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
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 32
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 33
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 33
“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
“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 30
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 29
“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
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 27
Alabadí, B., Civera, M., la Rosa, A. D., Martínez‐Hervás, S., Gómez‐Cabrera, M. C., & Real, J. T. (2023) · Nutrients · doi:10.3390/nu15143167 · Cited by 31
“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
Cheng, Y.-H., Wei, L., Chan, W. P., Hsu, C., Huang, S., Wang, H., & Lin, Y.-N. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2019.12.013 · Cited by 25
Watanabe, K., Holobar, A., Mita, Y., Tomita, A., Yoshiko, A., Kouzaki, M., Uchida, K., & Moritani, T. (2020) · The Journals of Gerontology: Series A · doi:10.1093/gerona/glz215 · Cited by 24
“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 30
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 28
“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
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
“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
Metadata
- 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 (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, 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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