Skip to main content
Log in

Effects of nutritional supplements on muscle mass and activities of daily living in elderly rehabilitation patients with decreased muscle mass: A randomized controlled trial

The journal of nutrition, health & aging Aims and scope Submit manuscript

Abstract

Objective

To investigate the effects of nutritional intervention with resistance training on skeletal muscle mass in elderly patients with disabilities in a convalescent rehabilitation setting.

Design

A randomized controlled trial. (UMIN Clinical Trials Registry ID: UMIN000006238).

Setting

A rehabilitation hospital.

Participants

39 elderly patients with decreased skeletal muscle mass in an inpatient convalescence rehabilitation unit.

Interventions

A combination of resistance training plus nutritional supplementation (R/N group) or resistance training alone (R group). The training and supplementation were conducted essentially from the patient’s admission to discharge (2–6 months).

Outcome Measures

The patients were evaluated at the time of admission and at the end of the intervention for skeletal muscle mass (calf circumference [CC] as a primary outcome, and arm circumference [AC]), hand grip strength (HG), Mini-Nutritional Assessment-Short Form (MNA®-SF) score, serum albumin level (Alb), body mass index (BMI), and activities of daily living (ADL) as represented by the Barthel Index (BI) score.

Results

Significant treatment effects were seen for CC, AC, BI, Alb in the R/N group compared to the R group. A mean treatment effect of 3.2 (95%CI: 2.0–4.4) was seen in CC, 1.4 (95%CI: 0.8–2.1) was seen in AC, 11.2 (95%CI: 0.5–21.8) was seen in BI, 0.3 (95%CI: 0.1–0.5) was seen in Alb.

Conclusion

The results of this study suggest that nutritional intervention added to resistance training during convalescent rehabilitation may improve skeletal muscle mass and activities of daily living.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony PS, Charlton KE, Maggio M, Tsai AC, Vellas B, Sieber CC. Mini Nutritional Assessment International Group: Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc 2010;58:1734–1738

    Article  PubMed  Google Scholar 

  2. Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, Abellan van Kan G, Andrieu S, Bauer J, Breuille D, Cederholm T, Chandler J, De Meynard C, Donini L, Harris T, Kannt A, Keime-Guibert F, Onder G, Papanicolaou D, Rolland Y, Rooks D, Sieber C, Souhami E, Verlaan S, Zamboni M. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 2011;12:249–256

    PubMed  Google Scholar 

  3. Yaxley A, Miller MD, Fraser RJ, Cobiac L, Crotty M. The complexity of treating wasting in ambulatory rehabilitation: Is it starvation, sarcopenia, cachexia or a combination of these conditions? Asia Pac J Clin Nutr 2012;21:386–393

    PubMed  Google Scholar 

  4. Sánchez-Rodríguez D, Marco E, Miralles R, Fayos M, Mojal S, Alvarado M, Vázquez-Ibar O, Escalada F, Muniesa JM. Sarcopenia, physical rehabilitation and functional outcomes of patients in a subacute geriatric care unit. Arch Gerontol Geriatr 2014;59:39–43

    Article  PubMed  Google Scholar 

  5. Wakabayashi H, Sashika H. Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning a prospective cohort study. J Rehabil Med 2014;46:277–282

    Article  PubMed  Google Scholar 

  6. Wakabayashi H, Sakuma K. Rehabilitation nutrition for sarcopenia with disability: a combination of both rehabilitation and nutrition care management. J Cachexia Sarcopenia Muscle 2014;5:269–277

    Article  PubMed Central  PubMed  Google Scholar 

  7. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M. European working group on sarcopenia in older people: Sarcopenia: European consensus on definition and diagnosis. Age Ageing 2010;39:412–423

    Article  PubMed Central  PubMed  Google Scholar 

  8. Morley JE, Argiles JM, Evans WJ, Bhasin S, Cella D, Deutz NE, Doehner W, Fearon KC, Ferrucci L, Hellerstein MK, Kalantar-Zadeh K, Lochs H, MacDonald N, Mulligan K, Muscaritoli M, Ponikowski P, Posthauer ME, Rossi-Fanelli F, Schambelan M, Schols AM, Schuster MW, Anker SD. Society for Sarcopenia, Cachexia, and Wasting Disease. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc 2010;11:391–396

    Article  PubMed Central  PubMed  Google Scholar 

  9. Cruz-Jentoft AJ, Landi F, Schneider SM, Zúñiga C, Arai H, Boirie Y, Chen LK, Fielding RA, Martin FC, Michel JP, Sieber C, Stout JR, Studenski SA, Vellas B, Woo J, Zamboni M, Cederholm T. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative(EWGSOP and IWGS). Age Ageing 2014;43:748–759

    PubMed Central  PubMed  Google Scholar 

  10. Martone AM, Lattanzio F, Abbatecola AM, La-Carpia D, Tosato M, Marzetti E, Calvani R, Onder G, Landi F. Treating sarcopenia in older and oldest old. Curr Pharm Des. 2015;30. [Epub ahead of print]

    Google Scholar 

  11. Beavers KM, Gordon MM, Easter L, Beavers DP, Hairston KG, Nicklas BJ, Vitolins MZ. Effect of protein source during weight loss on body composition, cardiometabolic risk and physical performance in abdominally obese, older sdults: a pilot feeding study. J Nutr Health Aging 2015;19:87–95. doi: 10.1007/s12603-015-0438-7

    Article  CAS  PubMed  Google Scholar 

  12. Komar B, Schwingshackl L, Hoffmann G. Effects of leucine-rich protein supplements on anthropometric parameter and muscle strength in the elderly: a systematic review and meta-analysis. J Nutr Health Aging, 2014. doi: 10.1007/s12603-014-0559-4

    Google Scholar 

  13. Yamada M, Arai H, Yoshimura K, Kajiwara Y, Sonoda T, Nishiguchi S, Aoyama T. Nutritional supplementation during resistance training improved skeletal muscle mass in community-dwelling frail older adults. J Frailty Aging 20141: 64–70

    Google Scholar 

  14. Bonnefoy M, Cornu C, Normand S, Boutitie F, Bugnard F, Rahmani A, Lacour JR, Laville M. The effects of exercise and protein-energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study. Br J Nutr 2003;89:731–739

    Article  CAS  PubMed  Google Scholar 

  15. Price R, Daly F, Pennington CR, McMurdo ME. Nutritional supplementation of very old people at hospital discharge increases muscle strength: a randomised controlled trial. Gerontology 2005;51:179–185

    Article  CAS  PubMed  Google Scholar 

  16. Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 2009;15:003288

    Google Scholar 

  17. Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, Roberts SB, Kehayias JJ, Lipsitz LA, Evans WJ. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994;330:1769–1775

    Article  CAS  PubMed  Google Scholar 

  18. Cesari M. Perspective: Protein supplementation against sarcopenia and frailty: future perspectives from novel data. J Am Med Dir Assoc 2013;14:62–63

    Article  PubMed  Google Scholar 

  19. Malafarina V, Uriz-Otano F, Iniesta R, Gil-Guerrero L. Effectiveness of nutritional supplementation on muscle mass in treatment of sarcopenia in old age: a systematic review. J Am Med Dir Assoc 2013;14:10–17

    Article  PubMed  Google Scholar 

  20. Milne AC, Avenell A, Potter J. Meta-analysis: protein and energy supplementation in older people. Ann Intern Med 2006;144:37–48

    Article  CAS  PubMed  Google Scholar 

  21. Rabadi MH, Coar PL, Lukin M, Lesser M, Blass JP. Intensive nutritional supplements can improve outcomes in stroke rehabilitation. Neurology 2008;71:1856–1861

    Article  CAS  PubMed  Google Scholar 

  22. Miller MD, Crotty M, Whitehead C, Bannerman E, Daniels LA. Nutritional supplementation and resistance training in nutritionally at risk older adults following lower limb fracture: a randomized controlled trial. Clin Rehabil 2006;20:311–323

    Article  PubMed  Google Scholar 

  23. Ishii S, Tanaka T, Shibasaki K, Ouchi Y, Kikutani T, Higashiguchi T, Obuchi SP, Ishikawa-Takata K, Hirano H, Kawai H, Tsuji T, Iijima K. Development of a simple screening test for sarcopenia in older adults. Geriatr Gerontol Int 2014;1:93–101

    Article  Google Scholar 

  24. Kawakami R, Murakami H, Sanada K, Tanaka N, Sawada SS, Tabata I, Higuchi M, Miyachi M. Calf circumference as a surrogate marker of muscle mass for diagnosing sarcopenia in Japanese men and women. Geriatr Gerontol Int, 2014;. doi: 10.1111/ggi.12377

    Google Scholar 

  25. Rolland Y, Lauwers-Cances V, Cournot M, Nourhashémi F, Reynish W, Rivière D, Vellas B, Grandjean H. Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study. J Am Geriatr Soc 2003;51:1120–1124

    Article  PubMed  Google Scholar 

  26. Landi F, Onder G, Russo A, Liperoti R, Tosato M, Martone AM, Capoluongo E, Bernabei R. Calf circumference, frailty and physical performance among older adults living in the community. Clin Nutr 2014;33:539–544

    Article  PubMed  Google Scholar 

  27. Shimokata H, Ando F. Association of daily physical performance with muscle volume and strength. Nihon Ronen Igakkai Zasshi 2012;49:195–198

    Article  PubMed  Google Scholar 

  28. Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992;40:922–935

    Article  CAS  PubMed  Google Scholar 

  29. Miyai I, Sonoda S, Nagai S, Takayama Y, Inoue Y, Kakehi A, Kurihara M, Ishikawa M. Results of new policies for inpatient rehabilitation coverage in Japan. Neurorehabil Neural Repair 2011;25:540–547

    Article  PubMed  Google Scholar 

  30. Cabinet Office, Government of Japan. The aging society: current situation and implementation measures FY. Annual report on the aging society. http://www8.cao.go.jp/kourei/english/annualreport/index-wh.html, 2013. Accessed 24 December 2014

  31. Tokunaga M, Watanabe S, Nakanishi R, Yamanaga H, Sannomiya K, Hirata Y. Comparison between convalescent rehabilitation hospitals participating in the stroke liaison critical pathway with respect to the gain of Nichijo-seikatsu-kino-hyokahyo score. Jpn J Compr Rehabil Sci 2012;3: 11–17 (article in Japanese)

    Google Scholar 

  32. Gaillard C, Alix E, Sallé A, Berrut G, Ritz P. Energy requirements in frail elderly people: a review of the literature. Clin Nutr 2007;26:16–24

    Article  CAS  PubMed  Google Scholar 

  33. O’Sullivan S, Schmitz T. Physical rehabilitation 5th edition. F.A. Davis Company, USA, 2006

    Google Scholar 

  34. Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony P, Charlton KE, Maggio M, Tsai AC, Grathwohl D, Vellas B, Sieber CC. MNA-International Group. Validation of the Mini Nutritional Assessment short-form (MNA®-SF): A practical tool for identification of nutritional status. J Nutr Health Aging 2009;13:782–788

    Article  CAS  PubMed  Google Scholar 

  35. Sakuma K, Yamaguchi A. Molecular mechanisms in aging and current strategies to counteract sarcopenia. Curr Aging Sci 2010;3:90–101

    Article  CAS  PubMed  Google Scholar 

  36. Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care 2009;12:86–90

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  37. Bergström J, Fürst P, Norée LO, Vinnars E. Intracellular free amino acid concentration in human muscle tissue. J Appl Physiol 1974;36:693–697

    PubMed  Google Scholar 

  38. Marshall S, Bauer J, Isenring E. The consequences of malnutrition following discharge from rehabilitation to the community: a systematic review of current evidence in older adults. J Hum Nutr Diet. 2014;27:133–141.

    Article  CAS  PubMed  Google Scholar 

  39. Foley NC, Salter KL, Robertson J, Teasell RW, Woodbury MG. Which reported estimate of the prevalence of malnutrition after stroke is valid? Stroke 2009;40:66–74

    Article  Google Scholar 

  40. Anker SD, John M, Pedersen PU, Raguso C, Cicoira M, Dardai E, Laviano A, Ponikowski P, Schols AM, Becker HF, Böhm M, Brunkhorst FM, Vogelmeier C. ESPEN Guidelines on enteral nutrition: cardiology and pulmonology. Clin Nutr 2006;25:311–318

    Article  CAS  PubMed  Google Scholar 

  41. Doley J. Nutrition management of pressure ulcers. Nutr Clin Pract 2010;25:50–60

    Article  PubMed  Google Scholar 

  42. Akner G, Cederholm T. Treatment of protein-energy malnutrition in chronic nonmalignant disorders. Am J Clin Nutr 2001;74:6–24

    CAS  PubMed  Google Scholar 

  43. Eneroth M, Olsson UB, Thorngren KG. Insufficient fluid and energy intake in hospitalised patients with hip fracture. A prospective randomised study of 80 patients. Clin Nutr 2005;24:297–303

    PubMed  Google Scholar 

  44. Carlsson M, Littbrand H, Gustafson Y, Lundin-Olsson L, Lindelöf N, Rosendahl E, Håglin L. Effects of high-intensity exercise and protein supplement on muscle mass in ADL dependent older people with and without malnutrition: a randomized controlled trial. J Nutr Health Aging. 2011;15:554–560.

    Article  CAS  PubMed  Google Scholar 

  45. Jyväkorpi SK, Puranen T, Suominen M. Effect of high-intensity exercise and protein supplementation on muscle mass in ADL dependent older people with and without malnutrition-a randomized controlled trial. J Nutr Health Aging. 2012;16:736

    Article  PubMed  Google Scholar 

  46. Kim HK, Suzuki T, Saito K, Yoshida H, Kobayashi H, Kato H, Katayama M. Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. J Am Geriatr Soc. 2012;60:16–23

    Article  PubMed  Google Scholar 

  47. Kim H, Suzuki T, Saito K, Kojima N, Hosoi E, Yoshida H. Long-term effects of exercise and amino acid supplementation on muscle mass, physical function and falls in community-dwelling elderly Japanese sarcopenic women: A 4-year follow-up study. Geriatr Gerontol Int, 2015. doi: 10.1111/ggi.12448

    Google Scholar 

  48. Gariballa S, Alessa A. Sarcopenia: prevalence and prognostic significance in hospitalized patients. Clin Nutr 2013;32:772–776

    Article  PubMed  Google Scholar 

  49. Frank AW, Farthing JP, Chilibeck PD, Arnold CM, Olszynski WP, Kontulainen SA. Community-dwelling female fallers have lower muscle density in their lower legs than non-fallers: Evidence from the Saskatoon Canadian multicentre osteoporosis study (CaMos) cohort. J Nutr Health Aging. 2015;19:113–120. doi: 10.1007/s12603-014-0476-6

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yoshihiro Yoshimura.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshimura, Y., Uchida, K., Jeong, S. et al. Effects of nutritional supplements on muscle mass and activities of daily living in elderly rehabilitation patients with decreased muscle mass: A randomized controlled trial. J Nutr Health Aging 20, 185–191 (2016). https://doi.org/10.1007/s12603-015-0570-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-015-0570-4

Key words

Navigation