Impacts of High-Protein Oral Nutritional Supplements Among Malnourished Men and Women with Sarcopenia: A Multicenter, Randomized, Double-Blinded, Controlled Trial

Background: Recent evidence suggests that nutritional interventions may improve muscle outcomes in malnutrition and sarcopenia.Objectives: We evaluated the effects of 2 high-quality oral nutritional supplements (ONS) differing in amount and type of key nutrients in older adult men and women.Design: A multicenter, randomized, double-blinded, controlled clinical trial.Participants: Malnourished and sarcopenic men and women, 65 years and older (n = 330).Intervention: A 24-week interventionperiod with 2 energy-rich (330 kcal) ONStreatment groups: Control ONS (C-ONS, 14 g protein; 147 IUvitamin D-3) versus Experimental ONS (E-ONS, 20 g protein; 499 IU vitamin D-3; 1.5 g CaHMB) takent wice daily. Both ONS also contained other vitamins, minerals, and nutrients in varying amounts.Measurements: Isokinetic peak torque (PT, Nm) leg strength, grip strength (kg), and gait speed (m.s(-1)) were assessed at baseline and 12 and 24 weeks. Left and right leg muscle mass (LMM, kg) were assessed by dual-energy x-ray absorptiometry (DXA). Muscle quality (MQ) was leg strength expressed relative to the tested LMM (Nm.kg(-1)). Subgroup analyses were performed: severe sarcopenia (low skeletal mass index, low grip strength [< 30 kg men; < 20 kg women], low gait speed [< 0.8 m.s(-1)]) and mild-moderate sarcopenia (low skeletal mass index, normal gait speed, or normal grip strength).Results: Both ONS groups (EONS and CONS) improved PT, MQ, grip strength, and gait speed from baseline with no treatment differences. Those with severe sarcopenia (44%) exhibited lower baseline PT and MQ, with no differences in strength improvements between treatments. However, participants with mild-moderate sarcopenia exhibited higher baseline PT and MQ, with differences in strength improvements at 12 weeks (E-ONS > C-ONS, P = .032) in those with normal grip strength. There were no treatment differences based on sarcopenic severity for either grip strength or gait speed.Conclusion: ONS improved strength outcomes in malnourished older adults with sarcopenia. In those with mild-moderate sarcopenia, but not severe sarcopenia, consumption of the EONS improved leg muscle strength and quality compared with the standard CONS. (C) 2016 AMDA e The Society for Post-Acute and Long-Term Care Medicine