Dose-response relationship between protein intake and muscle mass increase: a systematic review and meta-analysis of randomized controlled trials

Tagawa, Ryoichi; Watanabe, Daiki; Ito, Kyoko; Ueda, Keisuke; Nakayama, Kyosuke; Sanbongi, Chiaki; Miyachi, Motohiko

doi:10.1101/2020.02.21.20026252

Cited by 9 publications

(26 citation statements)

References 31 publications

(43 reference statements)

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“…Current data consistently demonstrate that ICU patients receive low amounts of protein (average of 0.6 g/ kg/day for the first two weeks) [24,[60][61][62][63][64][65][66][67]. Higher protein provision is associated with reduced mortality in adults in observational trials [61,[68][69][70][71][72][73][74], biochemical outcome parameters and morphometric outcomes in skeletal muscle [75][76][77][78][79], improved quality of life at 3-month post-ICU [69] or handgrip strength at hospital day 7 and muscle mass [73]. However, prospective studies show limited effects on clinical, patient-centered and functional outcomes or yield negative results [45,67,[74][75][76][77][78][79][80][81].…”

Section: Question 6: How Much Protein?mentioning

confidence: 99%

“…Higher protein provision is associated with reduced mortality in adults in observational trials [61,[68][69][70][71][72][73][74], biochemical outcome parameters and morphometric outcomes in skeletal muscle [75][76][77][78][79], improved quality of life at 3-month post-ICU [69] or handgrip strength at hospital day 7 and muscle mass [73]. However, prospective studies show limited effects on clinical, patient-centered and functional outcomes or yield negative results [45,67,[74][75][76][77][78][79][80][81]. Admittedly, a limited number of large RCTs examined clinical outcomes of specifically increasing protein administration.…”

Section: Question 6: How Much Protein?mentioning

confidence: 99%

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A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

Preiser

Arabi

Berger³

et al. 2021

Crit Care

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The preferential use of the oral/enteral route in critically ill patients over gut rest is uniformly recommended and applied. This article provides practical guidance on enteral nutrition in compliance with recent American and European guidelines. Low-dose enteral nutrition can be safely started within 48 h after admission, even during treatment with small or moderate doses of vasopressor agents. A percutaneous access should be used when enteral nutrition is anticipated for ≥ 4 weeks. Energy delivery should not be calculated to match energy expenditure before day 4–7, and the use of energy-dense formulas can be restricted to cases of inability to tolerate full-volume isocaloric enteral nutrition or to patients who require fluid restriction. Low-dose protein (max 0.8 g/kg/day) can be provided during the early phase of critical illness, while a protein target of > 1.2 g/kg/day could be considered during the rehabilitation phase. The occurrence of refeeding syndrome should be assessed by daily measurement of plasma phosphate, and a phosphate drop of 30% should be managed by reduction of enteral feeding rate and high-dose thiamine. Vomiting and increased gastric residual volume may indicate gastric intolerance, while sudden abdominal pain, distension, gastrointestinal paralysis, or rising abdominal pressure may indicate lower gastrointestinal intolerance.

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Section: Question 6: How Much Protein?mentioning

confidence: 99%

Section: Question 6: How Much Protein?mentioning

confidence: 99%

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

Preiser

Arabi

Berger³

et al. 2021

Crit Care

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show abstract

“…Nonetheless, many questions still arise when constructing dietary or physical activity guidelines focusing on skeletal muscle health 10 . Particularly, the optimal daily protein intake level required to optimize skeletal muscle mass gain or maintenance in healthy adults, which is still largely unclear 10–13 . It is also unclear whether additional protein ingestion can preserve lean body mass and muscle function in healthy adults who do not engage in RE 14 …”

Section: Introductionmentioning

confidence: 99%

“…Previous meta‐analyses have been conducted to ascertain whether additional protein ingestion is linked to increases in LBM (i.e. muscle mass), muscle strength, or physical function in adults 13,14,20–23 . However, the effects of protein ingestion independent of RE are not commonly explored 13,22 .…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta‐analysis of protein intake to support muscle mass and function in healthy adults

Nunes

Colenso-Semple

McKellar

et al. 2022

J cachexia sarcopenia muscle

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We performed a systematic review, meta‐analysis, and meta‐regression to determine if increasing daily protein ingestion contributes to gaining lean body mass (LBM), muscle strength, and physical/functional test performance in healthy subjects. A protocol for the present study was registered (PROSPERO, CRD42020159001), and a systematic search of Medline, Embase, CINAHL, and Web of Sciences databases was undertaken. Only randomized controlled trials (RCT) where participants increased their daily protein intake and were healthy and non‐obese adults were included. Research questions focused on the main effects on the outcomes of interest and subgroup analysis, splitting the studies by participation in a resistance exercise (RE), age (<65 or ≥65 years old), and levels of daily protein ingestion. Three‐level random‐effects meta‐analyses and meta‐regressions were conducted on data from 74 RCT. Most of the selected studies tested the effects of additional protein ingestion during RE training. The evidence suggests that increasing daily protein ingestion may enhance gains in LBM in studies enrolling subjects in RE (SMD [standardized mean difference] = 0.22, 95% CI [95% confidence interval] 0.14:0.30, P < 0.01, 62 studies, moderate level of evidence). The effect on LBM was significant in subjects ≥65 years old ingesting 1.2–1.59 g of protein/kg/day and for younger subjects (<65 years old) ingesting ≥1.6 g of protein/kg/day submitted to RE. Lower‐body strength gain was slightly higher by additional protein ingestion at ≥1.6 g of protein/kg/day during RE training (SMD = 0.40, 95% CI 0.09:0.35, P < 0.01, 19 studies, low level of evidence). Bench press strength is slightly increased by ingesting more protein in <65 years old subjects during RE training (SMD = 0.18, 95% CI 0.03:0.33, P = 0.01, 32 studies, low level of evidence). The effects of ingesting more protein are unclear when assessing handgrip strength and only marginal for performance in physical function tests. In conclusion, increasing daily protein ingestion results in small additional gains in LBM and lower body muscle strength gains in healthy adults enrolled in resistance exercise training. There is a slight effect on bench press strength and minimal effect performance in physical function tests. The effect on handgrip strength is unclear.

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“…The curve was modeled using 3 knots and was adjusted for age, gender, body mass index, history of smoking and drinking, presence of hypertension, dyslipidemia and heart disease, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, low-density lipoprotein, uric acid, high-sensitivity C-reactive protein, estimated glomerular filtration rate, and hemoglobin A1c highlights the clinical importance of increasing creatinineto-cystatin C ratio to improve health well-being. Although the effective approaches to increase creatinine-to-cystatin C ratio still remain to be identified, it is speculated that resistance training 30 as well as some nutritional ways like protein supplementation, 31,32 which aid in increasing muscle mass, might be worthy being recommended.…”

Section: Interpretationsmentioning

confidence: 99%

Changes in creatinine‐to‐cystatin C ratio over 4 years, risk of diabetes, and cardiometabolic control: The China Health and Retirement Longitudinal Study

Qiu

Cai

Yuan

et al. 2021

Journal of Diabetes

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Background: Creatinine-to-cystatin C ratio has attracted substantial interest as a measure to reflect health well-being, but no studies have assessed whether its longitudinal changes are associated with risk of diabetes. We aimed to examine their association, along with the exploration of the relationship of such changes with cardiometabolic control in middle-aged and older adults. Methods: We included a total of 3278 participants aged ≥45 years who provided measurements of creatinine and cystatin C at baseline and 4 years later from the China Health and Retirement Longitudinal Study. Diabetes was diagnosed based on glucose, hemoglobin A1c (HbA1c), medical history, or use of antidiabetic mediations. Odds ratio (OR) and 95% confidence interval (CI) were obtained using logistic regression analyses.Results: After 4-year follow-up, 272 participants developed diabetes. Larger increases in creatinine-to-cystatin C ratio were associated with lower risk of diabetes. The multivariable-adjusted OR for diabetes per 1 SD increase in creatinine-to-cystatin C ratio was 0.84 (95% CI 0.72-0.98). Compared with participants showing decreases in creatinine-to-cystatin C ratio but increases in body mass index (BMI), those experiencing increases in creatinine-to-cystatin C ratio and decreases in BMI had the largest risk reduction (multivariableadjusted OR 0.52). Changes in creatinine-to-cystatin C ratio showed inverse correlation with blood pressure, HbA1c, lipids, and C-reactive protein at the 4-year follow-up. Moreover, they also correlated inversely with changes in HbA1c and C-reactive protein (all P ≤ 0.004). Conclusions: Increases in creatinine-to-cystatin C ratio led to reduced risk of diabetes and may benefit cardiometabolic control.

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Dose-response relationship between protein intake and muscle mass increase: a systematic review and meta-analysis of randomized controlled trials

Cited by 9 publications

References 31 publications

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

Systematic review and meta‐analysis of protein intake to support muscle mass and function in healthy adults

Changes in creatinine‐to‐cystatin C ratio over 4 years, risk of diabetes, and cardiometabolic control: The China Health and Retirement Longitudinal Study

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