The effect of oral nutritional supplement on muscle fitness of patients undergoing dialysis: A systematic review and meta‐analysis

Abstract

Aim To summarize evidence regarding the effects of oral nutritional supplement on muscle fitness of patients undergoing dialysis. Design A systematic review and meta‐analysis. Review sources Five English databases (CENTRAL, PubMed, EMBASE, CINHAL, and Web of Science) and four Chinese databases (CNKI, WanFang, SinoMed, and VIP) were searched from inception to 31 July 2019 and only randomized controlled trials were included. Review methods Two reviewers independently searched these databases, selected trials, conducted bias assessment, extracted the data. Random‐effects meta‐analysis was conducted to assess the effect size. The predetermined subgroup included type of oral nutritional supplement (a mixture of macronutrients, whey protein, essential amino‐acids, and other nutrients) and intervention duration (over and less than 48 weeks). The subgroup analyses and sensitivity analyses were conducted to explore source of heterogeneity and robustness of results. Results Sixteen studies (910 participants) meeting the inclusion criteria were identified and included in this systematic review. Subgroup analysis showed that supplying a mixture of macronutrients (MD [MD] = 2.36 kg, 95% CI [0.45, 4.26], I2 = 0.00%), an intervention duration of 48 weeks (MD = 4.05 kg, 95% CI [1.43, 6.67], I2 = 0.00%) had some effects on increasing lean body mass. No effects of oral nutritional supplement were found on improving muscle strength or physical performance. Conclusion A mixture of macronutrients and an intervention duration as long as 48 weeks had some significant effects on improving lean body mass of patients undergoing dialysis. No effect of oral nutritional supplement on muscle strength or physical performance were found but with limited evidence. Impact No existing reviews have ever focused on improving muscle fitness of patients undergoing dialysis. This systematic review and meta‐analysis provided evidence of oral nutritional supplement on keeping muscle fitness of these patients and suggested possible type of oral nutritional supplement and intervention duration for clinical practice.

Sarcopenia and sarcopenic obesity in chronic kidney disease: update on prevalence, outcomes, risk factors and nutrition treatment

“…Adequate energy intake is an essential component of sarcopenia management. A 2020 meta-analysis by Lu et al [59] examined the impact of oral nutrition supplements on muscle fitness for patients on dialysis, including both patients with and without malnutrition. The authors reported that providing a combination of carbohydrates, protein and fat was better than protein supplements alone for muscle mass; however, a 48-week intervention length was required to see benefit.…”

“…A meta-analysis of randomized control trials investigated the effects of amino acid or protein supplements with and without exercise on muscle mass and strength, physical function in haemodialysis [59]. The authors noted that amino acid or protein supplements did not improve muscle mass or strength.…”

“…The authors recommend for those on plant protein diets to consider supplementing with amino acids, mixing different plant protein sources to achieve a better amino acid profile and/or blending plant and animal protein sources [63 & ]. A meta-analysis of randomized control trials investigated the effects of amino acid or protein supplements with and without exercise on muscle mass and strength, physical function in haemodialysis [59]. The authors noted that amino acid or protein supplements did not improve muscle mass or strength.…”

Effect of nutritional supplementation on mortality in peritoneal dialysis patients: A meta‐analysis

“…Patients with chronic kidney disease commonly experience protein-energy wasting [5]. The loss of proteins, amino acids and other essential nutrients during dialysis may further aggravate malnutrition [6].…”

Effect of Intradialytic Supine Ergometer Exercise on Hemodialysis Patients with Different Nutritional Status

“…A systematic review examining the combined effects of exercise and nutrition in healthy older adults found that exercise had a positive effect on muscle strength and muscle mass in many studies and that nutrition had a positive effect in some studies 9 ) . A meta-analysis examining the effects of oral nutritional supplements on muscle fitness of dialysis patients reported that supply of a mixture of macronutrients and an intervention duration of 48 weeks had some effects on increasing lean body mass 10) . As mentioned above, there have been studies that have looked at combined nutrition and exercise interventions, but it is not known whether the original nutritional status affects exercise function or the effectiveness of exercise.…”