Utilization of Hydroxyl-Methyl Butyrate, Leucine, Glutamine and Arginine Supplementation in Nutritional Management of Sarcopenia—Implications and Clinical Considerations for Type 2 Diabetes Mellitus Risk Modulation

Abstract

While onset characteristics may vary, sarcopenia gradually develops over time as a result of the aging process, leading to muscle loss, disturbance of the muscle to fat ratio, and a variety of negative symptoms undermining the wellbeing, quality of life, and lifespan in the aging population globally. There is evidence that sarcopenia may be a cause and consequence of type 2 diabetes mellitus (T2DM) in the aging population. The importance of nutritional management in the prevention and/or deceleration of sarcopenia is critical, with the main focus placed on the amount and quality of protein intake. Significant efforts are being made towards the development of medical nutrition therapies involving certain amino acids and amino compounds, as well as their combinations, for the improvement in muscle strength, muscle function and protein synthesis. This may reduce hospitalization times and hasten the recovery of patients with sarcopenia. The administration of protocols with varying dose and frequencies, as well as their efficacy, is being investigated. In the work herein, we present and evaluate data derived from human trials regarding the utilization of hydroxyl-methyl butyrate (HMB), L-leucine (Leu), L-glutamine (Gln) and L-arginine (Arg) supplementation for optimal management of sarcopenia in geriatric patients, a topic of significant clinical nutrition interest which may have important implications in T2DM status.

The Effects of Calcium-β-Hydroxy-β-Methylbutyrate on Aging-Associated Apoptotic Signaling and Muscle Mass and Function in Unloaded but Nonatrophied Extensor Digitorum Longus Muscles of Aged Rats

“…HMB has been shown to improve strength and fatigue resistance in quadriceps muscles of humans including the elderly in multiple studies especially when HMB treatment was combined with exercise [ 53 , 95 , 103 , 126 – 130 ]. However, we did not observe an increase in muscle force or fatigue resistance in the EDL muscles of Ca-HMB-treated rats after unloading by HS or during reloading as compared to rats that received water.…”

Assessment of pre- and post-operative nutritional status in patients undergoing orthognathic surgery

“…The biochemical indicators should be kept stable and this may occur 40 to 45 days after orthognathic surgery, as observed by other authors 19 . Although arginine and glutamine have relevant immunomodulator and anti-inflammatory effects, their ability to help lean mass recovery has not been convincingly shown among humans 8,9,[11][12][13]23,36,37 .…”

Protein Source and Muscle Health in Older Adults: A Literature Review

“…Various amino acids, such as β-alanine, L-glutamine, L-arginine, L-leucine and its bioactive form (hydroxymethyl butyrate) have been studied for nutritional management of sarcopenia because they are anti-catabolic and anabolic in nature [80]. For example, studies have shown that supplementation of β-alanine [81][82][83][84] may prevent and delay the progression of sarcopenia by addressing the systemic depletion of carnosine (β-alanyll-histidine), a dipeptide that acts as a pH buffer and is predominantly found in skeletal muscle.…”

“…For example, studies have shown that supplementation of β-alanine [81][82][83][84] may prevent and delay the progression of sarcopenia by addressing the systemic depletion of carnosine (β-alanyll-histidine), a dipeptide that acts as a pH buffer and is predominantly found in skeletal muscle. However, of these substrates, leucine is the most well studied, and requires greater understanding regarding adequate dosing and short-term versus long-term effects on muscle health [80]. Therefore, this review will discuss research surrounding the effects of leucine supplementation in older adults with low protein intake.…”