Highlights
- •Vitamin D plus protein supplementation increases muscle strength in patients with sarcopenia.
- •There is no evidence of improvement in muscle mass and performance by vitamin D plus protein in patients with sarcopenia.
- •Further RCTs are needed to clarify the optimal dose and duration of vitamin D and/or protein supplementation on sarcopenia indices.
Abstract
Purpose
The exact effect of vitamin D supplementation, either as monotherapy or in combination
with protein, on musculoskeletal health in patients with sarcopenia is currently unknown.
This study aimed to determine the effect of vitamin D alone or with protein supplementation
on muscle strength, mass, and performance in this population.
Methods
A comprehensive search was conducted in Medline, Cochrane Central and Scopus databases,
up to March 31st, 2020. Data were expressed as standardized mean difference (SMD) with 95 % confidence
intervals (CI). I2 index was employed for heterogeneity.
Results
The initial search identified 1164 studies, eight of which met the eligibility criteria
for qualitative and quantitative analysis, yielding a total of 776 patients. Vitamin
D (100–1600 IU/day) plus protein (10–44 g/day) supplementation exhibited a beneficial
effect on muscle strength, as demonstrated by an improvement in handgrip strength
(SMD 0.38 ± 0.07, 95 % CI 0.18–0.47, p = 0.04; I2 76.2 %) and a decrease in the sit-to-stand time (SMD 0.25 ± 0.09, 95 % CI 0.06–0.43,
p = 0.007; I2 0%) compared with placebo. However, the effect on muscle mass, assessed by skeletal
muscle index, was marginally non-significant (SMD 0.25 ± 0.13, 95 % CI -0.006–0.51,
p = 0.05; I2 0%). No effect on appendicular skeletal muscle mass or muscle performance (assessed
by walking speed) was observed with vitamin D plus protein.
Conclusions
Vitamin D supplementation, combined with protein, improves muscle strength in patients
with sarcopenia, but has no effect on muscle mass or performance.
Abbreviations:
CI (confidence intervals), SMD (standardized mean difference), PRISMA (preferred reporting items for systematic reviews and meta-analyses), PROSPERO (Prospective Register of Systematic Reviews), PICO (P: Population, I: Intervention or Exposure, C: Comparison, O: Outcome), rcts (randomized clinical trials), EWGSOP (European Working Group on Sarcopenia in Older People), AWGS (Asian Working Group for Sarcopenia), SD (standard deviation), 25(OH)D (25-hydroxy-vitamin D), HS (handgrip strength), ASMM (appendicular skeletal muscle mass), ALMM (appendicular lean muscle mass), SMI (skeletal muscle index), STSt (sit-to-stand time), BCAA (branched-chain amino acids), VDR (vitamin D receptor)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to MaturitasAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Summary comments.Am. J. Clin. Nutr. 1989; 50: 1231-1233https://doi.org/10.1093/ajcn/50.5.1231
- Skeletal muscle mass change during chemotherapy: a systematic review and meta-analysis.Anticancer Res. 2020; 40: 2409-2418https://doi.org/10.21873/anticanres.14210
- Sarcopenia is prevalent in patients with Crohn’s disease in clinical remission.Inflamm. Bowel Dis. 2008; 14: 1562-1568https://doi.org/10.1002/ibd.20504
- Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment.J. Am. Med. Dir. Assoc. 2020; 21 (e2): 300-307https://doi.org/10.1016/j.jamda.2019.12.012
- Sarcopenia: revised European consensus on definition and diagnosis.Age Ageing. 2019; 48: 16-31https://doi.org/10.1093/ageing/afy169
- The selection of a screening test for frailty identification in community-dwelling older adults.J. Nutr. Health Aging. 2014; 18: 199-203https://doi.org/10.1007/s12603-013-0365-4
- Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.N. Engl. J. Med. 1995; 332: 556-561https://doi.org/10.1056/NEJM199503023320902
- Sarcopenia and fragility fractures.Eur. J. Phys. Rehabil. Med. 2013; 49: 111-117
- A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.J. Gerontol. 1994; 49: M85-94
- Relationship between postmenopausal osteoporosis and the components of clinical sarcopenia.Maturitas. 2013; 75: 175-180https://doi.org/10.1016/j.maturitas.2013.03.016
- Sarcopenia and sarcopenic leg as potential risk factors for acute osteoporotic vertebral fracture among older women.Eur. Spine J. 2016; 25: 3424-3431https://doi.org/10.1007/s00586-015-3805-5
- High prevalence of sarcopenia and reduced leg muscle mass in Japanese patients immediately after a hip fracture.Geriatr. Gerontol. Int. 2013; 13: 413-420https://doi.org/10.1111/j.1447-0594.2012.00918.x
- Sarcopenia in post-menopausal women: is there any role for vitamin D?.Maturitas. 2015; 82: 56-64https://doi.org/10.1016/j.maturitas.2015.03.014
- Vitamin D deficiency.N. Engl. J. Med. 2007; 357: 266-281https://doi.org/10.1056/NEJMra070553
- Nutritional status and functionality in geriatric rehabilitation patients: a systematic review and meta-analysis.Eur. Geriatr. Med. 2020; 11: 195-207https://doi.org/10.1007/s41999-020-00294-2
- Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis.J. Am. Geriatr. Soc. 2011; 59: 2291-2300https://doi.org/10.1111/j.1532-5415.2011.03733.x
- International Clinical Practice Guidelines for Sarcopenia (ICFSR): screening, diagnosis and management.J. Nutr. Health Aging. 2018; 22: 1148-1161https://doi.org/10.1007/s12603-018-1139-9
- The effects of vitamin D on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials.J. Clin. Endocrinol. Metab. 2014; 99: 4336-4345https://doi.org/10.1210/jc.2014-1742
- Vitamin D, bones and muscle: myth versus reality.Australas. J. Ageing. 2017; 36: 8-13https://doi.org/10.1111/ajag.12408
- Relevance of vitamin D in the pathogenesis and therapy of frailty.Curr. Opin. Clin. Nutr. Metab. Care. 2017; 20: 26-29https://doi.org/10.1097/MCO.0000000000000334
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.BMJ. 2009; 339: b2700https://doi.org/10.1136/bmj.b2700
- RoB 2: a revised tool for assessing risk of bias in randomised trials.BMJ. 2019; 366: l4898https://doi.org/10.1136/bmj.l4898
- Mail-based intervention for sarcopenia prevention increased anabolic hormone and skeletal muscle mass in community-dwelling japanese older adults: the INE (Intervention by Nutrition and Exercise) study.J. Am. Med. Dir. Assoc. 2015; 16: 654-660https://doi.org/10.1016/j.jamda.2015.02.017
- Synergistic effect of bodyweight resistance exercise and protein supplementation on skeletal muscle in sarcopenic or dynapenic older adults.Geriatr. Gerontol. Int. 2019; 19: 429-437https://doi.org/10.1111/ggi.13643
- Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial.J. Am. Med. Dir. Assoc. 2015; 16: 740-747https://doi.org/10.1016/j.jamda.2015.05.021
- Whey protein, amino acids, and vitamin D supplementation with physical activity increases fat-free mass and strength, functionality, and quality of life and decreases inflammation in sarcopenic elderly 1, 2.Am. J. Clin. Nutr. 2016; 103: 830-841https://doi.org/10.3945/ajcn.115.113357.830
- Effects of branched-chain amino acids and vitamin D supplementation on physical function, muscle mass and strength, and nutritional status in sarcopenic older adults undergoing hospital-based rehabilitation: a multicenter randomized controlled trial.Geriatr. Gerontol. Int. 2018; : 1-6https://doi.org/10.1111/ggi.13547
- A high whey protein, vitamin D and E supplement preserves muscle mass, strength, and quality of life in sarcopenic older adults: a double-blind randomized controlled trial.Clin. Nutr. 2018; https://doi.org/10.1016/j.clnu.2017.12.020
- Medium-chain triglycerides (8:0 and 10:0) are promising nutrients for sarcopenia: a randomized controlled trial.Am. J. Clin. Nutr. 2019; 110: 652-665https://doi.org/10.1093/ajcn/nqz138
- Medium-chain triglycerides in combination with leucine and vitamin D increase muscle strength and function in frail elderly adults in a randomized controlled trial.J. Nutr. 2016; 146: 1017-1026https://doi.org/10.3945/jn.115.228965
- Effect of structured physical activity and nutritional supplementation on physical function in mobility-limited older adults: results from the VIVE2 randomized trial.J. Nutr. Health Aging. 2017; 21: 936-942https://doi.org/10.1007/s12603-017-0936-x
- The effect of combined resistance exercise training and vitamin D 3 supplementation on musculoskeletal health and function in older adults: a systematic review and meta-analysis.BMJ Open. 2017; https://doi.org/10.1136/bmjopen-2016-014619
- Mice with myocyte deletion of vitamin D receptor have sarcopenia and impaired muscle function.J. Cachexia Sarcopenia Muscle. 2019; 10: 1228-1240https://doi.org/10.1002/jcsm.12460
- Vitamin D receptor ablation and vitamin d deficiency result in reduced grip strength, altered muscle fibers, and increased myostatin in mice.Calcif. Tissue Int. 2015; 97: 602-610https://doi.org/10.1007/s00223-015-0054-x
- Vitamin D signaling regulates proliferation, differentiation, and myotube size in C2C12 skeletal muscle cells.Endocrinology. 2014; 155: 347-357https://doi.org/10.1210/en.2013-1205
- Vitamin D and its role in skeletal muscle.Calcif. Tissue Int. 2013; 92: 151-162https://doi.org/10.1007/s00223-012-9645-y
- Effects of vitamin D in skeletal muscle: falls, strength, athletic performance and insulin sensitivity.Clin. Endocrinol. (Oxf). 2014; 80: 169-181https://doi.org/10.1111/cen.12368
- Vitamin D deficiency down-regulates Notch pathway contributing to skeletal muscle atrophy in old wistar rats.Nutr. Metab. 2014; 11https://doi.org/10.1186/1743-7075-11-47
- Vitamin D supplementation and fracture risk: evidence for a U-shaped effect.Maturitas. 2020; 141: 63-70https://doi.org/10.1016/j.maturitas.2020.06.016
- Effect of nutritional supplement combined with exercise intervention on sarcopenia in the elderly: a meta-analysis.Int. J. Nurs. Midwifery Sci. 2017; 4: 389-401https://doi.org/10.1016/j.ijnss.2017.09.004
- The relationship between nutrition and frailty: effects of protein intake, nutritional supplementation, vitamin D and exercise on muscle metabolism in the elderly. A systematic review.Maturitas. 2016; 93: 89-99https://doi.org/10.1016/j.maturitas.2016.04.009
- Beneficial effects of leucine supplementation on criteria for sarcopenia: a systematic review.Nutrients. 2019; 11https://doi.org/10.3390/nu11102504
- Low protein intake is associated with frailty in older adults: a systematic review and meta-analysis of observational studies.Nutrients. 2018; 10https://doi.org/10.3390/nu10091334
Article info
Publication history
Published online: January 11, 2021
Accepted:
January 6,
2021
Received in revised form:
January 2,
2021
Received:
October 26,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
