Dr. Ray Chan
Specialist in Internal Medicine
THE IMPACT OF MUSCLE LOSS ON CLINICAL OUTCOMES & CLINICAL EFFECTS OF HMB
KEY MESSAGES
1. Inadequate nutrient intake and muscle loss are indicators of malnutrition.1,2
2. Muscle loss with decreased muscle function is associated with multiple adverse health outcomes:3
- High incidence of accidental falls (among older adults)
- Limitations in physical exercise
- Inability to perform tasks of daily activities
- Poor quality of life
3. Muscle loss is more severe for inactive hospitalized patients, especially as they age.4-9
- 10 days of hospitalization can result in loss of muscle mass* close to or even more than that lost by a healthy individual over 10 years.4-9
* The study results were based on Lean Body Mass (LBM) measurements; LBM is made up of 75% muscle
4. Although currently, there is no medication approved by the FDA for sarcopenia, certain strategies can be regarded as useful solutions for muscle loss:10
- Dietary counselling on increasing food intake10
- Intake of multivitamins or mineral supplements10
- Intake of oral nutritional supplements (ONS) with β-hydroxy-β-methyl butyrate (HMB) to further improve nutritional status and muscle loss10
5. β-hydroxy-β-methyl butyrate (HMB) is derived from leucine, which only takes up about 5% of the downstream metabolite.11
6. Scientific evidence suggests that HMB is associated with the stimulation of protein synthesis in muscle growth.12-14
7. RCT evidence of HMB (NOURISH study): HMB (2 servings of 1.5g CaHMB per day) plus high protein is helpful for malnourished, older, hospitalized adults in reducing mortality rates and improving nutritional status:15,†
- 90-day mortality rates were significantly reduced by up to 50% in patients who received high protein + HMB (2 servings of 1.5g CaHMB per day)vs placebo (4.8% vs 9.7%; P = 0.018)
- For patients with cardiovascular or pulmonary disease, handgrip strength was significantly improved in those who received high protein + HMB vs placebo at day 30.16
PAST EVENTS
Footnotes:
† Study design: The NOURISH study was a multicenter, prospective, randomized, double-blind, placebo-controlled, parallel-group study conducted in the United States between May 2012 and October 2014. Eligible patients were aged 65 years with a recent hospital admission (within 72 h) with a primary diagnosis of CHF, AMI, PNA, or COPD. A total of 622 enrolled patients received their allocated intervention and were included in the final ITT analysis, of whom 313 received standard-of-care plus high protein and 1.5 g HMB supplement 2 servings/day and 309 received standard-of-care with placebo supplement. The primary composite endpoint was the 90-day post-discharge incidence of death or nonelective readmission.15
AMI, acute myocardial infarction; CaHMB, calcium ß-hydroxy-ß-methyl butyrate; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; FDA, Food and Drug Administration; HMB, ß-hydroxy-ß-methyl butyrate; HP-HMB, high protein + ß-hydroxy-ß-methyl butyrate ICU, intensive care unit; ITT, intention-to-treat; LBM, lean body mass; ONS, oral nutritional supplement; PNA, pneumonia; RCT, randomized controlled trial.
References:
- White et al. JAND. 2012;112:730-738.
- White et al. JPEN. 2012;36:275-283.
- Jun L, et al. Int J Mol Sci 2023;24:2973.
- English KL. et al. Curr Opin Clin Nutr Metab Core. 2010;13(1):34-39.
- Kortabein P, et al. JAMA 2007/297(16):772-1774.
- Paddon-Jones D, et al. J Clin Endocrin Metab. 2004,89(9)-4351-8.
- Paddon Jones D, et al. J Clin Endocris Metab 2006,91012)-4836-48-41.
- Puthuchsary ZA, et al. JAMA, 2013;310:1591-1600.
- Deutz NE, et in Nutr. 2013 Oct32(5):704-12.
- Kwak JY, et al. Ann Geriatr Med Res. 2019;23(3):98-104.
- Holeček M. J Cachexia Sarcopenia Muscle 2017;8:529-41.
- Prado CM, et al. J Cachexia Sarcopenia Muscle. 2022;13:1623-41.
- Gerlinger-Romero F, et al. J Physiol Sci.2018;68(2):165-174.
- Wilson GJ, et al. Nutr Metab (Lond). 2008;5:1.
- Deutz NE, et al. Clin Nutr. 2016;35(1):18-26.
- Matheson EM, et al. Clin Nutr. 2021;40(3):844-849.
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