Biomarker Changes in Response to a 12-Week Supplementation of an Oral Nutritional Supplement Enriched with Protein, Vitamin D and HMB in Malnourished Community Dwelling Older Adults with Sarcopenia.

Susan Gawel,Gerard J. Davis,Menghua Luo,Joel T. Cramer,Suzette L. Pereira,Marni E. Shoemaker,Vikkie A. Mustad

doi:10.3390/nu14061196

Abstract

Malnutrition and sarcopenia commonly overlap and contribute to adverse health outcomes. Previously, chronic supplementation with two oral nutritional supplements (ONS), control (CONS) and experimental ONS enriched with protein, vitamin D and β-hydroxy β-methylbutyrate (HMB) (EONS), improved muscle strength and quality in malnourished sarcopenic older adults, with EONS demonstrating early strength benefits at 12 weeks. To understand the underlying biological mechanisms contributing to the observed early strength benefits of EONS, we examined serum biomarker changes in response to 12-week supplementation. Serum samples (EONS (n = 90) and CONS (n = 103)) collected at baseline and 12 weeks were analyzed. Biomarkers (n = 243) were measured using multiplexed immunoassay, commercial immunoassays and ELISAs. Sixty markers were excluded with levels below assay detection limits. Sixteen biomarkers significantly changed in response to both interventions including nutritional and metabolic markers. Thirteen biomarkers significantly changed in response to EONS but not CONS. Increases in immunoglobulins, myoglobin, total protein, vitamin E and magnesium were observed with EONS. Inflammation-related ferritin and osteopontin decreased, while soluble receptors for cytokines increased, suggesting decreased inflammation. Sex hormone-binding globulin associated with sarcopenia also decreased with EONS. Biomarkers reflective of multiple biological systems were impacted by nutritional intervention in sarcopenic older adults. Incremental biomarker changes were observed in response to EONS containing HMB that possibly link to improvements in skeletal muscle health.

Highlights

Malnutrition and sarcopenia are two conditions that can occur simultaneously and are prevalent in older adults
A majority of participants were nonobese (79.3%) and were considered normal weight or overweight when categorized by body mass index (BMI) (32.1% and 43.5%, respectively) (Table 1)
The findings from this study indicate that in sarcopenic malnourished older adults, multiple biochemical pathways related to nutrition, immunity, inflammation, anabolism and muscle metabolism can be impacted by nutrition

Summary

Introduction

Malnutrition and sarcopenia are two conditions that can occur simultaneously and are prevalent in older adults. Malnutrition and sarcopenia independently, and in conjunction, contribute to an increased risk of adverse health events such as reduced quality of life, mobility disability, hospitalization and mortality [4–7]. There is a need for interventions that can both restore nutrition status, as well as address loss of muscle strength and function towards improving quality of life, physical functionality, and long-term well-being. Chronic nutritional intervention studies using specific nutrients that target muscle health have shown positive benefits on muscle strength, quality and function in sarcopenic populations [8–10]. Older adults are recommended to consume at least 1.0–1.2 g protein/kg body weight/day, with even higher intake levels recommended for malnourished patients [13,14]

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