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.
Highlights
Aging, defined as the progression of deterioration with diminishing life functions gradually leading to the end of life, is a global phenomenon of significant study [1]
There is an evident relationship between sarcopenia and insulin resistance, and subsequently type 2 diabetes mellitus (T2DM), where muscle mass degradation leads to decreased glucose clearance, resulting in increased insulin resistance and T2DM
There is evidence suggesting that the addition of dietary supplements enriched in certain amino acids leads to improvements in muscle strength and muscle mass gain
Summary
Aging, defined as the progression of deterioration with diminishing life functions gradually leading to the end of life, is a global phenomenon of significant study [1]. With sarcopenic patients, the major goal of medical nutrition therapy is to prevent/delay further muscle decline, improve muscle mass quality, as well as support immunity and wound healing Studies with such patients have evaluated the effectiveness of nutritional supplementation in the clinical setting with very limited evidence, suggesting that there may be some positive effects on muscle mass quality and function through amino acid supplementation [15]. HMB, in conjunction with Arg and Gln, improves nitrogen metabolism in critically ill patients, increases protein synthesis over prolonged use and has been seen to reduce protein degradation, thereby effectively defending lean body mass [22,23]. While the mechanisms of age-related loss of muscle mass are not completely understood, Arg and Gln support enhanced net protein synthesis, and their co-administration with HMB further reduces protein breakdown [23] seemingly maximizing the maintenance of total lean body mass. Appropriate dietary interventions providing positive nitrogen balance can reduce muscle loss and induce anabolic effects in sarcopenia [29]
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