HMB (Beta-Hydroxy Beta-Methylbutyrate)

BACKGROUND: Resistance training has robust evidence for improving muscle health in older adults; however, the additional benefit of adjunctive supplementation with β-hydroxy β-methylbutyrate (HMB) remains unclear. This systematic review and meta-analysis evaluated the effect of HMB supplementation combined with resistance training on body composition and muscle strength in adults aged 50 years and older. METHODS: Four databases (PubMed, Scopus, Clinicaltrials.gov, and Cochrane) were systematically searched for randomized controlled trials investigating HMB supplementation with resistance training in older adults. The main results examined fat mass, muscle mass, and muscle strength. Meta-analyses were conducted using robust variance estimation with small-sample corrections. The Cochrane RoB 2.0 tool was used to assess the risk of bias. RESULTS: A total of 561 participants were involved in 13 RCTs. According to meta-analysis data, supplementing with HMB is not advantageous concerning fat mass (SMD = 0.24, 95% CI: -0.01 to 0.49), muscle mass (SMD = 0.05, 95% CI: -0.10 to 0.20), and muscle strength (SMD = 0.04, 95% CI: -0.72 to 0.63). There was low heterogeneity for body composition outcomes but high heterogeneity for strength measures. No evidence of publication bias was detected. CONCLUSIONS: The combination of HMB supplementation and resistance training does not improve body composition or muscle strength in adults aged 50 years and older. Based on the available evidence, HMB supplementation cannot be recommended as a routine adjunct to resistance training in individuals who are able to undertake structured exercise. © The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].

BACKGROUND & AIMS: Dietary anti-inflammatory interventions have shown promise in the prevention and management of sarcopenia. However, the efficacy of various anti-inflammatory diets/supplements in improving muscle strength, mass, and physical performance in patients with sarcopenia remains unclear. The objective of this study was to systematically assess the efficacy of various anti-inflammatory supplements in alleviating symptoms in patients with sarcopenia, thereby providing robust evidence to inform clinical practice and nutritional recommendations. METHODS: This study systematically searched 11 Chinese and English databases in August 2025 to include randomized controlled trials (RCTs) evaluating the intervention effects of anti-inflammatory diets or supplements on elderly patients with sarcopenia. Primary outcomes included handgrip strength, gait speed, the five times sit-to-stand test (FTSST), and the appendicular skeletal muscle mass index (ASMI). Secondary outcomes included the Short Physical Performance Battery (SPPB) score, fat-free mass (FFM), and laboratory parameters (triglycerides, high-density lipoprotein, low-density lipoprotein, and C-reactive protein). For primary outcomes, both pairwise and network meta-analyses were performed to compare the effects of different interventions. For secondary outcomes, only pairwise meta-analysis was conducted. RESULTS: Finally, 42 randomized controlled trials were included, involving 3063 elderly patients with sarcopenia, covering seven categories of anti-inflammatory supplements: combined supplements (combinations of at least two anti-inflammatory supplements), amino acids, whey protein, β-Hydroxy-β-methylbutyrate (HMB), Vitamin D, n-3 polyunsaturated fatty acids (PUFAs), and epicatechin. Network meta-analysis results indicated that whey protein (SMD=0.78, 95% CI: 0.07, 1.48), vitamin D (SMD=1.44, 95% CI: 0.76, 2.11), and Epicatechin (SMD=2.44, 95% CI: 1.69, 3.18) are the most effective measures to improve handgrip strength, gait speed, and ASMI, respectively. For FTSST, a significant improvement was only found for combined supplements in the pairwise meta-analysis (SMD = -0.34, 95% CI: -0.63, -0.05). Notably,

BACKGROUND/OBJECTIVES: Resistance training (RT) is a key strategy to counteract age-related declines in muscle strength and physical function. β-hydroxy-β-methylbutyrate (HMB) has been proposed as a complementary supplement to enhance these adaptations. However, the additional effects of RT plus HMB (RT+HMB) compared with RT alone remain unclear. This systematic review and meta-analysis evaluated the effects of RT+HMB versus RT alone on body composition, muscle quality (MQ), and physical function in older adults. METHODS: Following PRISMA guidelines (PROSPERO: CRD420251144810), six databases (PubMed, Scopus, Cochrane Library, CINAHL, Web of Science, and ScienceDirect) were searched up to July 2025. Randomized controlled trials comparing RT+HMB with RT alone were included. Methodological quality was assessed with the PEDro scale and risk of bias using Cochrane RoB 2. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. RESULTS: Ten trials (n = 596) met inclusion criteria. RT+HMB produced modest and borderline significant improvements in handgrip strength (SMD 0.24; 95% CI 0.00-0.48; p = 0.05) and moderate benefits in Short Physical Performance Battery (SPPB) scores (SMD 0.54; 95% CI 0.12-0.95; p = 0.01). No significant effects were observed for gait speed, appendicular lean mass, MQ, fat mass, or body weight (p > 0.05). Five trials (50%) were rated at high risk of bias, limiting confidence in pooled estimates. CONCLUSIONS: HMB supplementation combined with RT may yield modest improvements in functional performance, particularly handgrip strength and overall physical function, without statically significant effects in body composition and MQ. Further high-quality RCTs are warranted to confirm its clinical relevance.

BACKGROUND: Liver cirrhosis is a chronic, and progressive condition often complicated by malnutrition, sarcopenia, hepatic encephalopathy (HE), and frailty. Malnutrition is highly prevalent in patients with cirrhosis and is associated with an increased risk of decompensation and mortality. Consequently, leading liver societies (ESPEN, EASL, AASLD) recommend personalized nutritional interventions in patients with cirrhosis. While several studies have examined the effects of BCAAs on clinical and functional outcomes in cirrhosis, few have synthesized these outcomes in a single meta-analysis. Despite a growing number of RCTs on HPHC diets and HMB, existing reviews remain largely limited to sarcopenia-related outcomes. To date, no meta-analysis has evaluated the impact of nutritional interventions on frailty-related outcomes in cirrhosis. AIMS: To assess the impact of oral nutritional interventions, including branched-chain amino acids (BCAAs), high-protein, high-calorie (HPHC) diets, β-hydroxy β-methylbutyrate (HMB), and high-protein diets on clinical and functional outcomes in adults with cirrhosis. METHODS: We conducted a systematic review and meta-analysis of 21 randomized controlled trials (RCTs), of which 18 involving 3128 adults with cirrhosis were included in the meta-analysis, following PRISMA 2020 guidelines. RCTs published between January 1, 2000, and June 1, 2025, involving ≥4 weeks of oral nutritional therapy in patients with cirrhosis were included. Data were pooled using random effects model. Sensitivity, subgroup, and meta-regression analyses explored robustness and potential effect modifiers. The certainty of evidence was assessed using GRADE criteria. RESULTS: Nutritional intervention significantly reduced the risk of overt HE (RR 0.70; 95 % CI 0.52-0.95; NNT 11; I2 0 %), liver-related decompensation events (RR 0.69; 95 % CI 0.53-0.90; NNT 16; I2 0 %), hospitalization (RR 0.65; 95 % CI 0.49-0.86; NNT 8; I2 21.8 %), and mortality (RR 0.64; 95 % CI 0.49-0.84; NNT 23; I2 0 %). Handgrip strength improved significantly (MD 2.41 kg; 95 % CI 0.58-4.24; I2 87 %), and LFI showed borderline improvement (MD -0.35; 95 % CI -0.70 to -0.0005; I2 84.4 %). HPHC di

OBJECTIVE: A growing body of evidence confirms that nutritional supplementation strategies combined with resistance training can enhance muscle strength and mass in older adults. However, the optimal supplementation approach remains unclear. This study aimed to evaluate the comparative efficacy of different nutritional interventions combined with resistance training on muscle strength and mass in healthy older adults and determine the optimal strategy. METHODS: A systematic search was performed across three major biomedical databases (PubMed, Web of Science, and EMbase) to identify randomized controlled trials (RCTs) investigating the effects of nutritional supplementation combined with resistance training on muscle strength and mass in healthy older adults. A total of 19 eligible RCTs were included. The search covered literature from database inception to April 2025. Two researchers independently screened studies against predefined eligibility criteria and assessed methodological quality using the Cochrane risk-of-bias tool. Stata 18.0 was used to conduct network meta-analysis. CONCLUSION: Compared with resistance training alone, protein supplementation combined with resistance training significantly enhanced muscle strength [Standardized Mean Difference (SMD) = 0.45, 95% confidence interval (CI): 0.20,0.69; surface under the cumulative ranking curve (SUCRA) = 98.7%] and muscle mass [Mean Difference (MD) = 0.37, 95%CI: 0.04,0.70],whereas creatine supplementation demonstrated non-significant effects on muscle strength versus training alone (SMD = 0.03, 95% CI: -0.35,0.42) but yielded the most pronounced improvement in muscle mass (MD = 2.18, 95%CI: 0.92,3.44; SUCRA = 99.9%), outperforming both protein and β-hydroxy-β-methylbutyrate (HMB) interventions, with HMB supplementation critically failing to demonstrate significant benefits for muscle strength (SMD = -0.22, 95%CI: -0.57,0.12) or mass outcomes (MD = 0.05, 95%CI: -0.33,0.44). SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251026016.

BACKGROUND: Physical impairment has been gaining attention as a fundamental outcome in nutrition therapy for critically ill patients. This review aims to evaluate current evidence and identify knowledge gaps regarding nutrition therapy for physical function and muscle mass, based on 17 systematic reviews developed for the Japanese Critical Care Nutrition Guideline 2024. METHODS: Literature searches were performed in MEDLINE, CENTRAL, and ICHUSHI until April 2023, with additional searches up to September 2024. Studies were categorized by nutritional intervention and key findings were summarized. RESULTS: Overfeeding-of both energy and protein-increased adverse outcomes including impaired physical function. Excessive energy restriction also impaired physical outcomes, even during the hyperacute phase. Although adequate energy intake is physiologically necessary during recovery phases, most studies did not report nutritional intake during this period. Protein intake above the standard level helped preserve muscle mass. Nutrition therapy combined with early rehabilitation appears to support physical function. Under the equivalent energy intake, the route and method of administration had minimal impact, but can help ensure adequate delivery. The effects of specific nutrients remain unclear due to limited studies and insufficient or unreported energy intake. Nevertheless, omega-3 fatty acids, beta-hydroxy-beta-methylbutyrate, and synbiotics showed potential benefits. CONCLUSIONS: Although overfeeding may be harmful during the hyperacute phase, adequate energy intake, at least in the late period of the acute phase and subsequent phases, could play an important role in supporting the recovery of muscle mass and physical function. This approach may enhance the effectiveness of nutritional interventions in improving physical outcomes.

BACKGROUND: As dietary supplements have become integral to meeting athletes' specialised nutritional requirements, research into their effects on performance has intensified. Yet inconsistent findings leave the efficacy of some supplements-most notably branched-chain amino acids and β-hydroxy-β-methylbutyrate (HMB)-open to debate. To clarify which products offer the greatest benefit, we undertook a systematic review and network meta-analysis aimed at identifying the supplements most effective for athletes, including protein, creatine, β-alanine, HMB, vitamin D, caffeine, and others. METHODS: PubMed, Web of Science, the Cochrane Library, Embase and SPORTDiscus were searched from database inception to 15 March 2024 for RCTs evaluating the effects of dietary supplements (including but not limited to protein, creatine, β-alanine, HMB, caffeine, and vitamin D) on athletic performance. Risk of bias was appraised with the revised Cochrane RoB 2 tool. A network meta-analysis was performed in R. RESULTS: We included 35 randomized controlled trials comprising 991 athletes who completed strength and conditioning training in conjunction with various dietary supplements or a placebo. The risk of bias assessment indicated that 8.57% of studies were at low risk, 88.57% had some concerns, and 2.86% were at high risk of bias. Protein supplementation yielded the greatest improvement in muscular strength (standardized mean difference [SMD] = 0.64, 95% confidence interval [CI] 0.31-0.97; surface under the cumulative ranking curve [SUCRA] = 99.6%; very low-certainty evidence). Both β-alanine (SMD = 0.41, 95% CI 0.10-0.72; SUCRA = 89.0%; moderate-certainty evidence) and creatine (SMD = 0.30, 95% CI 0.07-0.53; SUCRA = 76.06%; moderate-certainty evidence) significantly enhanced jump performance, with β-alanine ranking marginally higher. Creatine also reduced sprint time (SMD = -0.42, 95% CI - 0.68 to -0.16; SUCRA = 94.57%; moderate-certainty evidence). No supplement significantly increased lean body mass. CONCLUSION: Protein supplementation appears to be the most effective strategy for increasing muscular strength; β-alanine and creatine both improve jump performance, with β-alanine of

BACKGROUND: Wrestling is a popular combat sport that requires muscular strength, power, agility, and endurance. Weight classes have motivated wrestlers to compete at a lower weight to optimise power-to-weight ratio and performance. To achieve these characteristics, athletes may use dietary supplements, however, their efficacy in wrestlers has not been systematically evaluated. OBJECTIVE: The purpose was to systematically review the literature to determine the efficacy of dietary supplements to improve body composition, physiological status, and performance in wrestlers. METHODS: A systematic search was conducted in PubMed, ProQuest Medline, Web of Science, Cochrane Library, and Scopus on the 21st of January 2024 and updated on the 6th of January 2025. Studies were included if the participants were healthy wrestlers ingesting any type of dietary supplement in comparison to a control. Data associated with intervention type and characteristics, target populations, outcomes, and analysis methods were extracted. RESULTS: A total of 24 eligible original articles were included that assessed various supplementation strategies on body composition, exercise performance, and metabolic markers in wrestlers. Individual studies revealed significant effects of sodium citrate, creatine monohydrate, spirulina, green tea and oolong tea extracts, and branched-chain amino acids on body mass or composition. β-Hydroxy-β-methylbutyrate (HMB-FA), creatine monohydrate, and iron supplementation improved recovery and may improve exercise performance. Beet-root juice supplementation enhanced muscular strength and balance. BCAA supplementation produced mixed results on muscle damage biomarkers and performance, while sodium citrate, creatine, and spirulina can act as buffering agents. Thyme tea appears to improve antioxidant capacity. CONCLUSIONS: Overall, individual studies show some promise for several dietary supplements to alter body mass and body composition, improve exercise recovery and performance, delay fatigue, and modify serum biomarkers; nevertheless, effect sizes were often small, and results were often mixed. © 2025. The Author(s).

BACKGROUND: β-Hydroxy β-Methylbutyrate (HMB) has shown potential in improving muscle protein turnover, which may be important for preventing muscle degradation in aging populations. The aim of this meta-analysis is to clarify the impact of HMB oral supplementation on muscle-related indicators and discover the interaction between dosage and duration. The findings will provide a scientific basis for the use of HMB oral supplementation in the management of muscle attenuation. METHODS: A computer systems-based search for articles of randomized controlled trial (RCT) in the PubMed, Cochrane Library, Web of Science, ScienceDirect, EBSCO English databases and China Journal Full-Text Database (CNKI), Wan Fang Chinese databases, was conducted up to October 2023. Data were pooled using weighted mean difference (WMD) and 95% confidence intervals (95% CI). RESULTS: A total of 21 RCTs were included, involving 1935 participants, all of them were > 50 years old. Results showed a positive impact of HMB oral supplementation in improving muscle mass (appendicular skeletal muscle mass: WMD = 1.56 kg, 95% CI: 0.03-3.09 kg and lean mass: WMD = 0.28 kg, 95% CI: 0.16-0.41 kg), strength (handgrip strength: WMD = 0.54 kg, 95% CI: 0.04-1.04 kg and five-time chair stand test: WMD = -0.73 s, 95% CI: -1.35, -0.11 s), and physical function (gait speed: WMD = 0.06 m/s, 95% CI: 0.01-0.10 m/s). Subgroup analysis revealed that the effect of a dosage of 3 g/d had significant improvement, and the effect of supplementation duration lasting > 12 weeks had significant improvement, and a dosage of 3g/day for more than 12 weeks was recommended. CONCLUSION: HMB oral supplementation can improve muscle mass, strength, and physical function. We recommend to implement supplementation at a dosage of 3 g for a duration exceeding 12 weeks to achieve optimal benefits. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/login, identifier 42024518958.

OBJECTIVES: To undertake a systematic review and meta-analysis to examine the evidence base for the effects of β-hydroxy-β-methylbutyrate (HMB) supplementation in patients with sarcopenia. DESIGN: Systematic review and meta-analysis. METHODS: The literature was searched via the PubMed, MEDLINE, Web of Science, EMBASE, CINAHL, Scopus, WANFANG, CNKI and VIP databases, through 23rd February 2024. The inclusion criteria were: randomized controlled trials (RCTs); patients diagnosed with sarcopenia defined according to well-accepted clinical consensus; HMB as an intervention; outcomes on muscle mass and/or muscle strength and/or physical performance. Data extraction was completed by independent pairs of reviewers. Meta-analyses of continuous outcomes were performed on the extracted data. Standard mean difference (SMD) with 95 % confidence intervals (CIs) between treatment and control group were used to express intervention effect estimates of HMB for each study. Risk of bias was assessed according to Version 2 of the Cochrane tool for assessing risk of bias in randomized trials (ROB 2). RESULTS: Of 196 records retrieved and screened, five RCTs met the eligibility criteria for qualitative and quantitative analysis, yielding 154, 359 and 359 participants for muscle mass, muscle strength, and physical performance, respectively. For the overall risk of bias, no studies were graded as "high risk of bias", one (20.0 %) as "some concerns", and four (80.0 %) as "low risk of bias" according to the ROB 2. The overall meta-analysis revealed a beneficial effect on muscle mass and strength, as demonstrated by a higher skeletal muscle mass index (SMD = 0.32; 95 % CI: [0.00,0.64]; Z value =1.98; P = 0.048), along with an elevated handgrip strength (SMD = 0.65; 95 % CI: [0.05, 1.25]; Z value = 2.12; P = 0.034) in the HMB intervention groups compared with the control groups. However, there was no evidence of a benefit on physical performance, assessed by gait speed (SMD = 0.19; 95 % CI: [-0.14, 0.53]; Z value = 1.14; P = 0.255). CONCLUSION: Overall, although limited and requiring interpretation with utmost caution, current evidence indicates that HMB supplementation is beneficial for

Oxidative stress contributes to age-related musculoskeletal decline, partly through disruption of glutathione-dependent redox homeostasis. Although creatine and β-hydroxy-β-methylbutyrate (HMB) have been individually linked to antioxidant and cytoprotective effects, their combined influence on systemic redox balance in older adults remains insufficiently characterized.To examine the effects of creatine plus HMB supplementation on oxidative stress biomarkers and composite redox indices, and to explore whether redox adaptations co-vary with changes in functional measures in physically active older adults.In a randomized, double-blind, placebo-controlled crossover trial, 30 physically active older adults (62.7 ± 5.3 years; 20 men, 10 women) completed two 6-week intervention phases (3 g/day creatine + 3 g/day calcium HMB vs. placebo) during supervised exercise training. Primary endpoints were oxidized glutathione and the Glutathione Redox Index. Secondary biomarkers and composite indices were analyzed with false discovery rate (FDR) control. Percent changes (Δ%) in functional tests were examined exclusively as exploratory correlates of redox adaptations.Supplementation was associated with attenuation of the placebo-related increase in oxidized glutathione and nominal preservation of the Glutathione Redox Index, although these effects did not remain significant after FDR adjustment. In men, a nominal increase in malondialdehyde was observed under supplementation. Exploratory analyses indicated weak associations between changes in composite redox indices and Δ% functional measures.Creatine plus HMB supplementation was associated with nominal modulation of glutathione-centered redox balance during training in active older adults. Exploratory redox-function associations support further investigation in larger, adequately powered trials. © 2026. The Author(s).

BACKGROUND: Hemodialysis (HD) patients frequently develop muscle wasting and chronic inflammation, conditions associated with functional decline and reduced quality of life (QoL). Nutritional strategies that provide targeted anabolic support without increasing nitrogen load may offer clinical benefits. The aim of this study was to evaluate the possible impact of a food for special medical purposes (FFSMP), composed of free-form branched-chain amino acids, β-hydroxy-β-methylbutyrate, and zinc, on muscle mass and strength, laboratory parameters, physical performance (PP), and QoL in HD patients. METHODS: in this randomized double-blind crossover study, 24 adult HD patients received the FFSMP (10 g/day; two sachets) supplementation or placebo for 12 weeks, separated by an 8-week wash-out (protocol code RS 29.23). Measured outcomes included quadriceps rectus femoris thickness (QRFT) muscle, body composition analysis, inflammatory markers, oxidative stress indices, other routine biochemical parameters, PP, and QoL (SF-36 questionnaire). RESULTS: FFSMP supplementation resulted in significant increases in QRFT and in fat-free mass percentage. Reductions in oxidative stress and inflammatory biomarkers were observed. Routine biochemical parameters remained stable, with the exception of a decrease in pre-dialysis urea. Functional performance measures did not differ between treatment periods. Improvements were noted in selected SF-36 domains, specifically energy/fatigue and general health. No major adverse events occurred during the study. CONCLUSIONS: In HD patients, this FFSMP produced favorable changes in markers of muscle mass and systemic inflammation without affecting short-term physical performance. These findings support the potential clinical utility of targeted amino acid supplementation in this patient population, highlighting the need for larger, longer-term trials.

OBJECTIVE: To investigate the effects of prebiotics combined with β-hydroxy-β-methylbutyrate (HMB) on muscle function, intestinal barrier integrity, and inflammation in elderly patients with sarcopenia. METHODS: A randomized controlled trial was conducted on 78 elderly sarcopenic patients recruited from Tongji University Affiliated Tenth People's Hospital and Baoshan District Geriatric Care Hospital (Jan 2023 - Jan 2025). Participants were randomly assigned Group A (n = 32, standard diet + HMB-supplement), Group B (n = 31, standard diet + HMB + fructooligosaccharides), or Group C (n = 15, standard diet alone) for 30 days. Outcomes included muscle function (skeletal muscle mass index, grip strength, calf circumference), intestinal barrier markers (serum diamine oxidase, D-lactic acid, endotoxin), and inflammatory and nutritional markers (CRP, neutrophil/lymphocyte ratio, systemic immune inflammation index, albumin, prealbumin). RESULTS: Baseline indicators did not differ among groups (P > 0.05). After intervention, skeletal muscle mass index and grip strength improved significantly in Groups A and B (P < 0.05), with higher grip strengths to Group B than C (adj. P = 0.017). Calf circumference decreased in all groups (P < 0.05), most in Group C (t = 4.461, P = 0.001). Group B exhibited lower diamine oxidase, D-lactic acid, and endotoxin levels than Groups A and C (P < 0.05) and the greatest reductions in CRP, NLR, and SII (P < 0.001). Albumin or prealbumin showed no significant changes (P > 0.05). CONCLUSION: HMB improves muscle function in sarcopenic elderly, prebiotics combined with HMB further enhance intestinal barrier repair and reduce inflammation, offering a promising gut-muscle-targeted nutritional strategy. © 2026. The Author(s).

BACKGROUND AND OBJECTIVE: The effectiveness of beta-hydroxy-beta-methylbutyrate (HMB) for sarcopenia in decompensated cirrhosis patients remains unclear. This pilot trial investigated the effect of HMB-containing oral nutritional supplement (ONS) on muscle mass as the primary outcome. Secondary outcomes included changes in muscle strength, quality, and physical performance. METHODS: This randomized controlled trial included 21 patients with stable decompensated cirrhosis and sarcopenia (April 2022-January 2024). Participants received either an HMB-containing ONS (daily total of 1.48 g Calcium HMB, 21 g protein, 524 kcal) (HMB group, n = 12) or maltodextrin (control group, n = 9) for 12 weeks. The primary outcome was the 12-week change in muscle mass measured by bioelectrical impedance analysis. Secondary outcomes included handgrip strength, anthropometry, and physical performance. RESULTS: At 12 weeks, there were no significant between-group differences in muscle mass parameters (e.g., appendicular skeletal muscle mass index [ASMI], fat-free mass index [FFMI]) or handgrip strength. However, the HMB group demonstrated significant within-group improvements from baseline in phase angle (4.6°-5.0°, p = 0.015), mid-arm muscle circumference [MAMC] (23.3-24.4 cm, p = 0.008), and 5-time chair stand test performance (18.6-16.5 s, p = 0.047). The supplement was well-tolerated with no significant adverse events. CONCLUSION: In patients with stable decompensated cirrhosis and sarcopenia, 12-week HMB-containing ONS was well-tolerated. While it did not significantly increase muscle mass or handgrip strength compared to the control group, HMB-containing ONS showed promise for improving key sarcopenia-related parameters-phase angle, mid-arm muscle circumference, and chair stand test performance when compared to baseline. Larger adequately powered randomized controlled trials are needed to confirm these findings. (Trial Registration: Thai Clinical Trials Registry on April 22, 2024, No. TCTR20240422012. The registration can be accessed at: https://thaiclinicaltrials.org/).

BACKGROUND: Although nutritional supplementation and exercise have shown independent efficacy in managing sarcopenia, data supporting their combined implementation in real-world clinical settings remain limited. METHODS: This 12-week multicenter randomized controlled trial enrolled 110 older adults (≥ 65 years) with sarcopenia or possible sarcopenia. Participants were randomly allocated (1:1) to either the intervention group (n = 55) or control group (n = 55). In addition to their habitual diets, the intervention group received daily muscle-targeted oral nutritional supplementation (MT-ONS, 2 × 10 g sachets/day: containing 8.4 g protein, 0.5 g calcium β-hydroxy-β-methylbutyrate, 200 IU D3 per sachet) alongside a structured exercise programs featuring twice-weekly resistance training (20 min/session), alternate-day chair-based exercises (10 min/session), and home-based activity recommendations. Control group participants maintained their habitual dietary and physical activity patterns without intervention. All outcome measures were assessed at baseline and post-intervention. RESULTS: The intervention group showed modest increases in BIA-derived appendicular lean tissue (mean change + 0.60 kg, 95% CI 0.33 to 0.88), skeletal muscle index (+ 0.20 kg/m², 95% CI 0.11 to 0.29), and handgrip strength (+ 2.22 kg, 95% CI 1.35 to 3.09) compared with the control group. Improvements were also observed in walking speed, chair-stand performance, Short Physical Performance Battery scores, serum vitamin D, and EQ-5D measures of quality of life. CONCLUSION: A 12-week combined intervention of multi-ingredient nutritional supplementation and exercise led to modest improvements in proxy measures of muscle mass, strength, function, and quality of life in older adults. As muscle mass was not directly measured and the study did not employ a factorial design, the relative contributions of exercise and supplementation cannot be determined. These findings suggest that combined interventions may help attenuate, rather than reverse, sarcopenia-related decline. TRIAL REGISTRATION: This clinical trial was registered on Chinese Clinical Trial Registry (ChiCTR2300077187) on 1 November 2023. ©

OBJECTIVE: To investigate the comprehensive intervention effects of transfer energy capacitive and resistive (TECAR) therapy combined with β-hydroxy-β-methylbutyrate (HMB) nutritional supplementation in older patients with sarcopenic obesity (SO). METHODS: We conducted a randomized controlled trial, enrolling 140 older patients who met the Asian diagnostic criteria for SO. Participants were randomly assigned to 4 groups, including a double-placebo group (Group A), TECAR + placebo group (Group B), sham TECAR + HMB group (Group C), and TECAR + HMB group (Group D), with 35 patients in each group. The intervention lasted 12 weeks. The primary outcome measure was the total score of the Short Physical Performance Battery (SPPB). Secondary outcome indicators included the modified Barthel Index (MBI), scores of the Mini Nutritional Assessment-Short Form (MNA-SF), handgrip strength, body mass, and body mass index (BMI). A two-way analysis of variance (ANOVA) was used to assess the interaction effects between TECAR and HMB. RESULTS: After the intervention, Group D (TECAR + HMB) demonstrated significant improvements across all metrics. The SPPB total score increased from 6.29 ± 1.34 to 8.06 ± 1.51 (P < 0.001), with notable enhancements in walking speed (2.71 ± 0.86 vs. 1.97 ± 0.82), chair stand (2.60 ± 0.55 vs. 2.11 ± 0.47), and balance (2.74 ± 0.74 vs. 2.20 ± 0.76). MBI improved from 71.74 ± 14.41 to 79.91 ± 10.52 (P < 0.001). Handgrip strength increased from (13.65 ± 5.05) kg to (15.72 ± 4.89) kg (P = 0.001). Body mass decreased from (81.78 ± 9.02) kg to (76.95 ± 9.89) kg (P < 0.001), and BMI reduced from (30.14 ± 1.68) kg/m2 to (28.34 ± 2.33) kg/m2 (P < 0.001). Interaction analysis revealed significant synergistic effects between TECAR and HMB in improving the SPPB total scores (F = 16.374, P < 0.001, η² = 0.107) and reducing BMI (F = 14.328, P < 0.001, η² = 0.095). CONCLUSION: TECAR therapy combined with HMB supplementation significantly enhances physical function, activities of daily living, and body composition in elderly patients with sarcopenic obesity, demonstrating a synergistic effect. 目的: 探讨电容电阻式靶向疗法（Transcutaneous Capacitive and Resistive Electric Transfer, T

BACKGROUND: Preoperative physical frailty is a significant predictor of adverse postoperative outcomes in older patients undergoing cardiac surgery. Inflammation plays a crucial role in the development of frailty and contributes to postoperative complications. This study investigated the effects of preoperative beta-hydroxy-beta-methylbutyrate (HMB), arginine, and glutamine supplementation on inflammatory markers, nutritional status, and renal function in older patients undergoing cardiac surgery. METHODS: This was a secondary analysis of a single-center, open-label, randomized controlled trial. Patients aged ≥65 years scheduled for elective cardiac surgery were randomized to receive either HMB supplementation (1200 mg HMB, 7000 mg l-glutamine, and 7000 mg L-arginine, twice daily) or routine care for at least two weeks before surgery. Serum levels of tumor necrosis factor-alpha (TNF-α), and other biochemical markers were measured at baseline, pre-surgery, and two weeks post-surgery. RESULTS: Forty-four patients (mean age 72.5 years, 36 % women) were analyzed. Preoperative HMB supplementation significantly reduced pre-surgery serum TNF-α levels compared to the control group (0.85 ± 0.28 pg/mL vs. 1.10 ± 0.44 pg/mL, p = 0.039). However, this difference was not observed two weeks post-surgery. No significant differences were observed in C-reactive protein levels or other nutritional markers between the two groups at any time point. CONCLUSIONS: Preoperative supplementation with a combination of HMB, glutamine, and arginine was effective in reducing preoperative TNF-α levels in older patients undergoing cardiac surgery, suggesting a potential anti-inflammatory effect. This anti-inflammatory effect suggests a potential mechanism for improving postoperative outcomes and warrants further investigation. Registration number of Clinical Trial: UMIN000030490 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034773).

BACKGROUND: The effectiveness and practicality of time-restricted eating (TRE) when trying to maximize muscle mass and strength is unclear. Thus, we examined the effects of a hypercaloric 16:8 TRE approach during supervised progressive resistance exercise. METHODS: Seventeen healthy and well-trained men (n = 10) and women (n = 7) were randomly assigned to TRE or control (FED). Both groups consumed a 10% hypercaloric high-protein (2.2 g/kg/d) diet and performed supervised resistance exercise 4× per wk for 8 wk. TRE consumed all calories within an 8 h window starting at least 1 h post-exercise, while FED consumed the same number of calories throughout the day. RESULTS: Eating windows were significantly different (TRE: 7.9 ± 0.1 h vs. FED: 13.2 ± 0.6 h). Calorie, carbohydrate, fat, and protein intake did not differ statistically between groups. Total exercise volume was significantly lower in TRE than FED (6,960 ± 287 vs. 7,334 ± 289 repetitions), as were subjective daily energy ratings (week 4 = -1.41; p = 0.04, week 8 = -1.04; p = 0.06). Both groups increased maximal upper and lower body strength (1RM) and muscular endurance (ME); however, gains in squat 1RM were 4.0 ± 1.9 kg lower in TRE (p = 0.05). Both groups increased fat-free mass similarly (TRE: 2.67 kg; FED: 1.82 kg, p = 0.04), but FED added 1.4 ± 0.6 kg more fat mass (p = 0.04). Subjective mood and sleep ratings did not change in either group. CONCLUSIONS: 16:8 TRE is viable during periods of muscle size, strength, and endurance development in well-trained young men and women when engaging in progressive resistance exercise and eating in a caloric surplus with adequate protein. However, the differences in total training volume, squat 1RM, fat mass accumulation, and energy are notable and practically relevant. These findings should be considered within the broader context of an individual's goals, lifestyle, preferences, and exercise demands.

The aim of the current parallel randomized controlled trial was to compare the effects of ingesting a dietary supplement admixture providing carbohydrates, leucine-fortified whey protein, creatine, β-hydroxy-β-methylbutyrate, and vitamin D3 (Master Recovery 1:1, Crown Sport Nutrition, Spain), versus an isoenergetic carbohydrate-only comparator on body composition, muscle thickness, muscle strength, and performance over a 6-week resistance training program, performed three times per week, in aging, physically active individuals. Twenty participants (10 peri- and post-menopausal females and 10 males) -completed the study after being randomly assigned to one of the following groups: post-workout multi-ingredient (PWS: n = 10, 52.0 ± 5 years, body mass 82.0 ± 18.0 kg) or a comparator (COM: n = 10, 51 ± 3 years, body mass 85.9 ± 17.0 kg). Treatment consisted of ingesting 60.0 g of the assigned supplement immediately after each workout. Compared to baseline, only PWS increased fat-free mass (+1.34 ± 1.2 kg, p = 0.003), reduced fat mass (-1.09 ± 0.7 kg, p < 0.001), waist circumference (-2.5 ± 1.8 cm, p < 0.001), and waist-to-hip ratio (-0.03 ± 0.03 cm, p = 0.007). At post-intervention, waist circumference reduction was different between groups (p = 0.02, d = 1.19). Both treatments similarly improved vastus lateralis and elbow flexor thickness, medicine ball throw, and endurance performance. Although countermovement jump improved for both treatments, the PWS group showed a significantly higher performance increase compared to COM (p < 0.01, d = 1.47). Compared to ingesting carbohydrates only, the use of a targeted multi-ingredient promoted noticeable body composition outcomes and better vertical jump improvements with no further effects on hypertrophy, upper body, and endurance performance. The study was registered as a clinical trial at ClinicalTrials.gov (NCT05769088).

BACKGROUND & AIMS: In older patients undergoing cardiac surgery, physical function is a critical determinant of postoperative outcomes. Beta-hydroxy-beta-methylbutyrate (HMB) supplementation has been shown to promote muscle protein anabolism and inhibit catabolism, thereby preventing muscle weakness. However, its efficacy in older patients undergoing cardiac surgery remains unknown. This study aimed to examine the effects of preoperative HMB supplementation on postoperative physical function and complications in this population. METHODS: In this single-center, open-label, randomized controlled trial, patients aged ≥65 years scheduled for cardiac surgery were randomized to receive HMB supplementation or no nutritional intervention. The HMB group received HMB 1200 mg, l-glutamine 7000 mg, and l-arginine 7000 mg, once or twice daily, for at least 2 weeks before surgery. Evaluations were performed at baseline and before and after surgery. The primary outcome was the 6-min walking distance (6MWD) before and after surgery. Secondary outcomes included the incidence of complications, muscle mass and strength, physical performance, and length of hospital stay. RESULTS: Forty-four patients with a mean age of 72.5 years (women, 38 %) were randomized to the HMB (n = 22) or control (n = 22) group. Compared with the control group, the HMB group demonstrated a statistically significant improvement in the 6MWD both at the pre-surgery (448.0 ± 73.5 m vs. 375.5 ± 58.8 m; P = 0.01) and post-surgery time points (428.9 ± 76.4 m vs. 304.5 ± 52.3 m; P = 0.001). Muscle strength and physical performance also showed significant improvements in the HMB group. However, no significant difference in muscle mass was observed between the groups at any time point. The HMB group had a shorter hospital length of stay compared with that of the control group (16.1 ± 3.8 days vs. 20.4 ± 7.6 days, P = 0.03), and no adverse events were observed with the intervention. CONCLUSIONS: Preoperative HMB supplementation in older adults undergoing cardiac surgery resulted in significant improvements in postoperative exercise capacity and physical function, along with a reduction in the length of hospital stay,

SIGNIFICANCE: Chronic wounds remain a major global health burden and often stall despite guideline-based care because of persistent inflammation, oxidative stress, impaired perfusion, and dysregulated extracellular matrix remodeling. Protein-based nutrition is best positioned as an adjunct to, rather than a substitute for, standard wound care. RECENT ADVANCES: Human studies, supported by mechanistic rationale, suggest that optimizing total protein intake (commonly ∼1.25 to 1.5 g/kg/day in appropriate patients) and, in selected settings, adding functional components such as arginine, glutamine, and β-hydroxy-β-methylbutyrate (HMB) may improve wound-area reduction and healing trajectories when integrated with standard care. Reported signals vary by etiology, including improved wound-area reduction and Pressure Ulcer Scale for Healing outcomes in pressure injuries, possible benefit in selected high-risk diabetic foot ulcer subgroups, and reduced venous ulcer area when supplementation is paired with consistent compression. CRITICAL ISSUES: Evidence remains heterogeneous across wound types and study designs, with inconsistent dosing, duration, endpoints, and patient-selection criteria that limit standardized implementation. Safety and feasibility are especially important in renal risk and diabetes, where renal function and glycemic control require monitoring. Clinical evidence was interpreted with attention to study design and reporting standards, including CONSORT, STROBE, or STARD, as applicable. FUTURE DIRECTIONS: This review translates current evidence into a clinician-oriented framework for patient selection, prescribing, monitoring, and treatment adjustment, emphasizing initiation triggers in stalled wounds and trajectory-based reassessment every 2-4 weeks. Future work should prioritize pragmatic, well-controlled trials comparing formulations and dosing windows by wound etiology, together with biomarker-informed stratification to improve personalization, safety, and real-world uptake.

PURPOSE OF REVIEW: Critical illness induces profound catabolic stress characterized by accelerated skeletal muscle breakdown, hypermetabolism, persistent catabolism including testosterone deficiency, and rapid functional decline. Loss of skeletal muscle contributes to prolonged hospitalization, ICU-acquired weakness, delayed recovery, and persistent disability in ICU survivors. This review summarizes recent evidence on anabolic therapies - including testosterone, oxandrolone/nandrolone, creatine, and β-hydroxy-β-methylbutyrate (HMB) - that may mitigate muscle wasting and improve functional recovery after critical illness. RECENT FINDINGS: Many ICU patients develop marked testosterone deficiency early during critical illness, which may contribute to persistent catabolism and impaired recovery. Oxandrolone has the strongest clinical evidence, particularly in burn injury. Emerging outcome and improved safety data suggest testosterone may improve strength and functional recovery, particularly in patients with low testosterone levels. Nandrolone is being evaluated in a randomized trial for ICU-acquired weakness. Nutritional supplements such as creatine and HMB can improve lean mass and strength, especially when combined with structured exercise. SUMMARY: Anabolic therapies appear most effective when integrated into multimodal recovery strategies combining personalized nutrition, progressive rehabilitation, and targeted pharmacologic support. Multidisciplinary prehabilitation/rehabilitation services/clinics may help accelerate recovery and reduce long-term disability in ICU survivors, though further multicomponent trials, including anabolic agents are urgently needed.

Age-related musculoskeletal diseases underscore the importance of comprehensive dietary interventions. The individual benefits of calcium β-hydroxy-β-methylbutyrate (CaHMB), colostrum basic protein (CBP), and hyaluronic acid (HA) on the musculoskeletal system have been well documented; however, their combined effects remain unclear. This study aims to investigate the effects of combined supplementation with CaHMB, CBP, and HA on age-related musculoskeletal degeneration and to explore the underlying mechanisms, with a particular focus on the muscle-bone axis. Twelve-month-old male C57BL/6J mice received a 6-month dietary intervention. The combination (COM) group was supplemented with CaHMB, CBP, and HA at substantially reduced doses (37.5%, 20%, and 14%, respectively). The COM group showed higher lean mass (18%) and a greater muscle cross-sectional area (35%) compared to the OLD group, with significantly enhanced grip strength by 41% and exercise performances. The COM group presented less decline in whole-body bone mineral density (5%) than the OLD group. The bone microstructure was improved by increasing the bone volume fraction and trabecular thickness/number, while a decrease in trabecular separation was observed in the COM group. Musculoskeletal improvements either matched or surpassed the benefits of individual components. Mechanistically, interventions modulated the key mediators of the muscle-bone axis, significantly upregulating beneficial myokines (irisin and IGF-1) and osteokine osteocalcin, while downregulating negative regulators (myostatin and sclerostin). These changes were correlated with the observed phenotypic enhancements. The low-dose combination of CaHMB, CBP, and HA provides comprehensive benefits against age-related muscle and bone loss, likely by modulating the muscle-bone axis, and outperforms individual components. Our findings support its potential as a multi-targeted nutritional strategy for the aging population.

BACKGROUND: Adequate nutrition and hydration are essential for maintaining skin integrity and supporting tissue repair in patients with pressure injuries. Current ESPEN guidelines emphasize the role of individualized nutritional therapy, including optimized energy and protein delivery and selected conditionally essential nutrients such as arginine, glutamine, and β-hydroxy-β-methylbutyrate (HMB), as part of a multidisciplinary approach to pressure ulcer management. This case series describes dietitian-led personalized nutritional interventions in critically ill, long-term hospitalized patients with advanced pressure ulcers. CASE SUMMARY: This descriptive case series reports four adult patients receiving long-term enteral nutrition in an acute or long-term care setting. Each case illustrates individualized nutritional assessment and intervention tailored to metabolic stress, nutritional risk, wound burden, and tolerance. Nutritional strategies included early initiation and optimization of enteral feeding, progressive achievement of energy and protein targets, glycemic control, and selective use of immunonutrition. Over prolonged follow-up, all patients demonstrated improvement and eventual healing of pressure ulcers within a comprehensive multidisciplinary care bundle. This series highlights the practical application of personalized nutrition in complex clinical scenarios rather than establishing causal efficacy. EXCLUSION CRITERIA: Patients were excluded from this case series if they met any of the following conditions: (1) Age below 18 years, (2) Pregnancy or lactation, (3) Patients receiving exclusive parenteral nutrition, (4) Presence of terminal illness or receiving palliative/end-of-life care, (5) Hemodynamic instability preventing initiation or continuation of enteral nutrition, (6) Pre-existing metabolic disorders that could significantly confound nutritional outcomes (e.g., inborn errors of metabolism), (7) Incomplete medical or nutritional records, and (8) Patients with anticipated length of stay are insufficient to assess nutritional intervention outcomes. INCLUSION CRITERIA: Patients were included in this case series if they met the following criteria

AIM: The liver exhibits a remarkable regenerative capacity, enabling this organ to maintain homeostasis even after significant injury. However, hepatic regeneration requires sufficient energy to sustain cellular hypertrophy and proliferation, thus ensuring efficient tissue repair. Therefore, dietary modulation of pathways regulating mitochondrial quality may enhance liver regeneration. This study aimed to investigate the effects of preoperative beta-hydroxy-beta-methylbutyrate (HMB) supplementation on mitochondrial quality control pathways and its impact on the liver regeneration process in mice undergoing partial hepatectomy (PHx). METHODS: Male C57BL/6J mice were supplemented with 600 mg/kg HMB via gavage for 10 days. On the 10th day, supplementation was discontinued, and the mice underwent a ⅔ liver resection. The subsequent 7 days have constituted the liver regeneration period. For a second injury induction, at the end of the 7th day of regeneration, acetaminophen (APAP) overdose was administered via gavage. We then analyzed several markers of mitochondrial quality and liver function. RESULTS: Our results indicate that preoperative HMB supplementation modulates cell cycle progression, preventing excessive hepatic mass accumulation. Additionally, HMB regulates mitochondrial dynamics by decreasing Parkin, Mfn2, and DRP1 protein levels while increasing the mitochondrial markers VDAC2 and Tom20. Following a second injury from an APAP overdose, the HMB-supplemented group demonstrated increased mtDNA content and enhanced mitochondrial capacity, both critical for effective tissue recovery. CONCLUSION: Our findings suggest that preoperative HMB supplementation preserves hepatic mitochondrial capacity after PHx. © 2026 The Author(s). Acta Physiologica published by John Wiley & Sons Ltd on behalf of Scandinavian Physiological Society.

OBJECTIVES: This review aimed to provide an overview of the effectiveness of combining exercise and dietary supplements on cognitive function in older adults and to examine whether the combined interventions exert synergistic effects. DESIGN: Narrative review. SETTING AND PARTICIPANTS: Older adults around the world. METHODS: A literature search was undertaken during August 2025 across Embase, PubMed, Web of Science, Cochrane Library, APA PsycArticles, and Psychology and Behavioral Sciences Collection. Relevant studies on the combined intervention of exercise and dietary supplements on cognitive function in older adults were retrieved. Two reviewers independently screened the studies and assessed the quality of studies. Data extraction was performed by one reviewer and then verified through discussion with the other author to reach a final consensus. A narrative synthesis was conducted to integrate the findings from the included studies. RESULTS: A total of 20 studies were included: 15 randomized controlled trials and 5 quasi-experimental studies. Exercise interventions included the following 4 types: resistance training, aerobic exercise, resistance training combined with aerobic exercise, and multicomponent exercise. Dietary supplements included vitamins, beta-alanine, leucine, folic acid, phosphatidylserine, Gingko biloba standardized leaf extract, calcium, rice wine lees, Bifidobacterium, creatine, protein, long-chain polyunsaturated fatty acid (LCPUFA), β-hydroxy β-methylbutyrate (HMB), branched-chain amino acids, and carbohydrates. Despite several studies reporting positive cognitive outcomes of the combined intervention compared with the control group, none demonstrated a statistically significant synergistic benefit. CONCLUSION AND IMPLICATIONS: The review found that although certain combinations benefited cognitive function, none demonstrated synergistic effects. High-quality studies on exercise combined with dietary supplements for cognition in older adults are needed in the future. To develop more effective interventions, future research could focus on elucidating the mechanisms by which exercise and dietary supplements affect cognition.

Sanxan, a microbial polysaccharide produced by Sphingomonas sp., is a novel food gum with distinctive rheological properties and favorable protein compatibility. Although approved as a novel food resource, systematic studies on its gelation behavior remain scarce, limiting its application in high-value-added food products. This study systematically investigated the effects of three distinct calcium sources: inorganic calcium (calcium chloride, CaCl2), organic calcium (calcium lactate, CaLa), and a novel calcium salt (calcium β-hydroxy-β-methylbutyrate, Ca-HMB), on the thermoreversible gel structures and rheological properties of sanxan gels through thermal and rheological analyses. The rheological data were modeled using the Arrhenius, Herschel-Bulkley, and power law equations. The incorporation of calcium ions enhanced the degradation threshold from 206.36 °C (control) to 220.61 °C (Ca-HMB, +6.9%) and 232.11 °C (CaLa, +12.5%), confirming improved thermal stability. Elevated Ca2+ concentrations reduced the gel activation energy by up to 71.1% (from 81,053.2 to 23,383.9 J·mol-1), with Ca-HMB exhibiting the most pronounced effect (a minimum reduction of 33.5%, to 53,919.6 J·mol-1). The gel sample formed with 8 mM Ca-HMB exhibited an exceptional thixotropic recovery rate of 86.6%. These results reveal that functional calcium salts differentially optimize gel performance by modulating the crosslinked network of sanxan gel, providing a theoretical foundation for designing nutritionally enhanced food gel systems with tailored textures.

Background: Sarcopenia is associated with adverse surgical outcomes. Recent literature suggested that pre-surgery prehabilitation, nutrition and β-Hydroxy β-methylbutyric acid (HMB) supplementation improve myological and functional outcomes. However, long-term outcomes remain uncertain. Thus, we aimed to analyse findings from the long-term follow-up of surgical patients undergoing oral supplementation and prehabilitation. Methods: A prospective single-centre pilot cohort study was conducted to evaluate the effects of multimodal prehabilitation using high-protein oral nutritional supplementation (HP-ONS) with HMB. Sarcopenic patients between 40 and 90 years old and undergoing gastrointestinal surgery were included from June 2022 to January 2024. Patients were followed up from two to four weeks pre-operatively to six months post-operatively. Paired Wilcoxon signed-rank tests were conducted to evaluate outcomes between time points. Results: 36 patients were included with a median age of 71.5 years (IQR: 55-90), and 50% were male. 12 (33.3%) patients were sarcopenic, while 24 (66.7%) were severely sarcopenic. No significant difference in IMAT% was observed at post-operative six months. Number of chair rise repetitions (Median:15 vs. 11, p < 0.001) and six-min walk test (Median: 387 m vs. 349 m, p = 0.020), mid-arm muscle circumference (Median: 23.7 cm vs. 22.5 cm, p = 0.013), mid-arm muscle area (Median: 44.8 cm2 vs. 39.3 cm2, p = 0.005), weight (Median: 51.6 kg vs. 50.8 kg, p = 0.023) and BMI (Median: 23.2 kg/m2 vs. 21.8 kg/m2, p = 0.025) increased significantly at six-months post-operatively from surgery. Conclusions: Our findings suggest that improvements in anthropometric and functional outcomes from prehabilitation may persist beyond the acute recovery period. If supported by future works, multimodal prehabilitation has the potential to optimise postoperative recovery amongst sarcopenic older adult surgical patients.

BACKGROUND: Older patients undergoing gastrectomy frequently exhibit sarcopenia and reduced physiologic reserve, increasing vulnerability to perioperative muscle loss. However, randomized evidence supporting multimodal exercise-nutrition prehabilitation in gastric cancer surgery remains limited. This trial evaluated whether prehabilitation attenuates preoperative lean body mass (LBM) loss and explored subgroups with greater benefit. METHODS: In this single-center, open-label randomized controlled trial, patients aged ≥ 65 years with resectable gastric adenocarcinoma scheduled for curative gastrectomy were randomized 1:1 to standard care or multimodal prehabilitation. The intervention included daily walking, resistance training, and β-hydroxy-β-methylbutyrate supplementation. The primary endpoint was change in LBM from baseline to preoperative assessment. Secondary endpoints included physical function and postoperative outcomes. Prespecified subgroup and exploratory adherence analyses were conducted. RESULTS: Of 110 randomized patients, 101 were analyzed (control, n = 52; prehabilitation, n = 49). Mean (SD) change in LBM was - 0.3 (1.2) kg in controls and 0.1 (1.0) kg with prehabilitation, yielding a mean difference of 0.4 kg (95% CI, 0.02-0.86; P = 0.043). Physical function and postoperative outcomes did not differ between groups. Greater LBM preservation was observed in women and in patients with lower baseline C-reactive protein or skeletal muscle index. Higher resistance training adherence was associated with greater LBM gain. CONCLUSIONS: Multimodal exercise-nutrition prehabilitation modestly preserved preoperative LBM in elderly gastrectomy patients but did not improve functional or postoperative outcomes. Risk-enriched trials are needed to determine whether targeted prehabilitation improves clinically meaningful endpoints. © 2026. The Author(s) under exclusive licence to The International Gastric Cancer Association and The Japanese Gastric Cancer Association.

Erratum for Aging Clin Exp Res. 2026 Jan 09;38(1):44. doi: 10.1007/s40520-025-03312-0.