Whey Protein Supplementation with or without Vitamin D on Sarcopenia-Related Measures: A Systematic Review and Meta-Analysis

Abstract

The effects of supplementation with whey protein alone or with vitamin D on sarcopenia-related outcomes in older adults are unclear. We aimed to assess the effect of whey protein supplementation alone or with vitamin D on lean mass (LM), strength, and function in older adults with or without sarcopenia or frailty. We searched PubMed, Web of Science, and SCOPUS databases. Randomized controlled trials (RCT) that investigated the effect of whey protein supplementation with or without vitamin D on sarcopenia outcomes in healthy and sarcopenic or frail older adults were included. Standardized mean differences (SMDs) were calculated for LM, muscle strength, and physical function data. The analysis showed that whey protein supplementation had no effect on LM and muscle strength; nevertheless, a significant improvement was found in physical function (SMD = 0.561; 95% confidence interval [CIs]: 0.256, 0.865, n = 33), particularly gait speed (GS). On the contrary, whey protein supplementation significantly improved LM (SMD = 0.982; 95% CI: 0.228, 1.736; n = 11), appendicular lean mass and physical function (SMD = 1.211; 95% CI: 0.588, 1.834; n = 16), and GS in sarcopenic/frail older adults. By contrast, co-supplementation with vitamin D enhanced LM gains (SMD =0.993; 95% CI: 0.112, 1.874; n = 11), muscle strength (SMD =2.005; 95% CI: 0.975, 3.035; n = 11), and physical function (SMD = 3.038; 95% CI: 2.196, 3.879; n = 18) significantly. Muscle strength and physical function improvements after whey protein supplementation plus vitamin D were observed without resistance exercise (RE) and short study duration subgroups. Moreover, the combination of whey protein and vitamin D with RE did not enhance the effect of RE. Whey protein supplementation improved LM and function in sarcopenic/frail older adults but had no positive effect in healthy older persons. By contrast, our meta-analysis showed that co-supplementation with whey protein and vitamin D is effective, particularly in healthy older adults, which is likely owing, we propose, to the correction of vitamin D insufficiency or deficiency. The trial was registered at https://inplasy.com as INPLASY202240167.

Keywords: frailty; mobility; muscle; physical function; resistance exercise.

FIGURE 1

Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow chart of the study selection process.

FIGURE 2

Forest plot of the randomized clinical trials (RCTs) examining the effect of whey protein supplementation on lean mass (LM; subgroups for total and appendicular lean mass). Data are expressed as standardized mean differences (SMDs) between the intervention and control groups with 95% CI. Estimates were pooled using the random-effects Hedges model. Letters between parentheses represent the following: a, TLM; b, ALM; c, with exercise training; and d, without exercise training. Abbreviations: ALM, appendicular lean mass; CI, confidence interval; SMD, standard mean difference; TLM, total lean mass.

FIGURE 3

Forest plot of the randomized clinical trials (RCTs) examining the effect of whey protein supplementation on physical function [subgrouping SPPB (score), gait speed (GS; m/s), and other physical tests (s)]. Data are expressed as SMDs between the intervention and control groups with 95% CI. Estimates were pooled using the random-effects Hedges model. Letters between parentheses represent the following: c, with exercise training; d, without exercise training; e, control (CHO); f, control (collagen), j, timed stand; k, TUG; l, walking time (s); m, sit-to-stand; n, chair stand; o, chair rise; p, stair climb; q, GS; and r, SPPB. Abbreviations: CI, confidence interval; GS, gait speed; SMD, standard mean difference; SPPB, Short Physical Performance Battery; TUG, timed up-and-go.