Nutritional Interventional trials in muscle and cachexia

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NUTRITIONAL INTERVENTIONAL TRIALS IN MUSCLE AND
CACHEXIA PHD RESEARCH DIRECTIONS FOR 2023
An Academic presentation by Dr. Nancy Agnes,
Head, Technical Operations, Phdassistance Group
www.phdassistance.com Email info_at_phdassistance.co
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Today's Outline
Introduction Interventions Musculoskeletal
conditions Multiple clinical conditions Older
adults with low muscle mass or function or
sarcopenia Older adults with malnutrition
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In brief
Muscle loss, especially alone or in the setting
of sarcopenia or cachexia, is a common condition
that predicts poor outcomes in ageing and
illness. Research has been done to investigate
the impact of specific nutrients on muscle mass
or function, as appropriate nutrition is crucial
for muscle maintenance. More research, however,
is required to inform evidence-based
decisions. This comprehensive review aimed to
gather and record ongoing clinical studies
evaluating dietary treatments as a strategy to
prevent or treat poor muscle mass or function
(strength and physical performance), sarcopenia,
or cachexia. ClinicalTrials.gov and the WHO
International Clinical Studies Registry Platform
were searched for planned and ongoing trials
through April 21, 2021. Based on the objective
to investigate the effects of dietary treatments
on muscle-related outcomes (i.e. muscle mass or
strength, physical performance, or muscle
synthesis rate) in both clinical and non-clinical
Trials , randomized controlled studies with 20
participants per arm were included (i.e. ageing).
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Introduction
Muscular mass loss with or without a
corresponding reduction in function (i.e.,
physical performance or muscle strength) can
happen due to ageing naturally or as a result of
acute and chronic illnesses. Recent pooled
analyses have shown that low muscle mass and
sarcopenia (i.e., low muscle mass and function)
are prevalent in community-dwelling and
hospitalized older adults and patients with lung
diseases, liver cirrhosis, cancer, and other
diseases. However, the prevalence of these
conditions may vary depending on the diagnostic
criteria used. Patients may also have muscle
loss without changes in body weight or even in
the context of obesity (sarcopenic obesity).
Cachexia is a catabolic disorder that is further
defined by extreme weight loss with or without
loss of fat mass and inflammation brought on by
underlying conditions, with catastrophic effects
on patients. Low muscle mass is one of the
distinguishing criteria of cachexia (1).
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Interventions
Trials were organized according to the kind of
nutrition intervention, dietary guidance, food
supplement, and multimodal therapies are given
to participants in the experimental
arm. According to the classifications provided
by the European Society for Clinical Nutrition
and Metabolism, nutritional treatments were
classified as food supplements, food
modifications, food products, fortified food
products, and oral nutritional supplements (ONS)
(ESPEN). The term "nutritional advise" was
developed to encompass studies that offered
participants dietary guidance from licensed
dietitians/nutritionists or assistance from
healthcare professionals, Medical research
workers , or self-help resources.
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Types of assessed nutrition interventions
Dietary advice Food product Food modification
Fortified food Food supplement Oral nutritional
supplements Specialized oral nutritional
supplements
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Musculoskeletal conditions
In patients with a variety of musculoskeletal
conditions, twelve nutrition trials (10.7) were
found (Figure 1). These patients included those
who have undergone or are about to undergo
orthopaedic surgery, older adults who are
temporarily immobilized while healing from an
acute fracture, and adults with osteoarthritis,
rheumatoid arthritis, low bone mass, or
osteoporosis. In addition, there are 40 to 400
people in the target sample size. In addition, an
overview of nutritional research , treatments
and food supplements stratified by
musculoskeletal diseases is provided by studies
that provide participants with food supplements,
high-protein ONS or ONS supplemented with HMB, or
food modification alone or in conjunction with
dietary guidance.
The critical outcomes of most trials are
performance, or a combination of these.
research methods
of muscle mass, muscular strength, physical
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Figure 1 Characteristics of interventions and
distribution of trials across patients with
obesity and metabolic diseases (2)
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Multiple clinical conditions

• In one experiment (0.9), 320 individuals with
  cancer of any kind, osteoporosis, stroke, or
  chronic renal disease are examined to see how
  dietary recommendations and resistance training
  affect their conditions.
• Muscle mass, physical performance and muscle stren
  gth are the three-month intervention's concurrent
  primary objectives.
• However, it is unknown if the authors intend to
  carry out distinct analyses by illness category.

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Older adults with low muscle mass or function or
sarcopenia
Ten trials (8.9) include 52200 older people
with sarcopenia or reduced muscle mass or
function. Although several studies merged
definitions, sarcopenia is characterized by many
diagnostic criteria, such as those of the Asian
Working Group for Sarcopenia, the European
Working Group on Sarcopenia in Older People
(EWGSOP2), or reduced muscle mass associated
with poor muscular strength (HGS). Most clinical
studies employ a variety of dietary supplements.
Older adults with malnutrition
One trial (0.9) recruited 93 institutionalized
older persons at risk of malnutrition or moderate
malnutrition. Participants get a whey protein at
lunch and a high-carbohydrate meal product at
supper for 90 days. Muscular mass measurements
using DXA are the primary outcome of interest,
while muscle strength measurements using HGS and
lower body strength tests are the secondary
outcomes (using the 6MWT and TUG tests)(3).
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Conclusion
This scoping review identified several current
RCTs investigating the impact of dietary
treatments on muscle mass, muscular function,
sarcopenia, or cachexia in ageing and
illness. More research is to be expected on the
impact of dietary supplements and ONS including
protein, amino acids, omega-3 fatty acids, or
HMB on these disorders. Although many studies
use the same therapies, there was methodological
variation in the research design, supplement
dose, duration of the intervention, and outcome
evaluation, and several trials lacked crucial
data. These problems or restrictions might make
it difficult to compare research, pool data, or
conduct upcoming meta-analyses, limiting the
ability of these ongoing investigations to
generate recommendations supported by the
available evidence. To improve the area, PhD
research offers suggestions for upcoming research
studies on nutrition and multimodal treatments
for cachexia, sarcopenia, and muscular health.
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About PhD Assistance
Many trials have similar interventions
methodological heterogeneity may challenge study
comparisons and future meta-analyses to provide
evidence-based recommendations and assess the
therapeutic effects of nutrition interventions
PhD. Assistance serves as an external mentor to
brainstorm your idea and translate that into a
research model. Finally, we deliver, What We
Promise.
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