Gu Wen-Tao, Zhang Lu-Wen, Wu Fu-Hua, Wang Shuo
Research Institute of Public Health, School of Medicine, Nankai University, Tianjin, China; Tianjin Key Laboratory of Food Science and Health, Key Laboratory of Special Diet Nutrition and Health Research, China National Light Industry, School of Medicine, Nankai University, Tianjin, China.
Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China.
Maturitas. 2025 Apr;195:108219. doi: 10.1016/j.maturitas.2025.108219. Epub 2025 Feb 20.
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.
Systematic review and meta-analysis.
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).
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).
Overall, although limited and requiring interpretation with utmost caution, current evidence indicates that HMB supplementation is beneficial for improving muscle mass and strength, but there is no evidence of a benefit on physical performance in patients with sarcopenia. In future, more well-designed HMB intervention trials should be conducted that include populations diagnosed with sarcopenia according to well-accepted clinical consensus.
进行一项系统评价和荟萃分析，以检验补充β-羟基-β-甲基丁酸（HMB）对肌少症患者影响的证据基础。
系统评价和荟萃分析。
通过PubMed、MEDLINE、科学网、EMBASE、CINAHL、Scopus、万方、知网和维普数据库检索文献，检索截止至2024年2月23日。纳入标准为：随机对照试验（RCT）；根据公认的临床共识诊断为肌少症的患者；以HMB作为干预措施；关于肌肉质量和/或肌肉力量和/或身体表现的结果。数据提取由独立的评审员对完成。对提取的数据进行连续结果的荟萃分析。使用治疗组和对照组之间的标准平均差（SMD）及95%置信区间（CI）来表达每项研究中HMB的干预效果估计值。根据Cochrane随机试验偏倚风险评估工具第2版（ROB 2）评估偏倚风险。
在检索和筛选的196条记录中，5项RCT符合定性和定量分析的纳入标准，分别有154、359和359名参与者纳入肌肉质量、肌肉力量和身体表现分析。对于总体偏倚风险，根据ROB 2，没有研究被评为“高偏倚风险”，1项（20.0%）为“有些担忧”，4项（80.0%）为“低偏倚风险”。总体荟萃分析显示，补充HMB对肌肉质量和力量有有益影响，表现为骨骼肌质量指数较高（SMD = 0.32；95% CI：[0.00, 0.64]；Z值 = 1.98；P = 0.048），与对照组相比，HMB干预组的握力也有所提高（SMD = 0.65；95% CI：[0.05, 1.25]；Z值 = 2.12；P = 0.034）。然而，没有证据表明补充HMB对通过步速评估的身体表现有有益影响（SMD = 0.19；95% CI：[-0.14, 0.53]；Z值 = 1.14；P = 0.255）。
总体而言，尽管现有证据有限且需要极其谨慎地解读，但目前的证据表明，补充HMB有利于改善肌肉质量和力量，但没有证据表明对肌少症患者的身体表现有有益影响。未来，应开展更多设计良好的HMB干预试验，纳入根据公认临床共识诊断为肌少症的人群。
