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Nutrients
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Addressing Muscle Mass and Strength Loss: Nutritional Insights and Strategies
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Addressing Muscle Mass and Strength Loss: Nutritional Insights and Strategies

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: 5 April 2026 | Viewed by 14325

Special Issue Editor

Prof. Dr. Paula Schmidt Azevedo

E-Mail Website
Guest Editor
Department of Internal Medicine, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, Brazil
Interests: malnutrition; nutrition risk assessment; in-hospital patient care; sarcopenia; cachexia
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Hospitalization can reduce muscle mass and function, compromising functional capacity and recovery, especially in older people. Individuals who are bedridden due to situations such as stroke, hip fracture, cancer, trauma, critical illness, or any other injury that leads to hospital admission can develop an inflammatory process that can lead to reduced appetite, immobility in bed, insulin resistance, and other conditions that further leads to the poor nutritional status and muscle decline. In these cases, the loss of muscle mass is closely involved with reduced functional capacity, increased length of hospital stays, and mortality. In addition, outpatients who suffer from chronic disease, such as osteoporosis, heart failure, cirrhosis, COPD, and rheumatoid arthritis, are also at risk for muscle mass and functional decline.

Studies involving supplementation with specific or combined nutrients and physical exercise are being conducted to find ways to mitigate this loss and avoid its complications. Furthermore, research into serum biomarkers of inflammation, muscle degradation, and synthesis is promising in understanding the mechanisms involved in this muscle loss so that more specific and efficient strategies can be applied to hospitalized or outpatient individuals, both for exacerbated chronic diseases and acute diseases and events. However, there are already gaps in how to effectively reduce the burden of nutritional conditions during in-hospital stays or throughout chronic disease. This Special Issue aims to publish research that provides insights and strategies for mitigating muscle mass and strength loss during hospitalization or during the treatment of chronic diseases. Your contributions to this Special Issue are greatly appreciated.

Prof. Dr. Paula Schmidt Azevedo
Guest Editor

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Keywords

  • in-hospital patient care
  • diet
  • malnutrition
  • nutritional supplements
  • frailty
  • lifestyle interventions
  • physical activity
  • muscle loss
  • muscle mass

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Published Papers (5 papers)

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Research

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16 pages, 1587 KB  
Article
Bioconversion-Based Postbiotics Enhance Muscle Strength and Modulate Gut Microbiota in Healthy Individuals: A Randomized, Double-Blind, Placebo-Controlled Trial
by Seung Hyeon Jung, Subin Hwang, Kun-Ho Seo, Yongsoon Park, Mi Jung Kim and Hyunsook Kim
Nutrients 2025, 17(24), 3937; https://doi.org/10.3390/nu17243937 - 17 Dec 2025
Viewed by 185
Abstract
Background: Postbiotics produced by kefir lactic acid bacteria through bioconversion of polyphenol-rich extract and whey protein are emerging as promising modulators of gut microbiota and muscle health. This study investigated whether Lentilactobacillus kefiri DH5-derived postbiotics, prepared with Cucumis melo L. and whey protein [...] Read more.
Background: Postbiotics produced by kefir lactic acid bacteria through bioconversion of polyphenol-rich extract and whey protein are emerging as promising modulators of gut microbiota and muscle health. This study investigated whether Lentilactobacillus kefiri DH5-derived postbiotics, prepared with Cucumis melo L. and whey protein (KP, Kefir lactic acid bacteria-derived postbiotics), improve muscle strength and gut microbiota composition in healthy adults. Methods: In this 12-week, randomized, double-blind, placebo-controlled trial, participants consumed either KP (6 g/day) or placebo. Handgrip strength, circulating biomarkers, and fecal microbiota profiling (using 16S rRNA sequencing) were analyzed. Correlations between microbial taxa and muscle-related biomarkers were assessed. Results: KP supplementation significantly increased dominant-hand grip strength and plasma irisin and reduced IL-1β concentrations after 12 weeks, whereas IGF-1, lean mass, and non-dominant grip strength showed no significant changes. Gut microbiota profiling revealed enrichment of Bifidobacterium adolescentis, Latilactobacillus sakei, Lentihominibacter hominis, Mediterraneibacter gnavus, Streptococcus anginosus and Phocaeicola plebeius, with concomitant reductions in Lachnospira eligens, Roseburia inulinivorans, Ruthenibacterium lactatiformans and Vescimonas fastidiosa. Notably, relative abundance of Faecalibacterium prausnitzii was positively correlated with plasma irisin concentration. Conclusions: KP supplementation produced a modest within-group improvement in grip strength, potentially through gut–muscle axis modulation involving irisin and anti-inflammation pathways. These preliminary findings suggest that kefir-derived postbiotics may have potential relevance for muscle health. Full article
(This article belongs to the Special Issue Addressing Muscle Mass and Strength Loss: Nutritional Insights and Strategies)
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15 pages, 2886 KB  
Article
Influence of CReatine Supplementation on mUScle Mass and Strength After Stroke (ICaRUS Stroke Trial): A Randomized Controlled Trial
by Juli T. Souza, Marcos F. Minicucci, Natália C. Ferreira, Bertha F. Polegato, Marina P. Okoshi, Gabriel P. Modolo, Filipe W. Leal-Pereira, Bethan E. Phillips, Philip J. Atherton, Kenneth Smith, Daniel J. Wilkinson, Adam L. Gordon, Suzana E. Tanni, Vladimir E. Costa, Maria F. Fernandes, Silméia G. Bazan, Leonardo M. Zornoff, Sérgio R. Paiva, Rodrigo Bazan and Paula S. Azevedo
Nutrients 2024, 16(23), 4148; https://doi.org/10.3390/nu16234148 - 29 Nov 2024
Cited by 2 | Viewed by 7193
Abstract
Background/Objectives: The acute phase of stroke is marked by inflammation and mobility changes that can compromise nutritional status. This study was a randomized, double-blind, placebo-controlled trial evaluating the effectiveness of creatine supplementation for older people during seven days of hospitalization for stroke compared [...] Read more.
Background/Objectives: The acute phase of stroke is marked by inflammation and mobility changes that can compromise nutritional status. This study was a randomized, double-blind, placebo-controlled trial evaluating the effectiveness of creatine supplementation for older people during seven days of hospitalization for stroke compared to usual care. Method: The primary outcome measures were changes in functional capacity, strength, muscle mass, and muscle degradation. The secondary outcomes were changes in serum biomarkers related to inflammation, fibrosis, anabolism, and muscle synthesis. In addition, a follow-up 90 days after the stroke verified functional capacity, strength, quality of life, and mortality. Following admission for an acute stroke, participants received either creatine (10 g) or a visually identical placebo (10 g) orally twice daily. Both groups received supplementation with protein to achieve the goal of 1.5 g of protein/kg of body weight/day and underwent daily mobility training during seven days of hospitalization. Results: Thirty older people were included in two similar groups concerning baseline attributes (15—treatment/15—placebo). Conclusions: Creatine supplementation did not influence functional capacity, strength, or muscle mass during the first 7 days or outcomes 90 days after stroke. There were no serious adverse events associated with creatine supplementation. However, it decreased progranulin levels, raising a new possibility of creatine action. This finding needs further exploration to understand the biological significance of creatine–progranulin interaction. Full article
(This article belongs to the Special Issue Addressing Muscle Mass and Strength Loss: Nutritional Insights and Strategies)
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Review

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23 pages, 2886 KB  
Review
Assessment of Sarcopenia in Patients with Liver Cirrhosis—A Literature Review
by Dorotea Bozic, Bisera Mamic, Iva Peric, Ivona Bozic, Ivan Zaja, Tomislav Ivanovic, Ana Gugic Ratkovic and Ivica Grgurevic
Nutrients 2025, 17(16), 2589; https://doi.org/10.3390/nu17162589 - 9 Aug 2025
Cited by 4 | Viewed by 2842
Abstract
Sarcopenia refers to a disorder involving the gradual and overall reduction in skeletal muscle mass and physical capability. It occurs in over one-third of individuals with liver cirrhosis and serves as an independent predictor of increased mortality risk. Assessment of sarcopenia is necessary [...] Read more.
Sarcopenia refers to a disorder involving the gradual and overall reduction in skeletal muscle mass and physical capability. It occurs in over one-third of individuals with liver cirrhosis and serves as an independent predictor of increased mortality risk. Assessment of sarcopenia is necessary in all patients with liver cirrhosis, as recommended by the European Association for the Study of the Liver (EASL) and the European Society for Clinical Nutrition and Metabolism (ESPEN). The evaluation of muscle mass can be performed using several validated methods such as the multislice computed tomography (MSCT), abdominal magnetic resonance imaging (MRI), dual X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), or muscle ultrasound. Assessment of muscle function encompasses measurements of both muscle strength and physical performance. Sarcopenia has a significant negative impact on the course of the disease, quality of life and outcomes of patients with liver cirrhosis. Considering the global healthcare impact and the significant influence on the course of disease, characteristics of simplicity, swiftness, safety, availability, reproducibility, and diagnostic accuracy are certainly the key factors to consider when choosing the proper diagnostic method for nutritional assessment. The aim of this review is to analyze the pathophysiological mechanisms underlying muscle mass loss in patients with liver cirrhosis, as well as to assess strengths and limitations of the methods currently in use to diagnose sarcopenia. Full article
(This article belongs to the Special Issue Addressing Muscle Mass and Strength Loss: Nutritional Insights and Strategies)
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Other

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12 pages, 826 KB  
Brief Report
The Effect of Routine High-Soy-Protein Soymilk Intake on the Skeletal Muscle Index (SMI) in Japanese Pre-Frail Elderly Individuals with an Ordinary Life: A Post Hoc Analysis of a Randomized Controlled Trial
by Daigo Sakamoto, Yuji Terashima, Makoto Sugawara, Ryoichi Unno, Tomoyuki Watanabe, Tomoko Uno and Mitsuo Maruyama
Nutrients 2025, 17(24), 3900; https://doi.org/10.3390/nu17243900 - 13 Dec 2025
Viewed by 449
Abstract
Background/Objectives: The primary outcome of a 12-week randomized controlled trial studying the effects of continuous high-soy-protein (HSP) soymilk consumption in Japanese frail and pre-frail elderly individuals has previously been reported. The authors of this post hoc study aimed to conduct a statistical analysis [...] Read more.
Background/Objectives: The primary outcome of a 12-week randomized controlled trial studying the effects of continuous high-soy-protein (HSP) soymilk consumption in Japanese frail and pre-frail elderly individuals has previously been reported. The authors of this post hoc study aimed to conduct a statistical analysis focusing on changes in the skeletal muscle index (SMI) and evaluate the effect of HSP soymilk intake on appendicular skeletal muscle mass (ASM). Methods: A full analysis of all subjects (n = 68, HSP group: n = 34, control group: n = 34) and a subgroup analysis of only pre-frail elderly individuals (n = 58, HSP group: n = 29, control group: n = 29) were performed. The following nine subgroup analyses were conducted: frailty phenotype, basal metabolic rate, walking speed, step counts, total energy expenditure (TEE), total energy intake (TEI), estimated protein intake, age, and sex. Results: In the overall analysis (primary combined cohort), the SMI showed no significant change between the HSP and control soymilk groups (p = 0.18); however, a significant difference in the change in the SMI between the HSP and control groups was revealed for pre-frail elderly subjects (mean difference in SMI change: 0.08 kg/m2 [95% CI 0.004, 0.15], p = 0.044). Furthermore, in four distinct subgroups restricted to the pre-frail elderly individuals—step counts (≥5000 steps/day), TEE (≥30 kcal/kg BW/day), TEI (≥30 kcal/kg BW/day), and male sex—the HSP group also showed significant differences in SMI change. Conclusions: In this study, no significant improvement in the SMI was observed across all subjects (frail and pre-frail elderly individuals); however, an exploratory subgroup analysis suggested that continued daily HSP soymilk intake was associated with potential benefits in pre-frail elderly individuals with high physical activity and energy intake levels. These findings are preliminary and require further research. Full article
(This article belongs to the Special Issue Addressing Muscle Mass and Strength Loss: Nutritional Insights and Strategies)
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15 pages, 983 KB  
Systematic Review
The Effects of Protein Nutrition on Muscle Function in Critical Illness: A Systematic Review and Meta-Analysis
by Mohamed A. Mohamed, Brett Doleman, Bethan E. Phillips and John P Williams
Nutrients 2025, 17(16), 2613; https://doi.org/10.3390/nu17162613 - 12 Aug 2025
Cited by 1 | Viewed by 2993
Abstract
Background: owing to altered protein metabolism during critical illness, skeletal muscles are utilised as a source of protein, with subsequent debilitating effects on both muscle structure and function. Protein nutrition has been shown to improve clinical outcomes in critically unwell patients; however, the [...] Read more.
Background: owing to altered protein metabolism during critical illness, skeletal muscles are utilised as a source of protein, with subsequent debilitating effects on both muscle structure and function. Protein nutrition has been shown to improve clinical outcomes in critically unwell patients; however, the impact on muscle function is less established. Therefore, the aim of this review was to systematically determine the effect of protein dose on skeletal muscle strength in critically ill patients. Methods: we searched five databases (Ovid MEDLINE, Embase, Emcare, CINAHL, and PubMed) and clinical trial registers for randomised controlled trials (RCTs) of non-pregnant, adult patients admitted to an intensive care unit (ICU), which assessed the impact of different doses of protein nutrition on muscle strength. Studies investigating only muscle structure or with co-interventions were excluded. Six RCTs were eligible for inclusion, and five were suitable for meta-analysis. Results: there was a significant difference in skeletal muscle strength with higher versus lower protein intakes, with a mean difference of 2.36 kg (95% CI: 0.37–4.35). The mean difference in protein dose was 0.46 g/kg/d (95% CI: 0.29–0.64). Inconsistency was evident across the included studies, with risk of bias ranging from moderate to high. Conclusion: muscle strength of ICU patients does appear to be affected by different protein doses. However, trials focusing on muscle function are limited by number and quality, highlighting a clear need for future work. Full article
(This article belongs to the Special Issue Addressing Muscle Mass and Strength Loss: Nutritional Insights and Strategies)
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