Efficacy of protein supplementation on frailty improvement, muscle strength, and physical performance among pre-frail older adults in Selangor, Malaysia

There will likely be 2 billion people over the age of 65 in the globe by 2050, which will have a significant impact on how health and social care are planned for and provided. Pre-frail people are more vulnerable to increasing frailty, hospitalization, falls, deteriorating disability, and mortality than robust adults, even though they are less vulnerable than frail older people. The efficacy of protein supplement (PS) in improving muscle strength, physical performance, and body composition in older adults has been widely promoted. However, the results of randomized clinical trials in this regard have been inconsistent, and a limited number of studies targeted pre-frailty status. Hence, the objective of the study was to evaluate the impact of protein supplements (PS) on older people's pre-frailty status, muscle strength, physical performance, and dietary intake. This trial's primary outcomes were frailty status and its phenotypes. Secondary outcomes included handgrip strength, physical performance, body composition, and nutritional intake. This study was 12 week-double-blinded, randomized, parallel, placebo-controlled clinical trial with a sample of 40 pre-frail older adults aged 60 years and above, divided into the interventional group: participants received 30 g of whey protein isolate and the placebo (maltodextrin) group. Assessments were conducted at baseline (week 0), middle (6th week), and at the end of the trial (12th week) and included a Frailty screen, handgrip strength, the Short Physical Performance Battery test (SPPB), and a 3-day dietary record to get the macronutrient change during the trial. The data were analyzed using the Chi-square test, Independent t-test, Cochran’s Q test, Mann-Whitney test, and repeated measures ANOVA using SPSS version 26, with significance determined if the p-value was less than 0.05. In the Protein Supplementation Group (PSG), a noteworthy decrease was observed in the number of pre-frail individuals with a score of 2, declining from 70% (n=14) to 15% (n=3) by week 12. However, these changes did not reach statistical significance between the groups. Muscle weakness and low activity were prevalent among participants, with PSG showing some -but not significant- improvement. Specifically, muscle weakness decreased from 40% (n=8) to 20% (n=4), and low activity decreased from 95% (n=19) to 30% (n=6) from baseline to week 12, although these changes were not statistically significant. Furthermore, significant time effects were observed for handgrip strength (HGS), indicating promising enhancements (p = 0.043), along with a notable trend towards a positive time*group interaction (p = 0.095). Moreover, protein intake demonstrated significant differences in time*group interaction within the interventional group, reflecting positive dietary changes (p < 0.001) by the end of the trial. Physical performance tests and body composition did not show significant differences between groups. The study revealed that whey protein supplementation did not produce significant changes in frailty status or physical performance among pre-frail older adults compared to the control group. However, promising improvements were noted in frailty phenotypes and handgrip strength, suggesting that longer intervention periods and larger sample sizes may yield more noticeable results. The study also highlights the critical role of participants' nutritional status and consistent protein intake in determining the efficacy of such interventions. Despite the lack of statistically significant effects, the comprehensive nature of this study contributes valuable insights to the existing literature, emphasizing the necessity for further exploration of individual responses and considerations of timing and dosage in nutritional interventions for older adults.

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