High-Protein Supplementation Improves Muscle Mass and Body Weight in Subjects Undergoing Cancer Therapy

by | Jan 2, 2025 | 2024, Cancer, Omega - 3, Proteins, Recent Articles

Written by Taylor Woosley, Science Writer. Findings of a meta-analysis including 37 studies featuring 3701 subjects shows that high-protein omega-3-enriched oral nutritional supplementation led to reduced body weight loss, increased muscle mass, and improved systemic inflammation markers in participants undergoing cancer therapy.

cancerCancer is a major public health and economic problem in the 21st century, with close to 20 million new cases of cancer diagnosed in 20221. The ongoing skeletal muscle loss observed during the treatment and progression of cancer is a common and devastating syndrome known as cancer-induced muscle wasting or cancer cachexia2. Low muscle mass in individuals with cancer has a profound impact on quality of life and is associated with poorer prognosis3.

Research suggests that high protein diets (1-1.5 gram of protein per kilo of body weight per day) appear instrumental in maintaining adequate nutritional status, with suggested protein intake being closer to the upper limit of recommended intake during cancer treatment4. Furthermore, n-3 polyunsaturated fatty acids (PUFAs) may have a direct effect on cancer progression due to their anti-inflammatory properties5. Previous study findings show that oral nutritional supplements containing high protein levels and n-3 PUFAs led to improvements in body weight, muscle mass, and quality of life in patients undergoing chemotherapy6.

Orsso et al. conducted a meta-analysis to assess the efficacy and safety of high-protein supplementation on clinical outcomes of subjects undergoing cancer therapy. Study inclusion consisted of randomized controlled trials comparing high-protein supplementation (≥10 g protein/serving) to placebo, standard of care, or lower dose protein supplements among subjects receiving any type of cancer treatment. High-protein supplementation consisted of food supplements, omega-3-enriched oral nutritional supplements (ONS), or specialized ONS. Studies including tube feeding alone or parenteral nutrition were excluded from the meta-analysis.

Primary study outcomes were body weight (or BMI) and health-related quality of life (HRQoL). Secondary outcomes included muscle and fat masses, muscle function, survival, hospitalization, response to cancer therapy/toxicity, and systemic inflammation.  Risk-of-bias (ROB) for each outcome domain was evaluated by two independent reviewers using the Revised Cochrane ROB tool for randomized trials. Heterogeneity was assessed using I2 statistics.

37 studies were included in the final meta-analysis, featuring 3701 subjects, with publication dates from 1993 to 2023. Median age of participants in the experimental group ranged from 44.1 to 69.1 years, while the control group ranged from 44.4 to 70.6 years. High-protein supplementation used included high-protein ONS, omega-3 ONS, glutamine, ONS containing arginine and omega-3 or omega-6, BCAA, β-hydroxy β-methylbutyrate (HMB) combined with arginine and glutamine, arginine, ONS containing arginine, glutamine, and omega-3, and ONS containing HMB and omega-3. The highest protein administration per supplement serving was 25 g, with 20 studies administering 2 servings daily. Significant findings of the meta-analysis are as follows:

  • Results of 23 RCTs examining body weight show that subjects receiving high-protein supplementation lost less body weight compared to controls, with a pooled MD of 1.45 kg (95% CI: 0.42, 2.48 kg; P=0.006; I2=80%). A significant effect was noted in studies with 3–12-week study durations (MD=0.82 kg; 95% CI: 0.24, 1.40; P=0.006; I2=20%) and for studies that continued beyond 13 weeks (MD=5.21 kg; 95% CI: 4.03, 6.39).
  • 5 RCTs exploring HRQoL reported findings that high-protein supplementation had no significant effect on global health scores (SMD=1.31; 95% CI: -0.50, 3.12; P=0.15; I2=97%) and on the physical functioning domain (SMD=2.26; 95% CI: -1.99, 6.52; P=0.30, I2=99%).
  • In 11 out of 13 (85%) studies on muscle mass show that high-protein supplementation had beneficial effect on muscle mass and skeletal muscle radiodensity compared to controls.
  • In 7 of 16 (44%) studies including survival outcomes, high-protein supplementation demonstrated a beneficial effect on survival outcomes, including overall survival, progression-free survival, and survival rates compared with controls at follow-up.
  • 11 out of 19 (58%) RCTs show a beneficial effect of high-protein supplementation on systemic inflammation compared to controls, despite variations in cancer types, disease stages, nutritional statuses, and treatment modalities.

Results of the meta-analysis suggest that high-protein supplementation led to less body weight loss, improved muscle mass and reduced systemic inflammation. Further RCTs focused on the efficacy of high-protein supplementation for subjects undergoing cancer treatment are necessary to better comprehend findings. Study limitations include the inclusion of supplements containing additional nutrients or ingredients alongside protein and the lack of additional higher-quality studies addressing HRQoL and secondary outcomes.

Source: Orsso, Camila E., Anne Caretero, Taiara Scopel Poltronieri, Jann Arends, Marian AE de van der Schueren, Nicole Kiss, Alessandro Laviano, and Carla M. Prado. “Effects of high-protein supplementation during cancer therapy: a systematic review and meta-analysis.” The American Journal of Clinical Nutrition 120, no. 6 (2024): 1311-1324.

© 2024 The Author(s). Published by Elsevier Inc. on behalf of American Society for Nutrition. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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Posted January 2, 2025.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

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  2. Mavropalias G, Sim M, Taaffe DR, et al. Exercise medicine for cancer cachexia: targeted exercise to counteract mechanisms and treatment side effects. J Cancer Res Clin Oncol. Jun 2022;148(6):1389-1406. doi:10.1007/s00432-022-03927-0
  3. Fairman CM, Kendall KL, Hart NH, Taaffe DR, Galvão DA, Newton RU. The potential therapeutic effects of creatine supplementation on body composition and muscle function in cancer. Crit Rev Oncol Hematol. Jan 2019;133:46-57. doi:10.1016/j.critrevonc.2018.11.003
  4. Laviano A. High protein diet in digestive cancers. Curr Opin Clin Nutr Metab Care. Sep 1 2022;25(5):348-353. doi:10.1097/mco.0000000000000857
  5. Guo Y, Ma B, Li X, et al. n-3 PUFA can reduce IL-6 and TNF levels in patients with cancer. Br J Nutr. Jan 14 2023;129(1):54-65. doi:10.1017/s0007114522000575
  6. de van der Schueren MAE, Laviano A, Blanchard H, Jourdan M, Arends J, Baracos VE. Systematic review and meta-analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials. Annals of oncology : official journal of the European Society for Medical Oncology. May 1 2018;29(5):1141-1153. doi:10.1093/annonc/mdy114

 

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