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NUTRITIONAL SUPPLEMENTATION AND MUSCLE MASS PRESERVATION IN ADULTS DURING BED REST: A SYSTEMATIC REVIEW TO INFORM CLINICAL PRACTICE

R. Jamieson, J. Porter

J Aging Res Clin Practice 2013;2(4):355-362

Background: Nutritional intervention is assumed to protect muscle mass in patients at bed rest. This review found no high quality studies performed in the clinical setting, with evidence limited to the effect of nutritional supplementation on lean muscle mass and functional outcomes. Objectives: This systematic review investigates whether nutritional intervention, in the absence of other countermeasures, is effective in preserving muscle mass during periods of bed rest. It considers relevant studies within a clinical context and critiques the nutritional methodologies used. Evidence review: Studies were identified by electronically searching MEDLINE, CINAHL, EMBASE and PubMed from the earliest available to September 2012, as well as a citation review of relevant papers. Included studies had at least one group receiving oral nutritional supplementation or a higher protein diet during bed rest in comparison to a control group not receiving nutrition intervention. Nutritional methodologies were investigated using a standardised protocol, and a meta-analysis was conducted. Findings: The initial search yielded 310 studies with six of these meeting inclusion criteria for the review. Methodological issues included an absence of detailed recruitment strategies, participants who were mostly young healthy males, and space flight as the primary study context. This limited the ability to extrapolate results to the clinical setting of older hospitalised patients at bed rest. A meta-analysis indicated that nutritional supplementation did not improve lean leg mass during bed rest. Conclusion: High level evidence to support the use of nutritional supplementation in protecting muscle mass during bed rest is lacking, especially in elderly patients under clinical situations. Translational trials are needed to direct clinical practice for healthcare providers.

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