[Observation of the impact of nutritional support with beta-hydroxy-beta-methylbutyrate on lean mass parameters of body composition in patients with obesity, type 2 diabetes mellitus and metabolically associated fatty liver disease].
Fraenkel E, Koky T, Lazúrová I • Orvosi hetilap • 2026
Taking HMB-containing dietary supplements led to an increase or maintenance of muscle mass in a significant portion of patients; however, the changes in muscle mass did not reach the level of statistical significance, with higher age and higher triglyceride levels having a negative impact.
Key Findings
Results
After 6 months of HMB-containing dietary supplement treatment, 28 of 48 patients showed an increase in muscle mass while 20 showed a slight decrease.
Of the 28 patients with muscle mass increase: 16 had an increase up to 5% of original muscle mass, 8 had an increase above 5%, and 4 had an increase exceeding 10%
All 20 patients who showed a decrease had a reduction within 5% of their original muscle mass
Overall changes in muscle mass did not reach the level of statistical significance
Individual responses to the intervention varied considerably
Results
C-peptide and alkaline phosphatase showed significant positive linear relationships with the degree of muscle mass increase.
C-peptide showed a significant positive correlation with muscle mass change (r = 0.42, p = 0.03)
Alkaline phosphatase showed a significant positive correlation with muscle mass change (r = 0.51, p = 0.01)
These correlations were identified using simple linear regression analysis
No significant relationship was found between muscle mass change and any body composition parameter
Results
Age and triglyceride levels showed significant negative linear relationships with the degree of muscle mass increase.
Age showed a significant negative correlation with muscle mass change (r = -0.39, p = 0.05)
Triglycerides showed a significant negative correlation with muscle mass change (r = -0.41, p = 0.04)
These negative relationships indicate that older patients and those with higher triglycerides had less muscle mass increase with HMB supplementation
Results
Logistic regression identified age as a negative predictor and triglycerides as a borderline negative predictor of muscle mass change.
Age appeared as a negative predictor (OR = 0.87, CI: 0.77-0.99, p = 0.04)
Triglycerides appeared as a borderline negative predictor (OR = 0.21, CI: 0.04-1.03, p = 0.05)
No body composition parameters were identified as significant predictors
Methods
The study enrolled 48 patients with type 2 diabetes, sarcopenic obesity, and MASLD with specific baseline metabolic and body composition parameters.
Patients aged 55-84 years, average age 72.48 ± 8.26 years; 40 female and 8 male
A control group of 20 persons of similar age without diabetes or MASLD was included; liver steatosis was confirmed using transient elastography
Conclusions
The study concluded that its results regarding HMB supplementation effectiveness can be considered negative due to lack of statistically significant muscle mass changes.
The authors state: 'in this regard, the conclusion of the study can be considered as negative'
Interpretation is limited by the small number of participants (n=48) and the cross-sectional nature of the study
The authors call for larger prospective studies to confirm these results
The cross-sectional design limits causal interpretation of findings
What This Means
This research suggests that a diabetes-specific nutritional supplement containing beta-hydroxy-beta-methylbutyrate (HMB) — a compound thought to help build and preserve muscle — had mixed results in elderly patients with type 2 diabetes, obesity-related muscle loss (sarcopenic obesity), and fatty liver disease (MASLD). After six months of supplementation, just over half of the 48 patients (28 out of 48) showed some increase in muscle mass, while the remaining 20 showed a small decrease. However, the overall changes were not large enough to be considered statistically significant, meaning the results could have occurred by chance. Notably, patients who were older or had higher blood triglyceride (fat) levels tended to benefit less from the supplement, while those with higher C-peptide levels (a marker of insulin production) and higher alkaline phosphatase levels showed greater muscle gains.
This research suggests that the response to HMB supplementation is highly individual and may depend on a person's age and metabolic profile. Older age and elevated triglycerides emerged as factors that negatively predicted response to the supplement, while retained insulin-producing capacity (reflected by C-peptide) was associated with better outcomes. These findings could help clinicians identify which patients are more or less likely to benefit from HMB supplementation, though the authors caution that the study's small size (48 patients) and cross-sectional design limit the strength of these conclusions.
The practical takeaway from this research is that HMB-containing supplements may help some people with diabetes and fatty liver disease maintain or modestly increase muscle mass, but they do not appear to produce dramatic, uniform benefits across all patients. The authors call for larger, prospective studies to better understand who benefits most from this type of nutritional intervention and why individual responses vary so widely.
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Fraenkel E, Koky T, Lazúrová I. (2026). [Observation of the impact of nutritional support with beta-hydroxy-beta-methylbutyrate on lean mass parameters of body composition in patients with obesity, type 2 diabetes mellitus and metabolically associated fatty liver disease].. Orvosi hetilap. https://doi.org/10.1556/650.2026.33671