Preliminary clinical study on the synergistic effects of prebiotics and β-hydroxy-β-methylbutyrate in improving muscle function and intestinal barrier function in elderly patients with sarcopenia.

Skeletal muscle mass index and grip strength improved significantly in Groups A (HMB alone) and B (HMB + fructooligosaccharides) after 30 days of intervention.

• 78 elderly sarcopenic patients were randomized to Group A (n=32, standard diet + HMB), Group B (n=31, standard diet + HMB + fructooligosaccharides), or Group C (n=15, standard diet alone) for 30 days.
• Skeletal muscle mass index and grip strength improvements were statistically significant in Groups A and B (P < 0.05).
• Grip strength was significantly higher in Group B compared to Group C after intervention (adj. P = 0.017).
• Baseline indicators did not differ among groups (P > 0.05), supporting comparability of groups.

Calf circumference decreased in all three groups after intervention, with the greatest decrease observed in Group C (standard diet alone).

• Calf circumference decreased significantly in all groups (P < 0.05).
• Group C showed the most pronounced decrease in calf circumference (t = 4.461, P = 0.001).
• This suggests that HMB supplementation (Groups A and B) may have attenuated muscle loss as reflected by calf circumference compared to standard diet alone.

Group B (HMB + fructooligosaccharides) exhibited significantly lower intestinal barrier permeability markers compared to Groups A and C.

• Group B showed lower serum diamine oxidase, D-lactic acid, and endotoxin levels than both Groups A and C after intervention (P < 0.05).
• Diamine oxidase, D-lactic acid, and endotoxin are markers of intestinal barrier integrity.
• These findings suggest that adding prebiotics (fructooligosaccharides) to HMB provides additional benefit for intestinal barrier repair beyond HMB alone.

Group B showed the greatest reductions in inflammatory markers CRP, neutrophil/lymphocyte ratio (NLR), and systemic immune inflammation index (SII).

• Group B (HMB + fructooligosaccharides) demonstrated the greatest reductions in CRP, NLR, and SII compared to the other groups (P < 0.001).
• These markers reflect systemic inflammation, suggesting a synergistic anti-inflammatory effect of combining prebiotics with HMB.
• Group C (standard diet alone) and Group A (HMB alone) did not achieve equivalent reductions in these inflammatory markers.

Albumin and prealbumin levels showed no significant changes across any group after the 30-day intervention.

• Neither albumin nor prealbumin changed significantly in any of the three groups (P > 0.05).
• These nutritional markers were measured as secondary outcomes alongside muscle function and intestinal barrier markers.
• The 30-day intervention duration may have been insufficient to produce detectable changes in these slower-responding nutritional biomarkers.

The study recruited elderly sarcopenic patients from two institutions over a two-year period and used a randomized controlled trial design.

• Participants were recruited from Tongji University Affiliated Tenth People's Hospital and Baoshan District Geriatric Care Hospital from January 2023 to January 2025.
• 78 patients were randomly assigned to three groups: Group A (n=32), Group B (n=31), and Group C (n=15).
• The intervention duration was 30 days.
• Outcomes measured included skeletal muscle mass index, grip strength, calf circumference, serum diamine oxidase, D-lactic acid, endotoxin, CRP, NLR, SII, albumin, and prealbumin.