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.

OBJECTIVE

To investigate the effects of prebiotics combined with β-hydroxy-β-methylbutyrate (HMB) on muscle function, intestinal barrier integrity, and inflammation in elderly patients with sarcopenia.

METHODS

A randomized controlled trial was conducted on 78 elderly sarcopenic patients recruited from Tongji University Affiliated Tenth People's Hospital and Baoshan District Geriatric Care Hospital (Jan 2023 - Jan 2025). Participants were randomly assigned Group A (n = 32, standard diet + HMB-supplement), Group B (n = 31, standard diet + HMB + fructooligosaccharides), or Group C (n = 15, standard diet alone) for 30 days. Outcomes included muscle function (skeletal muscle mass index, grip strength, calf circumference), intestinal barrier markers (serum diamine oxidase, D-lactic acid, endotoxin), and inflammatory and nutritional markers (CRP, neutrophil/lymphocyte ratio, systemic immune inflammation index, albumin, prealbumin).

RESULTS

Baseline indicators did not differ among groups (P > 0.05). After intervention, skeletal muscle mass index and grip strength improved significantly in Groups A and B (P < 0.05), with higher grip strengths to Group B than C (adj. P = 0.017). Calf circumference decreased in all groups (P < 0.05), most in Group C (t = 4.461, P = 0.001). Group B exhibited lower diamine oxidase, D-lactic acid, and endotoxin levels than Groups A and C (P < 0.05) and the greatest reductions in CRP, NLR, and SII (P < 0.001). Albumin or prealbumin showed no significant changes (P > 0.05).

CONCLUSION

HMB improves muscle function in sarcopenic elderly, prebiotics combined with HMB further enhance intestinal barrier repair and reduce inflammation, offering a promising gut-muscle-targeted nutritional strategy.