蛋白質補充品對衰弱老年人身體組成、肌力與功能之效果：隨機對照試驗之系統性回顧與統合分析

在全世界人口持續老化之背景下，衰弱是個重要的議題，而充足蛋白質攝取是處理衰弱時重要的一部分，因此進行了隨機對照試驗之系統性回顧與統合分析，以研究衰弱或具衰弱危險性老年人攝取蛋白質補充品(protein supplement, PS)對身體組成(體重、肌肉量、體脂肪重)、肌力和身體功能表現之效果。2023年4月於PubMed、Embase、Cochrane CENTRAL、WOS、CINAHL、PEDro進行檢索，經由系統性文獻回顧過程納入18篇隨機對照試驗，其中16篇進行統合分析。結果顯示，在不考慮是否混合其他介入的情況下，PS在體重(MD=1.206)、瘦組織質量(MD=0.666)、四肢瘦組織質量(MD=0.321)之增加皆比安慰劑顯著地多，且受介入療法(intervention regimen)、介入期(intervention duration)、營養介入提供之熱量(isocaloric intervention)、非特意安排且無法分離之其他成分(soft contrast)之影響。然而，在體脂肪、肌力和身體功能的各項指標皆無顯著差異；除了坐站起走(TUG)外，在敏感度分析、次群組分析和統合迴歸分析之結果仍然維持不顯著。此外，不良事件無組間顯著差異。綜上所述，衰弱老年人可能藉PS有效提升體重與肌肉量，此效果可能在搭配運動介入、介入期較長、搭配其他營養素/礦物質，或熱量攝取較高時更好；不過PS對肌力或身體功能表現之效果則需要更多研究才得以進一步了解其中關係。

Frailty is an important issue based on the population ageing around the world, and sufficient protein intake is a key component of frailty management. Hence, a systematic review and meta-analysis of randomized controlled trials was conducted to investigate the effects of protein supplement (PS), compared with placebo, on body composition (i.e. body weight, muscle mass, and body fat), muscle strength, and physical functional performance in older adults with or at risk of frailty.A search was performed on PubMed, Embase, Cochrane CENTRAL, WOS, CINAHL, and PEDro up to April 2023. According to the systematic review process, 18 RCTs were included in this review, and 16 of these were analyzed. PS was more effective than placebo on body weight (BW), lean mass (LM), and appendicular lean mass (ALM/ASMM), with the difference of means (MDs) being 1.206, 0.666 and 0.321, respectively; and these effects were influenced by moderators such as intervention regimen, intervention duration, isocaloric intervention and soft contrast. There were, however, no significant differences on body fat, muscle strength, and physical functional performance; no any result was changed in sensitivity analysis, subgroup analysis or meta-regression in addition to timed up-and-go test (TUG).In conclusion, PS significantly improved body weight and muscle mass for frail elderly, and the effect was greater while PS was concomitant with other intervention (especially resistance training) or longer intervention duration. More studies are still needed to explore the effects on muscle strength or physical functional performance in frail elderly.