ArticlePDF Available

Collagen peptide supplementation in combination with resistance training improves body composition and increases muscle strength in elderly sarcopenic men: A randomised controlled trial

Authors:
  • Collagen Research Institute

Abstract and Figures

Protein supplementation in combination with resistance training may increase muscle mass and muscle strength in elderly subjects. The objective of this study was to assess the influence of post-exercise protein supplementation with collagen peptides v. placebo on muscle mass and muscle function following resistance training in elderly subjects with sarcopenia. A total of fifty-three male subjects (72·2 (sd 4·68) years) with sarcopenia (class I or II) completed this randomised double-blind placebo-controlled study. All the participants underwent a 12-week guided resistance training programme (three sessions per week) and were supplemented with either collagen peptides (treatment group (TG)) (15 g/d) or silica as placebo (placebo group (PG)). Fat-free mass (FFM), fat mass (FM) and bone mass (BM) were measured before and after the intervention using dual-energy X-ray absorptiometry. Isokinetic quadriceps strength (IQS) of the right leg was determined and sensory motor control (SMC) was investigated by a standardised one-leg stabilisation test. Following the training programme, all the subjects showed significantly higher (P<0·01) levels for FFM, BM, IQS and SMC with significantly lower (P<0·01) levels for FM. The effect was significantly more pronounced in subjects receiving collagen peptides: FFM (TG +4·2 (sd 2·31) kg/PG +2·9 (sd 1·84) kg; P<0·05); IQS (TG +16·5 (sd 12·9) Nm/PG +7·3 (sd 13·2) Nm; P<0·05); and FM (TG -5·4 (sd 3·17) kg/PG -3·5 (sd 2·16) kg; P<0·05). Our data demonstrate that compared with placebo, collagen peptide supplementation in combination with resistance training further improved body composition by increasing FFM, muscle strength and the loss in FM.
Content may be subject to copyright.
Collagen peptide supplementation in combination with resistance training
improves body composition and increases muscle strength in elderly
sarcopenic men: a randomised controlled trial
Denise Zdzieblik
1
, Steffen Oesser
2
, Manfred W. Baumstark
3
, Albert Gollhofer
1
and Daniel König
1,3
*
1
Department for Nutrition, Institute for Sports and Sports Science, University of Freiburg, Freiburg 79117, Germany
2
CRI, Collagen Research Institute GmbH, Kiel 24118, Germany
3
Department of Rehabilitation, Prevention and Sports Medicine, Centre for Internal Medicine, University Hospital Freiburg,
79106 Freiburg, Germany
(Submitted 22 February 2015 Final revision received 22 June 2015 Accepted 29 June 2015)
Abstract
Protein supplementation in combination with resistance training may increase muscle mass and muscle strength in elderly subjects. The
objective of this study was to assess the inuence of post-exercise protein supplementation with collagen peptides v. placebo on muscle mass
and muscle function following resistance training in elderly subjects with sarcopenia. A total of fty-three male subjects (72·2(
SD 4·68) years)
with sarcopenia (class I or II) completed this randomised double-blind placebo-controlled study. All the participants underwent a 12-week
guided resistance training programme (three sessions per week) and were supplemented with either collagen peptides (treatment group (TG))
(15 g/d) or silica as placebo (placebo group (PG)). Fat-free mass (FFM), fat mass (FM) and bone mass (BM) were measured before and after
the intervention using dual-energy X-ray absorptiometry. Isokinetic quadriceps strength (IQS) of the right leg was determined and sensory
motor control (SMC) was investigated by a standardised one-leg stabilisation test. Following the training programme, all the subjects showed
signicantly higher (P<0·01) levels for FFM, BM, IQS and SMC with signicantly lower (P<0·01) levels for FM. The effect was signicantly
more pronounced in subjects receiving collagen peptides: FFM (TG +4·2(
SD 2·31) kg/PG +2·9(SD 1·84) kg; P<0·05); IQS (TG +16·5
(SD 12·9) Nm/PG +7·3(SD 13·2) Nm; P<0·05); and FM (TG 5·4(SD 3·17) kg/PG 3·5(SD 2·16) kg; P<0·05). Our data demonstrate that
compared with placebo, collagen peptide supplementation in combination with resistance training further improved body composition by
increasing FFM, muscle strength and the loss in FM.
Key words: Sarcopenia: Collagen hydrolysate: Collagen peptides: Resistance exercise: Ageing: Protein supplementation
In general, ageing is associated with a decline in motor func-
tion, muscle mass and a decrease in muscular performance
(1,2)
.
The denition of sarcopenia includes both an age-related
decline in muscle mass and a reduction in functional muscular
performance. Sarcopenia is associated with an increased risk for
falls and an overall prevalence for frailty
(3,4)
. Several investi-
gations have shown that the onset of sarcopenia can be post-
poned and the progress decelerated by regular physical activity,
mainly resistance exercise
(57)
. Furthermore, it has been
demonstrated that additional dietary proteins enhance the rate
of post-exercise net muscle protein synthesis and decrease
muscle protein breakdown following resistance exercise
(810)
.
Consequently, the combination of prolonged resistance exer-
cise and post-exercise protein supplementation should increase
fat-free mass (FFM) and/or muscle strength in randomised
controlled trials (RCT). However, although several well-
controlled studies have shown an increase in strength or FFM,
a comparable number of investigations have yielded negative
results
(8,9)
. In a most recent meta-analysis, Cermak et al.
(11)
included twenty-two RCT that have investigated the effect of
resistance exercise and protein supplementation on FFM and
muscle strength in both young and older subjects. Their ana-
lyses showed that protein supplementation increases FFM and
strength to a signicantly higher level than placebo and that this
effect of dietary protein was evident in both younger and older
subjects. In most of these RCT, the proteins administered were
whey, milk, soya or casein; in some studies, a mixture of dif-
ferent essential amino acids was administered.
In the present study, we investigated the effect of post-
exercise protein supplementation with collagen peptides on
*Corresponding author: Dr D. König, email Daniel.Koenig@uniklinik-freiburg.de
Abbreviations: FFM, fat-free mass; FM, fat mass; PG, placebo group; RCT, randomised controlled trial; TG, treatment group.
British Journal of Nutrition, page 1 of 9 doi:10.1017/S0007114515002810
© The Authors 2015. This is an Open Access article, distributed under the terms of the Creative
Commons Attribution licence (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted
re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
muscle mass and muscle function during a 3-month resistance
training programme. Collagen is an extracellular protein that
accounts for 2530 % of the total protein content within the
human body. The process of hydrolysis yields collagen pep-
tides that are designated as foodstuff. The peptides are rapidly
resorbed in the small intestine, which may be important for
post-exercise recovery, although the existence of the post-
exercise metabolic window has recently been challenged
(12)
.
Moreover, collagen peptides are absorbed in intact form to
some extent, up to 10 kDa
(1215)
.
It is generally believed that the protein applied should be
high in branched chain amino acids (BCAA), particularly leu-
cine, which is known to activate several intracellular signal
transduction pathways involved in initiating translation such as
the mTOR signalling pathway
(16,17)
.
Collagen is generally regarded as having a relatively low
biological value, mainly due to the low amount of BCAA and
lysine (Table 1). Nevertheless, the mixture of amino acids has
been shown to be superior compared with whey protein in
maintaining N balance and body weight during a low-protein
diet
(18)
. In addition, collagen contains relatively high amounts of
arginine and glycine, both known to be important substrates for
the synthesis of creatine in the human body
(19)
.
Although hydrolysed collagen is contained in sports drinks
and bars aimed at improving regeneration and post-exercise
muscle recovery, to our knowledge, no controlled study has
thus far investigated the effect of collagen peptide supple-
mentation on FFM, muscle strength and motor control. We
investigated the respective effects in combination with resis-
tance training in a randomised placebo-controlled design in
fty-three elderly men with sarcopenia class I and II.
Methods
Subjects
A total of 148 subjects (Fig. 1) answered an advertisement in a
local newspaper in which healthy men, aged >65 years, who
experienced a considerable loss in muscular strength or
physical performance within the last 34 years, were sought.
Subjects needed to be able to participateinthe3-monthresistance
training and be free of acute diseases or illness-related cachexia.
After a telephone interview, forty-two subjects already met the
exclusion criteria. These subjects had chronic illnesses (liver,
kidney, cancer without recurrence for 5 years, CVD, advanced
arthrosis) or other diseases that made participation in the exer-
cise programme impossible; 106 persons were then invited to
attend our outpatient ward for further examinations. From these
106 subjects, again forty-six of them met the exclusion criteria,
Table 1. Amino acid composition of the collagen peptides
Amino acid Weight (%) Mol (%)
Hydroxyproline 11·39·6
Aspartic acid 5·84·8
Serine 3·23·4
Glutamic acid 10·17·5
Glycine 22·132·3
Histidine 1·20·8
Arginine 7·85·0
Threonine 1·81·7
Alanine 8·510·5
Proline 12·311·8
Tyrosine 0·90·5
Hydroxylysine 1·71·2
Valine 2·42·3
Methionine 0·90·9
Lysine 3·82·9
Isoleucine 1·31·1
Leucine 2·72·3
Phenylalanine 2·11·4
Enrolment Assessed for eligibility (n 148)
Excluded (n 88)
- Not meeting inclusion criteria (n 80)
- Declined to participate (n 6)
- Other reasons (n 2)
Randomised (n 60)
Allocated to intervention (TG) (n 30)
- Received allocated intervention (n 30)
Lost to follow-up (give reasons) (n 4)
(Non-compliance with study protocol, missing
too many training session)
Allocation
Follow-up
Analysis
Analysed (n 26)
- No further exclusion from analysis
Analysed (n 27)
- No further exclusion from analysis
Lost to follow-up (give reasons) (n 3)
(Non-compliance with study protocol, missing
too many training session)
Allocated to intervention (PG) (n 30)
- Recieved allocated intervention (n 30)
Fig. 1. Flowchart of subject recruitment and dropouts before and during the study. TG, treatment group; PG, placebo group.
2 D. Zdzieblik et al.
mainly because sarcopenia was absent or because the medical
examination yielded further contraindications to participate in
the resistance training programme. The presence of sarcopenia
was screened using a handheld dynamometer (Trailite; LiteEx-
press GmbH). According to the European working group on
sarcopenia in older people, handgrip strength (<32 kg) is well
suited for detecting low muscle strength
(20)
. The presence of
sarcopenia was then assured by dual-energy X-ray absorptio-
metry (DXA) measurement of muscle mass. The diagnosis and
classication of sarcopenia were established by the loss of
muscle mass and muscle function according to current guide-
lines
(2022)
. Sarcopenia class I was diagnosed if DXA muscle
mass was 12SD lower than the sex-specic mean for young
adults, and sarcopenia class II was diagnosed if the muscle mass
was lower than 2 SD.
Among all, sixty subjects gave their written informed consent
after being informed about the nature and the possible risks of
the investigation. All the subjects completed a comprehensive
medical examination and routine blood testing (ESR, haemo-
gram, creatinine, creatine kinase, urea, ALT, AST) to exclude
other chronic diseases.
The study protocol was approved by the ethics committee of
the University of Freiburg.
Study design
The participants of the study were randomly assigned to the
treatment group (TG) (collagen peptide supplementation) or to
the placebo group (PG). Randomisation was performed using a
random number generator
(21)
. Blinding of investigators and
participants was not lifted until all the data were entered, the
data set was secured and the statistical analysis was performed.
The primary outcome measure was the change in FFM before
and after the intervention, which lasted for 12 weeks.
Compliance was checked by collecting unused supplements.
In addition, subjects were asked to keep daily records about the
timing of ingestion, side-effects or other problems related to the
training programme or the supplements. In addition, blood
samples were collected at the beginning and at the end of the
study to evaluate the safety of the product and to verify adverse
reactions.
Protein supplementation
The subjects assigned to the TG (n30) were given 15 g of collagen
peptides/d. The test product with a mean molecular weight of
approximately 3 kDa is derived from a complex multi-step
procedure by the degradation of type I collagen. The product
was provided by GELITA AG (BODYBALANCE
). The amino
acid composition of the collagen peptides is shown in Table 1.
Subjects in the PG (n30) received silicon dioxide (Sipernat
350; Evonik). Silicon dioxide (silica) was chosen because it is a
safe food additive and is absorbed in negligible amounts by the
intestine. Therefore, silicon dioxide induces no metabolic
effects in contrast to, for example, carbohydrates applied in
some of the previous studies in this eld.
Collagen peptides as well as placebo were given in powder
form and were dissolved by the participants in 250 ml water.
Subjects were instructed to drink the solution as soon as
possible following each training session but not later than 1 h
after training. During the rst hour after training, no other food
was allowed, except for water to compensate for sweat loss.
Subjects also ingested collagen hydrolysate/placebo on the
days without training; they were requested that the time point
when they drank the solution without previous training should
not differ from the days with training.
Exercise intervention programme
The resistance training was carried out at the University of
Freiburg and consisted of a 12-week guided training
programme on tness devices (pull down, leg press, bench
press, back press, etc.) involving all larger muscle groups.
Subjects took part in the resistance training programme in the
afternoon three times a week over a time period of 60 min.
Individual adaptations of the training protocol were regularly
made as a function of the actual performance. The intensity was
based on the number of possible repetitions (week 14: fteen
repetitions, week 59: ten repetitions, week 1012: eight
repetitions; 4 s/repetition). Subjects were excluded from the
study if they missed >10 % of the training sessions.
Methods
Body composition was measured before and after the 3-month
training period using DXA (Stratos DR 2D Fan Beam; Degen
Medizintechnik).
Muscular strength was tested by measuring isokinetic quad-
riceps strength of the right leg before and after the training
programme (Con-Trex) and sensory motor control (SMC) was
determined using a standardised one-leg stabilisation test
(Posturomed; Haider-Bioswing) as described previously
(22)
.
Dietary intake
Dietary intake was evaluated before and at the end of the study
using 4 daysnutritional protocols. Subjects were asked to ll
out the protocols using household measurements. The proto-
cols were analysed using PRODI 6.0 (Prodi).
Statistical methods
All the data in the tables are presented as means and standard
deviations and as means with their standard errors in the bar
charts. Statistical analysis was performed using the Statistical
Package for the Social Sciences Software (SPSS for Windows,
version 20.0.1). Normality of all the variables was tested before
statistical evaluation using the KolmogorovSmirnov test. All the
variables were normally distributed. Baseline differences were
tested using the unpaired samples ttest. Testing for changes
between examination at baseline and following the 3-month
intervention within groups were performed using the paired
samples ttest. Testing for changes between groups following
the intervention (collagen peptide group=TG v. PG) was
carried out using two-way repeated-measures ANOVA for
Collagen peptides and sarcopenia 3
continuous variables. The factors were TG (collagen hydrolysate/
placebo) and time (levels were pre- and post-intervention).
The strength of relationships was analysed using Pearsons
linear correlation coefcient r.APvalue of 0·05 or less was
considered to indicate statistical signicance. Based on previous
studies, we expected an increase in FFM (primary outcome
measure) by 2 kg with a 2·5SD
(23)
. With an αof 0·05 and a
power of 0·80, a number of twenty-ve subjects in each group
was considered appropriate. Considering a dropout rate from
20 %, we chose a number of thirty subjects in each group.
Results
Subjects
A total of fty-three men with a mean age of 72·2(SD 4·68) years
completed the study (twenty-six men in the TG and twenty-
seven men in the PG). Age did not differ signicantly between
the completers in both groups (TG =72·3(
SD 3·7) years and
PG =72·1(
SD 5·53) years).
All seven dropouts were related to incompliance with the
study design and training protocol. Excluded participants pre-
dominantly had missed >10 % of the training sessions due to
various reasons. No dropout was related to side-effects of the
administered collagen peptide supplement or placebo. No
serious adverse events were noted and, especially, no
pathological ndings could be observed in the routine
blood tests.
Based on the results of the handgrip test and the DXA mea-
surements
(24)
, twenty-one subjects of the total study population
were categorised as having class I sarcopenia and thirty-two as
having class II sarcopenia. Again, data were balanced at
baseline with no statistically signicant differences between the
TG and the PG, regarding classication of sarcopenia
(TG =eleven class I and fteen class II; PG =ten class I and
seventeen class II).
Body composition and muscle strength
In both the groups, a statistically signicant (P<0·001) increase
in FFM and a signicant loss in fat mass (FM) (P<0·001) could
be observed after 3 months (Table 2). Moreover, muscle
strength and SMC improved signicantly (P<0·001) in both
the groups. Moreover, data for bone mass (BM) revealed a
statistically signicant (P<0·001) increase in both the groups at
the end of the study.
Fig. 2 demonstrates that the observed increase in FFM of
2·90 (SEM 1·84)kg in the PG was more pronounced after
supplementation with 15 g collagen peptides (+4·22 (SEM 2·31) kg).
The observed group difference was statistically signicant
(P<0·05). In addition, the decrease in FM in the collagen
peptide-supplemented group (5·45 (SEM 3·17) kg) was more
pronounced (P<0·05) compared with the PG (3·51
(SEM 2·16) kg). Although the difference was not signicant, base-
line characteristics showed that subjects in the PGweighedless
andhadrelativelymoreFFMandlessFMcomparedwithsubjects
in the collagen-supplemented group. In both the groups, the loss
ofFMcorrelatedwithanincreaseinFFM;inthecollagen-
supplemented group, the correlation coefcient (r0·72; P<0·001)
wasmorepronouncedthaninthecontrolgroup(r0·55;
P<0·003) (Figs 3 and 4).
Muscle strength was increased in both the study groups after
12 weeks, but again the effect in the collagen peptide group
(16·12 (SEM 12·9) Nm) was more distinct than in the PG (+7·38
(SEM 13·2) Nm), demonstrating a statistically signicant
difference (P<0·05) (Fig. 5). SMC was not signicantly different
from that of the PG (Fig. 5).
BM was signicantly (P<0·001) increased during the course
of the intervention in both the groups. The difference between
the groups after the intervention did not reach signicance.
The analysis of the nutritional protocols revealed that
the subjects consumed a typical western diet and that they were
not protein decient (protein 16·4(
SEM 4·2) % (0·91 g/kg
Table 2. Body composition, muscle strength and sensory motor control in the subjects before and after supplementation with collagen hydrolysate
or placebo
(Mean values and standard deviations)
Treatment group (n26) Placebo group (n27)
Baseline examination Final examination Baseline examination Final examination
Mean SD Mean SD Mean SD Mean SD
Significance between groups in
RM ANOVA testing assessing
(treatment × time) interaction (P)
Weight (kg) 88·212·187·311·983·114·882·814·5NS
Fat-free mass (%) 64·74·26 70·31*** 4·866·84·77 70·4*** 4·94 <0·05
Fat mass (%) 31·634·58 25·67*** 5·22 29·55·53 25·4*** 5·55 <0·05
Bone mass (%) 3·60·47 4·02*** 0·59 3·81 0·61 4·18*** 0·71 NS
Fat-free mass (kg) 56·96·68 61·1*** 6·88 54·96·96 57·8*** 7·46 <0·05
Fat mass (kg) 28·17·09 22·7*** 7·08 25·18·69 21·6*** 8·15 <0·05
Bone mass (kg) 3·140·36 3·46*** 0·38 3·10·36 3·34*** 0·43 NS
Power (knee extension) (Nm) 12327·3 140*** 28·3 132 27 139* 27·4<0·05
Sensory motor control (mm) 1205852 477*** 228 1374 639 516*** 24 NS
RM, repeated measurements; mm, length of path on posturometer.
*P<0·05 within the group from baseline to final examination; *** P<0·001 within the group from baseline to final examination.
No significant difference at baseline between treatment group and placebo group.
4 D. Zdzieblik et al.
body weight), fat 33·23 (SEM 7·1) % and carbohydrates 43·8
(SEM 8·7) %). Total energy intake was 7757·1 kJ/d (1854 kcal/d),
which is in the lower reference level for this age group; how-
ever, underreporting cannot be ruled out in these subjects
aiming at improving their body compositing. There were no
signicant differences between the dietary intake before and
after the intervention period. Dietary intake did not differ
between the groups.
Discussion
The main nding of the present study is that collagen peptides
further increased the benets of the 3-month resistance training
in older subjects with sarcopenia. Compared with placebo,
subjects in the collagen-supplemented group showed a higher
increase in FFM and muscle strength as well as a higher
reduction in FM.
The results of the current study are in accordance with
previous investigations, showing that resistance exercise
improves strength, FFM, co-ordination as well as postural con-
trol in the ageing population
(25)
.
However, there is a controversial discussion as to whether
the anabolic effect of resistance exercise can be further
enhanced by protein supplementation, particularly in the
elderly
(26,27)
. In experimental settings, it has been clearly
demonstrated that the ingestion of dietary protein following
10
8
6
4
2
0
Δ Fat-free mass (kg)
–12 –10 –8 –6 –4 –2 0 2
Δ Fat mass (kg)
Fig. 3. Correlation (Pearsonsr) between fat-free mass and fat mass changes after a 12 weeks of resistance training in elderly men (age >65 years, n26) in
combination with a daily dosage of 15 g collagen peptides (r0·72; P<0·001).
7
5
3
1
–1
–3
–5
–7
–9
Fat-free mass
Fat mass
*
Change in mass (kg)
*
Fig. 2. Change in fat-free mass and fat mass after 12 weeks of resistance training in elderly men (age>65 years) with collagen peptide supplementation (treatment
group, n26; ) or placebo (placebo group, n27; ). Values are means, with their standard errors represented by vertical bars. Significance was tested by ANOVA
considering time × treatment interactions. * Mean value was significantly different from that of the placebo group (P<0.05).
Collagen peptides and sarcopenia 5
resistance exercise stimulates muscle protein synthesis rates in
the post-exercise period
(28,29)
. Nevertheless, the ndings of RCT
investigating this combined effect over a longer period of time
have yielded controversial results. Although a considerable
amount of well-controlled studies have reported an increase in
FFM and muscle strength following the combination of resis-
tance exercise with protein supplementation, other investiga-
tors could not conrm a synergistic effect
(8,9)
. A meta-analysis
by Cermak et al.
(11)
analysed the combined effect of protein
and resistance exercise in both younger and older subjects by
pooling twenty-two RCT. The data indicate that protein
supplementation increases the gains in FFM and muscular
strength in both young and elder subjects
(11)
. Moreover, a most
recent review supports the efcacy of nutritional supple-
mentation in the treatment of sarcopenia
(30)
.
In the present investigation, the increase in FFM and muscle
strength and the decrease in FM seemed to be more pronounced
compared with previous reports
(11)
. This might be explained by
the fact that the training was very extensive. It was designed and
supervised by renowned experts in motor control and resistance
training
(7)
. In addition, the workload was individually adapted
throughout the study, and the main goal of the training
procedure was the induction of muscular hypertrophy. More-
over, the participants of the present study were not suffering
from severe sarcopenia with no signs of frailty or cachexia.
Nevertheless, no signicant correlation between the degree of
10
8
6
4
2
0
Δ Fat-free mass (kg)
–12 –10 –8 –6 –4 –2 0 2
Δ Fat mass (kg)
Fig. 4. Correlation (Pearsonsr) between fat-free mass and fat mass changes after a 12 weeks of resistance training in elderly men (age >65 years, n26) in the
placebo group (r0·55; P<0·003).
25
20
15
10
5
0
25
20
15
10
5
0
cm
Nm
–10
–15
–10
–15
–5
–5
NS
P<0.05
Motor control
Muscle strength
Fig. 5. Changes in strength output and motor control after 12 weeks of resistance training referred to baseline in elderly men (age >65 years) with collagen peptide
supplementation (treatment group (TG), n26) or placebo (placebo group (PG), n27). Values are means with their standard error of means. Significance tested by
ANOVA considering time × treatment interactions. , PG; , TG.
6 D. Zdzieblik et al.
sarcopenia and the individual response to supplementation and
training in any of the parameters in the subjects investigated
could be observed. All the subjects were living independently
with a normal dietary pattern, and the recorded nutritional
protocols revealed adequate protein intake. Nevertheless, the
subjects did not perform physical exercise, particularly resistance
exercise, on a regular basis (<1 h/week). This could further
explain why the anabolic stimulus of resistance training induced
such a positive effect in this non-frail population.
Other investigations with comparable study designs were not
able to observe an efcacy of protein supplementation in
combination with resistance exercise on body composition and
muscle strength in the elderly
(3133)
. Beside factors such as age,
health, nutrition status of the subjects and design of the training
programme, the type of dietary protein intake could also play a
role. In a previous study, we could demonstrate that soya
protein together with a resistance training programme, com-
parable with the one applied in the present investigation,
increased muscle mass to a higher extent than in the control
group without protein supplementation
(34)
.
The effects of collagen peptides on body composition and
muscular power output have not been investigated previously.
Thus far, studies have mainly focused on the effects of collagen
peptides on skin health and degenerative joint diseases such as
osteoarthritis
(13,14,3540)
. The impact on body composition has
not been in the focus, as it is generally believed that the relatively
low biological value of collagen would not favour a signicant
improvement on muscular net protein synthesis. The results of
the present investigation do not support this assumption, and the
following ndings could contribute to further explain the
increase in FFM and strength following collagen peptides
supplementation: it has been shown that collagen peptide intake
was superior to whey protein in maintaining N balance and body
weight during a low-protein diet
(18)
.Althoughcollagenhasalow
protein digestibility corrected amino acid score, its N content
may be higher compared with whey on a per gram basis due to a
high proportion of amino acids having low molecular weight or
containing more than one N atom.
Furthermore, it has been speculated that the timing of protein
supplementation as well as the absorption kinetic of the
administered protein can have an inuence on the efcacy
(41)
.
Some studies revealed that a fast digestion and rapid absorption
kinetic could inuence the enhancement of muscle hyper-
trophy by proteins. It has been proposed that the anabolic
window for optimal post-exercise anabolic effects begins to
close after 90120 min
(42,43)
. In the present study, collagen
peptides were ingested within 60 min after training. Therefore,
it could be possible that the short post-exercise interval and the
rapid digestibility and absorption of collagen peptides following
supplementation
(15,44)
may have supported the post-exercise
muscle protein anabolism. It has to be critically remarked that a
most recent meta-analysis did not support the hypothesis of this
anabolic window theory
(30)
. Therefore, further research in this
area including collagen peptides is necessary.
Another rather speculative explanation for the observed
effects could be that collagen is rich in arginine and glycine,
both known to be important substrates for the synthesis of
creatine in the human body. Creatine supplementation has
been shown to improve both muscle mass and muscular
function in some but not all studies
(45)
. In the recent years,
evidence supporting the theory suggesting that creatine
supplementation may also play a role in reducing sarcopenia in
aged subjects is increasing
(46)
. Therefore, it would be interesting
to determine the amount of creatine in the muscle cells
following collagen peptide supplementation in future studies.
In addition, Timmerman & Volpi
(47)
discussed the positive
effect of an increased microvascular perfusion, and thus
increased amino acid delivery, on enhanced anabolic responses
after protein supplementation. Collagen peptides have shown
to positively inuence microcirculation
(48,49)
; therefore, this
might cause an additional benecial effect in promoting muscle
growth compared with other protein sources.
Finally, several investigations have shown that collagen
peptides signicantly reduce pain in subjects with osteoarthritis
as well as functional joint pain
(13,50)
. Therefore, it could be
speculated that the subjects who were supplemented with
collagen peptides were able to perform the resistance exercises
with less pain, and therefore had a better training gain.
The reason for the higher increase in muscular strength
may also be related to one of the above-mentioned factors or
simply goes along with the higher amount of muscle mass. The
existence of a specic effect on muscular recruitment cannot be
assessed on the basis of the design of the study.
Nevertheless, the study has several limitations. The statistical
analysis was a completersanalysis and not an intention-to-treat
analysis. We decided to choose this approach as the dropout
causes were not in direct relationship with the intervention pro-
tocol and the subjects dropped out before the nal examination.
Furthermore, we chose a placebo that did not deliver any
extra calories. It could be speculated that the additional amount
of energy provided by the collagen peptides may be responsible
for the respective effects. However, to our knowledge, there are
no data showing that additional calories for example, by car-
bohydrates would favour muscle hypertrophy. Therefore, we
do not think that it was simply the lower amount of calories in
the control group that accounts for the differences observed.
Finally, the randomisation yielded two groups with baseline
differences in FM and FFM; although the difference was not
statistically signicant, an inuence of these baseline differences
on the respective results cannot be ruled out completely.
In conclusion, the ndings of the present study have
conrmed previous results that 60 min of resistance exercise,
performed three times per week, is well suited to signicantly
increase muscle mass, muscular strength and motor control in
subjects with sarcopenia class I or II. Moreover, the study has
demonstrated that the combination of resistance exercise and
collagen peptide supplementation resulted in a more pro-
nounced improvement of body composition, as indicated by a
signicant increase in muscle mass and decrease in FM, com-
pared with placebo. In addition, muscular strength was sig-
nicantly improved after collagen peptide intake compared
with the training programme plus placebo.
Further studies should investigate the effect of combined
resistance training and collagen peptide intake in other study
populations, including sex and different age groups and should
focus on the mode of action as well as on the required dosage.
Collagen peptides and sarcopenia 7
Acknowledgements
The authors thank the whole team of the Mooswaldklinik in
Freiburg for the realisation of the training programme and the
energy they have put into this project.
Part of the costs were paid by Gelita AG, Uferstraße 7,
Eberbach, Germany.
D. K. was the principal investigator of the study. S. O. and
M. W. B. were involved in the design and execution of the study
and performed the statistical analysis. All the authors read and
approved the nal version of the manuscript. The planning,
organisation, monitoring and analysis of the study were per-
formed independently by the investigators.
There are no conicts of interest.
References
1. Wang C & Bai L (2012) Sarcopenia in the elderly: basic and
clinical issues. Geriatr Gerontol Int 12, 388396.
2. Walston JD (2012) Sarcopenia in older adults. Curr Opin
Rheumatol 24, 623627.
3. Ruiz M, Cefalu C & Reske T (2012) Frailty syndrome in
geriatric medicine. Am J Med Sci 344, 395398.
4. Malafarina V, Uriz-Otano F, Iniesta R, et al. (2012) Sarcopenia
in the elderly: diagnosis, physiopathology and treatment.
Maturitas 71, 109114.
5. Pillard F, Laoudj-Chenivesse D, Carnac G, et al.(2011)Physical
activity and sarcopenia. Clin Geriatr Med 27,449470.
6. Peterson MD & Gordon PM (2011) Resistance exercise for the
aging adult: clinical implications and prescription guidelines.
Am J Med 124, 194198.
7. Mayer F, Gollhofer A & Berg A (2003) Krafttraining mit Älteren
und chronisch Kranken (Resistance training in elderly or
chronically ill subjects). Deutsch Z Sportmed 54,8894.
8. Candow DG, Forbes SC, Little JP, et al. (2012) Effect of
nutritional interventions and resistance exercise on aging
muscle mass and strength. Biogerontology 13, 345358.
9. Phillips SM, Tang JE & Moore DR (2009) The role of milk- and
soy-based protein in support of muscle protein synthesis and
muscle protein accretion in young and elderly persons. JAm
Coll Nutr 28, 343354.
10. Walker DK, Dickinson JM, Timmerman KL, et al. (2011)
Exercise, amino acids, and aging in the control of human
muscle protein synthesis. Med Sci Sports Exerc 43, 22492258.
11. Cermak NM, Res PT, de Groot LC, et al. (2012) Protein sup-
plementation augments the adaptive response of skeletal
muscle to resistance-type exercise training: a meta-analysis.
Am J Clin Nutr 96, 14541464.
12. Ohara H, Matsumoto H, Ito K, et al. (2007) Comparison of
quantity and structures of hydroxyproline-containing peptides
in human blood after oral ingestion of gelatin hydrolysates
from different sources. J Agric Food Chem 55, 15321535.
13. Bello AE & Oesser S (2006) Collagen hydrolysate for the
treatment of osteoarthritis and other joint disorders: a review
of the literature. Curr Med Res Opin 22, 22212232.
14. Benito-Ruiz P, Camacho-Zambrano MM, Carrillo-Arcentales JN,
et al. (2009) A randomized controlled trial on the efcacy and
safety of a food ingredient, collagen hydrolysate, for improving
joint comfort. Int J Food Sci Nutr 60,Suppl.2,99113.
15. Oesser S, Adam M, Babel W, et al. (1999) Oral administration
of (14)C labeled gelatin hydrolysate leads to an accumulation
of radioactivity in cartilage of mice (C57/BL). J Nutr 129,
18911895.
16. Leenders M & van Loon LJ (2011) Leucine as a pharmaconu-
trient to prevent and treat sarcopenia and type 2 diabetes.
Nutr Rev 69, 675689.
17. Morley JE, Argiles JM, Evans WJ, et al. (2010) Nutritional
recommendations for the management of sarcopenia. JAm
Med Dir Assoc 11, 391396.
18. Hays NP, Kim H, Wells AM, et al. (2009) Effects of whey and
fortied collagen hydrolysate protein supplements on nitro-
gen balance and body composition in older women. J Am Diet
Assoc 109, 10821087.
19. Brosnan JT & Brosnan ME (2007) Creatine: endogenous
metabolite, dietary, and therapeutic supplement. Annu Rev
Nutr 27, 241261.
20. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. (2010) Sarcope-
nia: European consensus on denition and diagnosis: Report
of the European Working Group on Sarcopenia in
Older People. Age Ageing 39, 412423.
21. Urbaniak GC & Plous S (2011) Research randomizer
(version 3.0). www.randomizer.org
22. Boeer J, Mueller O, Krauss I, et al. (2010) Effects of a sensory-
motor exercise program for older adults with osteoarthritis or
prosthesis of the hip using measurements made by the
Posturomed oscillatory platform. J Geriatr Phys Ther 33,1015.
23. Miller PE, Alexander DD & Perez V (2014) Effects of whey
protein and resistance exercise on body composition: a meta-
analysis of randomized controlled trials. J Am Coll Nutr 33,
163175.
24. Werle S, Goldhahn J, Drerup S, et al. (2009) Age- and gender-
specic normative data of grip and pinch strength in a healthy
adult Swiss population. J Hand Surg Eur Vol 34,7684.
25. Liu CJ & Latham NK (2009) Progressive resistance strength
training for improving physical function in older adults.
Cochrane Database Syst Rev Issue 3, CD002759.
26. Evans WJ (2004) Protein nutrition, exercise and aging. JAm
Coll Nutr 23, 601S609S.
27. Paddon-Jones D, Short KR, Campbell WW, et al. (2008) Role
of dietary protein in the sarcopenia of aging. Am J Clin Nutr
87, 1562S1566S.
28. Beelen M, Koopman R, Gijsen AP, et al. (2008) Protein
coingestion stimulates muscle protein synthesis during
resistance-type exercise. Am J Physiol Endocrinol Metab 295,
E70E77.
29. Koopman R, Saris WH, Wagenmakers AJ, et al. (2007)
Nutritional interventions to promote post-exercise muscle
protein synthesis. Sports Med 37, 895906.
30. Malafarina V, Uriz-Otano F, Iniesta R, et al. (2013) Effective-
ness of nutritional supplementation on muscle mass in
treatment of sarcopenia in old age: a systematic review. JAm
Med Dir Assoc 14,1017.
31. Leenders M, Verdijk LB, van der HL, et al. (2013) Protein
supplementation during resistance-type exercise training in
the elderly. Med Sci Sports Exerc 45, 542552.
32. Chale A, Cloutier GJ, Hau C, et al. (2013) Efcacy of whey
protein supplementation on resistance exercise-induced changes
in lean mass, muscle strength, and physical function in mobility-
limited older adults. JGerontolABiolSciMedSci68,682690.
33. Verdijk LB, Jonkers RA, Gleeson BG, et al. (2009) Protein
supplementation before and after exercise does not further
augment skeletal muscle hypertrophy after resistance training
in elderly men. Am J Clin Nutr 89, 608616.
34. Deibert P, Solleder F, Konig D, et al. (2011) Soy protein based
supplementation supports metabolic effects of resistance
training in previously untrained middle aged males. Aging
Male 14, 273279.
35. McAlindon TE, Nuite M, Krishnan N, et al. (2011) Change in
knee osteoarthritis cartilage detected by delayed gadolinium
8 D. Zdzieblik et al.
enhanced magnetic resonance imaging following treatment
with collagen hydrolysate: a pilot randomized controlled trial.
Osteoarthritis Cartilage 19, 399405.
36. Proksch E, Segger D, Degwert J, et al. (2014) Oral supple-
mentation of specic collagen peptides has benecial effects
on human skin physiology: a double-blind, placebo-
controlled study. Skin Pharmacol Physiol 27,4755.
37. Proksch E, Schunck M, Zague V, et al. (2014) Oral intake of
specic bioactive collagen peptides reduces skin wrinkles and
increases dermal matrix synthesis. Skin Pharmacol Physiol 27,
113119.
38. Oesser S & Seifert J (2003) Stimulation of type II collagen
biosynthesis and secretion in bovine chondrocytes cultured
with degraded collagen. Cell Tissue Res 311, 393399.
39. Kim HK, Kim MG & Leem KH (2013) Osteogenic activity of
collagen peptide via ERK/MAPK pathway mediated boosting
of collagen synthesis and its therapeutic efcacy in
osteoporotic bone by back-scattered electron imaging and
microarchitecture analysis. Molecules 18, 1547415489.
40. Adam M, Spacek P & Hulejova H (2002) What is the effect of
collagen peptides peroral administration in postmenopausal
osteoporosis. Ces Reumatol 10, 131137.
41. Pennings B, Boirie Y, Senden JMG, et al. (2011) Whey protein
stimulates postprandial muscle protein accretion more effec-
tively than do casein and casein hydrolysate in older men. Am
J Clin Nutr 93, 9971005.
42. Fielding RA & Parkington J (2002) What are the dietary protein
requirements of physically active individuals? New evidence
on the effects of exercise on protein utilization during post-
exercise recovery. Nutr Clin Care 5, 191196.
43. Kerksick C, Harvey T, Stout J, et al. (2008) International
Society of Sports Nutrition position stand: nutrient timing. J Int
Soc Sports Nutr 5, 17.
44. Ichikawa S, Morifuji M, Ohara H, et al. (2009) Hydroxyproline-
containing dipeptides and tripeptides quantied at high con-
centration in human blood after oral administration of gelatin
hydrolysate. Int J Food Sci Nutr 61,19.
45. Antonio J & Ciccone V (2013) The effects of pre versus post
workout supplementation of creatine monohydrate on body
composition and strength. J Int Soc Sports Nutr 10, 36.
46. Candow DG (2011) Sarcopenia: current theories and the
potential benecial effect of creatine application strategies.
Biogerontology 12, 273281.
47. Timmerman KL & Volpi E (2013) Endothelial function and the
regulation of muscle protein anabolism in older adults. Nutr
Metab Cardiovasc Dis 23, Suppl. 1, S44S50.
48. Nonaka I, Katsuda S, Ohmori T, et al. (1997) In vitro and in
vivo anti-platelet effects of enzymatic hydrolysates of collagen
and collagen-related peptides. Biosci Biotechnol Biochem 61,
772775.
49. Kouguchi T, Ohmori T, Shimizu M, et al. (2013) Effects of a
chicken collagen hydrolysate on the circulation system in
subjects with mild hypertension or high-normal blood pressure.
Biosci Biotechnol Biochem 77,691696.
50. Moskowitz RW (2000) Role of collagen hydrolysate in bone
and joint disease. Semin Arthritis Rheum 30,8799.
Collagen peptides and sarcopenia 9
... Combinations of exercise and protein interventions are frequently recommended for optimizing body composition [23,24], due to potential synergistic effects of exerciseinduced bone (re-)modelling and the provision of protein as a substrate for bone synthesis [19]. However, the evidence regarding their impact on bone health in middle-aged and older adults remains heterogeneous [25][26][27][28][29][30]. To the best of our knowledge, systematic reviews directly comparing the combined effects of these interventions with the solitary effects of either exercise or protein interventions are lacking. ...
... The mean age ranged from 54 [29] Records identified from: [42]. Two studies included only male participants [26,44], and four included only female participants [29,[45][46][47], with three studies conducted in postmenopausal women [29,46,47]. Regarding health status, studies included participants with sarcopenia [42], osteopenia/ osteoporosis [29], pre-frailty/frailty [25] and poor muscular strength/physical performance [26]. ...
... Two studies included only male participants [26,44], and four included only female participants [29,[45][46][47], with three studies conducted in postmenopausal women [29,46,47]. Regarding health status, studies included participants with sarcopenia [42], osteopenia/ osteoporosis [29], pre-frailty/frailty [25] and poor muscular strength/physical performance [26]. Information on funding sources of included RCTs and declarations of potential competing interests of study authors can be found in Table SI3. ...
Article
Full-text available
Osteoporosis has become a global public health concern making prevention and treatment essential to reduce severe consequences for individuals and health systems. This systematic review with meta-analysis aimed to determine the effects of combined protein and exercise interventions compared to (a) exercise alone and (b) protein alone on bone mineral content (BMC) or density (BMD) in middle-aged and older adults. We systematically searched Medline, CINAHL, CENTRAL, Web of Science, and SPORTDiscus until 24th January 2023. Pairwise random-effects meta-analyses were performed to calculate weighted mean differences (WMD) with 95% confidence intervals (95% CI). We evaluated risk of bias (Cochrane RoB2) and certainty of evidence (CoE; GRADE). If pooling was not possible, the results were summarized descriptively. For the comparison of combined protein supplementation and exercise vs. exercise alone, no meta-analysis for BMD (2 RCTs) was possible. For BMC, little to no intervention effect was found (WMD 0.03 kg; 95% CI − 0.00 to 0.05; 4 RCTs; IG = 97/CG = 98; I2 = 58.4%). In a sensitivity analysis, restricted to combined milk-protein supplementation and exercise, the result remained similar (0.01 kg; 95% CI − 0.01 to 0.03; 4 RCTs; IG = 71/CG = 71; I2 = 0.0%; low CoE). For the comparison of combined protein and exercise interventions vs. protein alone, no RCT on BMC was identified; the results on total or regional BMD (2 RCTs) were inconclusive. Based on our findings, no robust conclusions can be drawn on whether combining protein and exercise interventions is more beneficial for bone health than one component alone. Sufficiently powered studies with longer duration are required to clarify these questions (CRD42022334026).
... For nutrition interventions in older adults with sarcopenia, a highprotein diet or a diet rich in essential nutrients are recommended. Creatine [21], essential amino acids (EAAs) [21,22], whey protein, and collagen peptides [23] have been proposed as protein supplementation components for sarcopenia in older patients. Particularly, supplementation with EAAs has been proven to be highly effective for muscle protein synthesis [23][24][25]. ...
... Creatine [21], essential amino acids (EAAs) [21,22], whey protein, and collagen peptides [23] have been proposed as protein supplementation components for sarcopenia in older patients. Particularly, supplementation with EAAs has been proven to be highly effective for muscle protein synthesis [23][24][25]. However, in older adults with sarcopenia, anabolic response to protein synthesis often falls short of that in normal older adults, which requires careful consideration for nutritional supplementation [26,27]. ...
... A combined intervention strategy with resistance exercises and protein supplementation has been suggested as the most effective approach for improving muscle mass, strength, and physical function in older adults with muscle atrophy [8,22,30]. Other previous studies similarly observed improvements in knee extensor strength and thigh muscle strength with protein (40 g/day) and collagen peptide supplementation (15 g/ day), respectively [23,31]. Despite the positive effects of exercise-nutrition combined interventions, developing and implementing such programs for patients with sarcopenia, especially in community-based primary care settings, presents challenges and limitations due to the lack of evidence-based nutrition interventions. ...
Article
Full-text available
Background Sarcopenia is a geriatric disease characterized by loss of muscle mass and strength. Although combined exercise and nutrition intervention are known to be effective for sarcopenia, clinical trials involving outpatients with sarcopenia in primary care are scarce. We describe a protocol for a trial to examine the effects of a 12-week combined exercise and nutrition intervention in Korean older adults with possible sarcopenia in community-based primary care. Methods This multicenter, randomized, controlled trial will include 94 community-dwelling older outpatients aged 65–85 years with possible sarcopenia (47 participants in the intervention and control groups each). Resistance exercises, which incorporate concentric and eccentric exercises, will consist of an introductory phase (3 weeks: twice-weekly supervised exercise sessions and once-weekly home exercises; contraction exercises), an expanded phase (3 weeks: twice-weekly supervised exercise sessions and once-weekly home exercises; eccentric exercises), and a maintenance phase (6 weeks: once-weekly supervised exercise sessions and twice-weekly home exercises; power/eccentric exercises). Nutritional supplementation will be provided according to the nutritional status of the participants using a Mini-Nutritional Assessment. Participants will be assessed at baseline, 12 and 24 weeks, and the primary outcome will be the 5-times chair stand test results. Discussion To the best of our knowledge, this will be the first clinical trial to evaluate the efficacy of a combined exercise and nutritional supplementation intervention in older outpatients with possible sarcopenia in community-based primary care clinics. These findings will provide new insights to clinicians regarding the long-term usability for doctors and outpatients with possible sarcopenia in community-based primary care. Trial registration This trial was prospectively registered at ClinicalTrials.gov on September 16, 2023 (registration number: NCT06049914).
... However, the effect on protein synthesis of hydrolyzed collagen supplementation may be limited [68,69] and combination with physical exercise could lead to better results. In the study by Zdzieblik et al. [45], after an intake of hydrolyzed collagen, the significant increases observed in muscle mass and muscle strength would not occur exclusively at the expense of the regeneration of contractile tissues but also of passive tissues, suggesting an adaptation of the connective tissue, which would explain the improvements in strength performance [39]. ...
... The aim of this study was to evaluate whether nutritional supple- increases in lean mass than training alone [44]. Also, collagen peptide supplementation has been shown to promote greater increases in lean mass in elderly men with sarcopenia [45]. Our results reflect changes in body composition with a different impact depending on gender: body fat decreased significantly in women, while muscle mass increased in men, and these changes were more evident in participants with collagen supplementation. ...
... Notably, hydrolyzed collagen has been used as an isocaloric, protein-matched placebo by our research team because of its inferior anabolic potential, including low levels of methionine (i.e., rate limiting for translation initiation), EAAs, BCAAs, and poor amino acid digestibility score (DIAAS of 0). Thus, our results are in contrast to those of Jendricke, Zdzieblik and König, who have reported generally superior results for collagen peptide vs. whey protein supplementation upon body composition, bone health, and knee joint discomfort in a series of studies [61][62][63][64][65]. Currently, we, and others [66], are unable to explain this discrepancy, and we refer the readers to the excellent reviews performed by Deane and Atherton and Holwerda and van Loon for more information on collagen and its therapeutic potential on muscle, bone, and connective tissue [35,67]. ...
Article
Full-text available
Background: Anabolic resistance accelerates muscle loss in aging and obesity, thus predisposing to sarcopenic obesity. Methods: In this retrospective analysis of a randomized clinical trial, we examined baseline predictors of the adaptive response to three months of home-based resistance exercise, daily physical activity, and protein-based, multi-ingredient supplementation (MIS) in a cohort of free-living, older males (n = 32). Results: Multiple linear regression analyses revealed that obesity and a Global Risk Index for metabolic syndrome (MetS) were the strongest predictors of Δ% gains in lean mass (TLM and ASM), LM/body fat ratios (TLM/%BF, ASM/FM, and ASM/%BF), and allometric LM (ASMI, TLM/BW, TLM/BMI, ASM/BW), with moderately strong, negative correlations to the adaptive response to polytherapy r = −0.36 to −0.68 (p < 0.05). Kidney function, PA level, and chronological age were only weakly associated with treatment outcomes (p > 0.05). Next, we performed a subgroup analysis in overweight/obese participants with at least one other MetS risk factor and examined their adaptive response to polytherapy with two types of protein-based MIS (PLA; collagen peptides and safflower oil, n = 8, M5; whey/casein, creatine, calcium, vitamin D3, and fish oil, n = 12). The M5 group showed greater improvements in LM (ASM; +2% vs. −0.8%), LM/body fat ratios (ASM/FM; +3.8% vs. −5.1%), allometric LM (ASM/BMI; +1.2% vs. −2.5%), strength (leg press; +17% vs. −1.4%), and performance (4-Step-Stair-Climb time; −10.5% vs. +1.1%) vs. the PLA group (p < 0.05). Bone turnover markers, indicative of bone accretion, were increased pre-to-post intervention in the M5 group only (P1NP; p = 0.036, P1NP/CTX ratio; p = 0.088). The overall anabolic response, as indicated by ranking low-to-high responders for Δ% LM (p = 0.0079), strength (p = 0.097), and performance (p = 0.19), was therefore significantly higher in the M5 vs. PLA group (p = 0.013). Conclusions: Our findings confirm that obesity/MetS is a key driver of anabolic resistance in old age and that a high-quality, whey/casein-based MIS is more effective than a collagen-based alternative for maintaining musculoskeletal health in individuals at risk for sarcopenic obesity, even when total daily protein intake exceeds current treatment guidelines.
... Additionally, in a fracture mouse model, type 2 collagen from squid cartilage induced myogenic IGF-1 and irisin, which are myokines related to muscle growth and development and muscle cell production, respectively [122]. Consistent with these results, a clinical study found postexercise protein supplementation with collagen peptides to significantly affect muscle mass and function compared with the placebo following resistance training in older patients with sarcopenia [123]. Consequently, collagen peptides have exhibited favorable outcomes in clinical trials and are currently the focus of extensive research. ...
Article
Full-text available
Aging is closely linked to various health challenges, including cardiovascular disease, metabolic disorders, and neurodegenerative conditions. This study emphasizes the critical role of bioactive compounds derived from marine sources, such as antioxidants, omega-3 fatty acids, vitamins, minerals, and polysaccharides, in addressing oxidative stress, inflammation, and metabolic disorders closely related to aging. Incorporating these materials into functional foods not only provides essential nutrients but also delivers therapeutic effects, thereby promoting healthy aging and mitigating age-related diseases. The growth of the global anti-aging market, particularly in North America, Europe, and Asia, underscores the significance of this study. This review systematically analyzes the current research, identifying key bioactive compounds, their mechanisms of action, and their potential health benefits, thus highlighting the broad applicability of marine-derived bioactive compounds to enhancing healthy aging and improving the quality of life of aging populations.
... In the last decade, the literature has underlined the role of hydrolyzed collagen as a therapeutic option in cases of osteoarthritis and other musculoskeletal disorders, including RC tendinopathy [21][22][23][24]. However, to the best of our knowledge, no studies have been published on the effectiveness of collagen low-molecular-weight peptide (LWP) injections in treating supraspinatus tendon tears. ...
Article
Full-text available
Background: This study evaluates the clinical efficacy and safety of two ultrasound (US)-guided injections of a 5 mg/1 mL low-molecular-weight peptide (LWP) solution derived from hydrolyzed bovine collagen in patients with supraspinatus partial tendon tears. Methods: A total of 21 patients with symptomatic partial tears of the supraspinatus tendon, detected by US, were consecutively enrolled and received one injection at a baseline visit (T0) and one after two weeks (T1). The primary outcome measure was the visual analogue scale (VAS) for pain. Secondary outcomes were the shoulder pain and disability index (SPADI) total score and the safety of LWP injections. Patients were examined at baseline (T0), at a week 2 follow-up visit (T1), and at a week 12 follow-up visit (T2). Results: A statistically significant improvement was found for both VAS pain and SPADI total scores, between T0 and T2 visits. US-guided injections were well tolerated and, apart from one patient with a progression of a tendon tear, no adverse events were recorded. Conclusions: Intratendinous tear US-guided injection therapy with an LWP solution was found to be safe and effective in improving both pain and shoulder function at a 12-week follow-up visit. The present pilot study should be considered the first step justifying a larger confirmatory investigation.
Article
Full-text available
This study aims to extract pepsin soluble collagen (PSC) from sturgeon cartilage, hydrolyze to sturgeon cartilage collagen peptides (SCCP), and prepare SCCP nanoliposomes to explore the treatment effects of osteoarthritis (OA) in rats. PSC was extracted using 0.5 M acetic acid and pepsin (10%) and enzymatically hydrolyzed with 4.5% alcalase plus 4.5% flavourzyme to obtain SCCP. Amino acid analysis revealed the presence of glycine, proline, and hydroxyproline in high amounts, while SDS‐PAGE showed that the PSC belonged to type II collagen with molecular weight (MW) of SCCP being <2 kDa and MALDI‐TOF‐MS indicated the MW distribution to range from 302.594 to 683.050 Da with the peptide fragments <500 Da accounting for 89.71%. SCCP nanoliposomes composed of phosphatidylcholine, fatty acid sucrose ester, glycerol, and deionized water were prepared with size at 34.58 nm, polydispersity index at 0.19, zeta potential at ‐54.53 mV, and encapsulation efficiency at 88.14%. Tube feeding of SCCP/SCCP nanoliposomes into OA rats alleviated pain responses by joint damage through reduction in hind limb weight‐bearing difference, knee joint width difference, and levels of serum biomarkers including CTX‐II, TGF‐β1, PIICP, and COMP. Histopathologic images demonstrated the mitigation of joint damage symptoms in the tissue by reducing cartilage joint damage, inhibiting chondrocyte apoptosis, promoting chondrocyte regeneration, and reducing synovitis. Collectively, the high dose of SCCP nanoliposomes was the most effective in alleviating OA possessing a great potential to be developed into a health food or botanic drug for the treatment of joint‐related disease.
Preprint
Key Points This section will be completed further Importance Toddlerhood is a key window of opportunity for development of musculoskeletal system and microbiome. In this study we tested the efficacy of a synbiotic-based young child formula on bone and muscle strength and microbiome maturation in young children during motor-skill development. Intervention In this randomized, double-blind controlled trial, children aged 2-3 years received either an experimental young child formula (EYCF) containing a combination of Limosilactobacillus reuteri DSM 17938 and galacto-oligosaccharides (GOS) or a minimally fortified milk (CM) for 6 months. A third arm remained on their habitual diet. Main outcomes and measures Bone quality (tibia speed of sound), muscle strength (handgrip), microbiota composition (shotgun metagenomics) and functionality (fecal metabolome) were evaluated at baseline, and after 3 months and 6 months of intervention. Microbiota and metabolomic features were associated to each other and to clinical bone and muscle readouts at the same timepoints. Results Tibial speed of sound was significantly increased after 6 months (primary end point, p<0.01) and 3 months (p<0.05) of EYCF vs CM feeding. These effects on bone strength were paralleled by significantly higher muscle strength after 6 months in EYCF vs CM. The intervention significantly remodeled microbiome composition, with enrichment of L. reuteri , and higher bifidobacteria presence in the stools of EYCF vs CM children at both 3 and 6 months. Increased L. reuteri abundance after 6 months of EYCF consumption was associated with higher bone quality and muscle strength. Stool metabolomics were significantly modulated by EYCF consumption with 45 metabolites significantly modified and associated to microbiome compositional changes such as Bifidobacterium spp. and L. reuteri expansion. Pairing of metagenomic and metabolomic signatures induced by EYCF revealed an enrichment of tryptophane and indole metabolism which significantly associated to bone and muscle strength clinical outcomes. Conclusions and relevance Consumption of an experimental young child formula containing a L. reuteri + GOS synbiotic improves musculoskeletal development in toddlers that was associated with a modulation of microbiota composition and functionality. These results provide novel mechanistic insights on gut-musculoskeletal crosstalk during early life and demonstrate that nutritional interventions targeting the microbiome can support healthy bone and muscle development and may contribute to functional motorskills acquisition during childhood. Trial registration The trial was registered at clinicaltrial.gov as NCT04799028
Article
Introduction: This study aimed to determine the effects of Stored Energy on changes in body weight (BW) and skeletal muscle mass (SMM) in patients with post-acute stroke and sarcopenia. Methods: This retrospective cohort study included patients with stroke and sarcopenia consecutively admitted to a Japanese rehabilitation hospital between 2015 and 2022. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia in 2019 criteria. Total Stored Energy (kcal) was defined as total energy intake minus total energy requirements during hospitalization, and energy requirements were estimated as actual BW (kg) × 30 (kcal/day). Multiple regression analysis was used to adjust for the effects of confounders and to analyze the association between Total Stored Energy divided by length of hospital stay (= Stored Energy) and changes in BW and SMM during hospitalization. Results: Of the total 556 patients, 193 patients (mean age, 80 years; 43% male) were analyzed. The median (IQR) Total Stored Energy was -1544 (-18524, 16566) kcal and Stored Energy was -23 (-169, 165) kcal/day; 90 patients had Stored Energy > 0. Multiple linear regression analysis showed that Stored Energy was independently and positively associated with BW gain (β=0.412, P<0.001) and SMM gain (β=0.263, P<0.001). Conclusion: Stored Energy has a positive impact on BW and SMM in patients with post-acute stroke and sarcopenia.
Article
Full-text available
Dietary consumption of food supplements has been found to modulate skin functions and can therefore be useful in the treatment of skin aging. However, there is only a limited number of clinical studies supporting these claims. In this double-blind, placebo-controlled study, the effectiveness of the specific bioactive collagen peptide (BCP) VERISOL® on eye wrinkle formation and stimulation of procollagen I, elastin and fibrillin biosynthesis in the skin was assessed. A hundred and fourteen women aged 45-65 years were randomized to receive 2.5 g of BCP or placebo, once daily for 8 weeks, with 57 subjects being allocated to each treatment group. Skin wrinkles were objectively measured in all subjects, before starting the treatment, after 4 and 8 weeks as well as 4 weeks after the last intake (4-week regression phase). A subgroup was established for suction blister biopsies analyzing procollagen I, elastin and fibrillin at the beginning of the treatment and after 8 weeks of intake. The ingestion of the specific BCP used in this study promoted a statistically significant reduction of eye wrinkle volume (p < 0.05) in comparison to the placebo group after 4 and 8 weeks (20%) of intake. Moreover a positive long-lasting effect was observed 4 weeks after the last BCP administration (p < 0.05). Additionally, after 8 weeks of intake a statistically significantly higher content of procollagen type I (65%) and elastin (18%) in the BCP-treated volunteers compared to the placebo-treated patients was detected. For fibrillin, a 6% increase could be determined after BCP treatment compared to the placebo, but this effect failed to reach the level of statistical significance. In conclusion, our findings demonstrate that the oral intake of specific bioactive collagen peptides (Verisol®) reduced skin wrinkles and had positive effects on dermal matrix synthesis. © 2014 S. Karger AG, Basel.
Article
Full-text available
Collagen hydrolysate (CH) has been reported to exhibit a positive effect on bone. In the present study, the in vitro effects of CH (<3 kDa) were examined and the in vivo experiments confirmed the positive effects of CH in ovariectomized (OVX) rats. Bone mineral density (BMD) was examined by DXA analysis. Scanning electron microscopic analysis and quantitative 3D-color backscattered electrons imaging analysis were performed on the lumbar vertebrae. CH increased osteoblastic cell proliferation and alkaline phosphatase activity in a dose-dependent manner. Collagen synthesis and collagen, type1, alpha1 (COL1A1) gene expression were also increased by CH treatment. Furthermore, CH-induced COL1A1 gene expression was completely abolished by extracellular signal-regulated kinase (ERK) inhibitor, suggesting the involvement of ERK/MAPK signaling for transcriptional effects on COL1A1 expression. OVX rats supplemented with CH showed osteoprotective effects as the BMD levels were increased compared with control. Moreover, CH prevented the trabecular bone loss induced by OVX and improved the microarchitecture of lumbar vertebrae. CH administration dose-dependently reduced the serum procollagen type I N-terminal propeptide level, which was elevated by OVX. The present study suggests that CH isolated in this study is a promising alternative to current therapeutic agents for the management of osteoporosis.
Article
Full-text available
Various dietary supplements are claimed to have cutaneous anti-aging properties; however, there are a limited number of research studies supporting these claims. The objective of this research was to study the effectiveness of collagen hydrolysate (CH) composed of specific collagen peptides on skin biophysical parameters related to cutaneous aging. In this double-blind, placebo-controlled trial, 69 women aged 35-55 years were randomized to receive 2.5 g or 5.0 g of CH or placebo once daily for 8 weeks, with 23 subjects being allocated to each treatment group. Skin elasticity, skin moisture, transepidermal water loss and skin roughness were objectively measured before the first oral product application (t0) and after 4 (t1) and 8 weeks (t2) of regular intake. Skin elasticity (primary interest) was also assessed at follow-up 4 weeks after the last intake of CH (t3, 4-week regression phase). At the end of the study, skin elasticity in both CH dosage groups showed a statistically significant improvement in comparison to placebo. After 4 weeks of follow-up treatment, a statistically significantly higher skin elasticity level was determined in elderly women. With regard to skin moisture and skin evaporation, a positive influence of CH treatment could be observed in a subgroup analysis, but data failed to reach a level of statistical significance. No side effects were noted throughout the study. © 2013 S. Karger AG, Basel.
Article
Full-text available
Chronic supplementation with creatine monohydrate has been shown to promote increases in total intramuscular creatine, phosphocreatine, skeletal muscle mass, lean body mass and muscle fiber size. Furthermore, there is robust evidence that muscular strength and power will also increase after supplementing with creatine. However, it is not known if the timing of creatine supplementation will affect the adaptive response to exercise. Thus, the purpose of this investigation was to determine the difference between pre versus post exercise supplementation of creatine on measures of body composition and strength. Nineteen healthy recreational male bodybuilders (mean +/- SD; age: 23.1 +/- 2.9; height: 166.0 +/- 23.2 cm; weight: 80.18 +/- 10.43 kg) participated in this study. Subjects were randomly assigned to one of the following groups: PRE-SUPP or POST-SUPP workout supplementation of creatine (5 grams). The PRE-SUPP group consumed 5 grams of creatine immediately before exercise. On the other hand, the POST-SUPP group consumed 5 grams immediately after exercise. Subjects trained on average five days per week for four weeks. Subjects consumed the supplement on the two non-training days at their convenience. Subjects performed a periodized, split-routine, bodybuilding workout five days per week (Chest-shoulders-triceps; Back-biceps, Legs, etc.). Body composition (Bod Pod(R)) and 1-RM bench press (BP) were determined. Diet logs were collected and analyzed (one random day per week; four total days analyzed). 2x2 ANOVA results - There was a significant time effect for fat-free mass (FFM) (F = 19.9; p = 0.001) and BP (F = 18.9; p < 0.001), however, fat mass (FM) and body weight did not reach significance. While there were trends, no significant interactions were found. However, using magnitude-based inference, supplementation with creatine post workout is possibly more beneficial in comparison to pre workout supplementation with regards to FFM, FM and 1-RM BP. The mean change in the PRE-SUPP and POST-SUPP groups for body weight (BW kg), FFM (kg), FM (kg) and 1-RM bench press (kg) were as follows, respectively: Mean +/- SD; BW: 0.4 +/- 2.2 vs 0.8 +/- 0.9; FFM: 0.9 +/- 1.8 vs 2.0 +/- 1.2; FM: -0.1 +/- 2.0 vs -1.2 +/- 1.6; Bench Press 1-RM: 6.6 +/- 8.2 vs 7.6 +/- 6.1.Qualitative inference represents the likelihood that the true value will have the observed magnitude. Furthermore, there were no differences in caloric or macronutrient intake between the groups. Creatine supplementation plus resistance exercise increases fat-free mass and strength. Based on the magnitude inferences it appears that consuming creatine immediately post-workout is superior to pre-workout vis a vis body composition and strength.
Conference Paper
Aging is associated with remarkable changes in body composition. Loss of skeletal muscle, a process called sarcopenia, is a prominent feature of these changes. In addition, gains in total body fat and visceral fat content continue into late life. The cause of sarcopenia is likely a result of a number of changes that also occur with aging. These include reduced levels of physical activity, changing endocrine function (reduced testosterone, growth hormone, and estrogen levels), insulin resistance, and increased dietary protein needs. Healthy free-living elderly men and women have been shown to accommodate to the Recommended Dietary Allowance (RDA) for protein of 0.8 g . kg(-1) . d(-1) with a continued decrease in urinary nitrogen excretion and reduced muscle mass. While many elderly people consume adequate amounts of protein, many older people have a reduced appetite and consume less than the protein RDA, likely resulting in an accelerated rate of sarcopenia. One important strategy that counters sarcopenia is strength conditioning. Strength conditioning will result in an increase in muscle size and this increase in size is largely the result of increased contractile proteins. The mechanisms by which the mechanical events stimulate an increase in RNA synthesis and subsequent protein synthesis are not well understood. Lifting weight requires that a muscle shorten as it produces force (concentric contraction). Lowering the weight, on the other hand, forces the muscle to lengthen as it produces force (eccentric contraction). These lengthening muscle contractions have been shown to produce ultrastructural damage (microscopic tears in contractile proteins muscle cells) that may stimulate increased muscle protein turnover. This muscle damage produces a cascade of metabolic events which is similar to an acute phase response and includes complement activation, mobilization of neutrophils, increased circulating an skeletal muscle interleukin-1, macrophage accumulation in muscle, and an increase in muscle protein synthesis and degradation. While endurance exercise increases the oxidation of essential amino acids and increases the requirement for dietary protein, resistance exercise results in a decrease in nitrogen excretion, lowering dietary protein needs. This increased efficiency of protein use may be important for wasting diseases such as HIV infection and cancer and particularly in elderly people suffering from sarcopenia. Research has indicated that increased dietary protein intake (up to 1.6 g protein . kg(-1) . d(-1)) may enhance the hypertrophic response to resistance exercise. It has also been demonstrated that in very old men and women the use of a protein-calorie supplement was associated with greater strength and muscle mass gains than did the use of placebo.
Article
Objectives: The objective of the present meta-analysis was to examine the effect of whey protein (WP), with or without resistance exercise, on body weight and body composition in randomized controlled trials (RCTs) conducted in generally healthy adult study populations. Methods: A comprehensive literature search was conducted to identify RCTs that investigated WP (concentrate, isolate, or hydrolystate) and body weight, body mass index (BMI), body fat, lean body mass (LBM), fat-free mass (FFM), and waist circumference. Random effects meta-analyses were conducted to generate weighted group mean differences (WGMD) for between-group comparisons (WP vs other protein sources or carbohydrates) and within-WP group comparisons (i.e., differences from baseline to trial end). Studies were classified into 2 distinct groups-WP as a supplement without dietary modification (WPS) and WP as a replacement for other sources of calories (WPR)-and were meta-analyzed separately. Subgroup analyses included examining the effect of resistance exercise and type of WP on the relationship between WP and body composition. Results: Fourteen RCTs were included, with a total of 626 adult study completers. Five studies examined the effects of WPR and the remaining 9 studies examined the effects of WPS. Body weight (WGMD: -4.20 kg, 95% confidence interval [CI], -7.67, -0.73) and body fat (WGMD: -3.74 kg, 95% CI, -5.98, -1.50) were significantly decreased from baseline in the WPR within-group analyses. In the between-group analyses, the effects of WP were more favorable when compared with carbohydrates than protein sources other than whey, although findings did not reach statistical significance. Results from the subgroup analyses indicated a statistically significant increase in LBM (WGMD: 2.24 kg, 95% CI, 0.66, 3.81) among studies that included a resistance exercise component along with WP provision. Conclusion: The current body of literature supports the use of WP, either as a supplement combined with resistance exercise or as part of a weight loss or weight maintenance diet, to improve body composition parameters.
Article
We investigated the effects of a chicken collagen hydrolysate (CCH) on the circulation system in humans. A total of 58 subjects with either mild hypertension (systolic blood pressure (SBP) of 140-159 mm Hg or diastolic blood pressure (DBP) 90-99 mm Hg) or high-normal blood pressure (SBP 130-139 mm Hg or DBP 85-89 mm Hg) were assigned to two groups, one involving a placebo and the other, the test food (including CCH of 2.9 g/d). The parameters related to each subject's circulation system were monitored over the study period of 18 weeks. The Δbrachial-ankle pulse wave velocity (baPWV), an indicator of arterial stiffness and marker of vascular damage, was significantly lower in the test food group than in the placebo group during the treatment period. The blood pressure in the test food group was also significantly lower than that in the placebo group, while the serum nitrogen oxide (NOx) was higher in the test food group after the treatment. These results suggest that CCH exerted modulatory effects on the human circulation system.
Article
Background: Protein ingestion after a single bout of resistance-type exercise stimulates net muscle protein accretion during acute postexercise recovery. Consequently, it is generally accepted that protein supplementation is required to maximize the adaptive response of the skeletal muscle to prolonged resistance-type exercise training. However, there is much discrepancy in the literature regarding the proposed benefits of protein supplementation during prolonged resistance-type exercise training in younger and older populations. Objective: The objective of the study was to define the efficacy of protein supplementation to augment the adaptive response of the skeletal muscle to prolonged resistance-type exercise training in younger and older populations. Design: A systematic review of interventional evidence was performed through the use of a random-effects meta-analysis model. Data from the outcome variables fat-free mass (FFM), fat mass, type I and II muscle fiber cross-sectional area, and 1 repetition maximum (1-RM) leg press strength were collected from randomized controlled trials (RCTs) investigating the effect of dietary protein supplementation during prolonged (>6 wk) resistance-type exercise training. Results: Data were included from 22 RCTs that included 680 subjects. Protein supplementation showed a positive effect for FFM (weighted mean difference: 0.69 kg; 95% CI: 0.47, 0.91 kg; P < 0.00001) and 1-RM leg press strength (weighted mean difference: 13.5 kg; 95% CI: 6.4, 20.7 kg; P < 0.005) compared with a placebo after prolonged resistance-type exercise training in younger and older subjects. Conclusion: Protein supplementation increases muscle mass and strength gains during prolonged resistance-type exercise training in both younger and older subjects.