Overview
Research Article Title: Impact of Hydroxy-Methyl-Butyrate Supplementation on Malnourished Patients Assessed Using AI-Enhanced Ultrasound Imaging
Authors: D Luis et al.
Published in: Journal of Cachexia, Sarcopenia and Muscle
Date of Publication: 24 February 2025
Link to Artcile →
Summary
Disease-related malnutrition is linked to a variety of negative health impacts such as decreased functional abilities like limited physical performance, reduced muscle strength, and significant limitations in everyday activities. The Global Leadership Initiative on Malnutrition states that muscle mass measurement is considered an important factor when diagnosing disease-related malnutrition.
This study aimed to evaluate the effects of an oral nutrition supplement (ONS) enriched with hydroxy-methyl-butyrate (HMB) on improving nutritional status, muscle mass, and muscle quality in adult patients with disease-related malnutrition (DRM), and to monitor these changes using an AI-enhanced ultrasound imaging system.
Key Findings:
- Reduced malnutrition and sarcopenia: The percentage of patients classified as having sarcopenia dropped from 24% to 18%; severe malnutrition decreased from 14% to 2%.
- Improved body composition: Significant improvements in fat-free mass, skeletal muscle mass, and skeletal muscle index.
- Functional improvements: Handgrip strength increased significantly; TUG test performance improved (i.e., participants completed the mobility test faster).
- Muscle quality improvements: Including a significant increase in thickness of the vastus intermedius muscle via AI-ultrasound.
Methodology
The study was conducted over the course of 3 months on 51 participants who were diagnosed with DRM, with 14% having severe malnutrition.
Participants included 21 males and 29 females with an average age of 57.8 years.
The 3-month duration included nutrition education, medical nutrition therapy, and 2 servings of the oral nutritional supplement.
Product used: Ensure Plus Advance, 2 servings per day
Two daily servings provided 660 calories, 78 g carbohydrate, 26 g protein, 22 g fat, and 3 g HMB.
Telephone follow-ups occurred every 4 weeks.
Outcomes measured:
- Nutritional status was evaluated by the following biomarkers: albumin, prealbumin, and C-reactive protein.
- Body composition (fat and skeletal muscle mass) was determined by bioelectrical impedance analysis.
- Muscle mass and quality via ultrasound of thigh muscles (rectus femoris and vastus intermedius) were analyzed using an AI-based imaging system to automatically quantify muscle thickness and echogenicity-based quality indices.
Why It Matters
The study suggests that in adults with DRM, supplementation with an HMB-enriched oral nutritional supplement (along with dietary counseling) over 3 months can meaningfully improve muscle mass, muscle quality, functional strength, and overall nutritional status.
The use of AI-enhanced ultrasound imaging is noteworthy, as it provides an objective, quantitative method to monitor muscle changes (mass and quality) over time. This may be especially useful in clinical settings to track recovery from malnutrition or muscle wasting.
Since malnutrition and sarcopenia are linked with worse outcomes (morbidity, longer hospital stays, lower quality of life), improving these parameters could reduce risks associated with DRM or sarcopenia.
Limitations
- No control group: Absence of a randomized control limits the ability to conclusively attribute improvements solely to HMB supplementation.
- Short follow-up: Three months is sufficient to show early improvements, but longer-term sustainability of gains and outcomes such as morbidity, quality of life, hospitalization, mortality, or muscle function over time were not assessed.
- Reliance on self-reported adherence: Supplement intake was self-reported, which may introduce bias or inaccuracies.
Final Thoughts
This real-world study provides encouraging evidence that in adults with disease-related malnutrition, supplementation with a high-protein, HMB-enriched oral nutrition product over 3 months can lead to measurable improvements in nutritional status, muscle mass and quality, and functional capacity with meaningful clinical benefits.
The use of AI-enhanced ultrasound imaging demonstrates a practical, non-invasive, and operator-independent way to monitor muscle changes and potentially a more accessible alternative to advanced imaging modalities (e.g., CT, MRI, DXA), especially in routine clinical settings.
The inclusion of nutritional interventions such as this one to help reduce or even prevent muscle mass loss and enhance physical function is crucial to optimize recovery.
Some additional nutrition interventions via the ESPEN guidelines include:
- 30 kcal/kg body weight per day
- Higher protein intake: 1.2–1.5 g/kg body weight per day of protein (~25–30 grams of protein per meal)
- Inclusion of high-quality protein sources to meet daily needs and maximize muscle protein synthesis
To optimize patients’ nutritional status, partnering with a Registered Dietitian is best practice, ensuring nutrition education that is both safe and effective for optimal outcomes.
This article was written by Katie Frushour, MS, RD, CSSD, a dietitian at Mend.
