Table 3 Characteristics & outcomes of included articles

Maltais et al., 2016

[31]

Total (N = 26); Control (n = 10), Intervention 1, Int 1 (n = 8),

Int 2 (n = 8)

Mean age = 65 ± 5 years old (y/o)

Randomised controlled trial (RCT),

4 months

Control: Post-exercise shakes

Intervention 1: Dairy Group

Int 2: Non-dairy isocaloric and Isoprotein

Research center, Canada

Sarcopenia:

appendicular lean mass index lower than 10.75 kg/m2

Obesity: BMI > 30 kg/m²

Three weekly 1 h-sessions, including a 10-min

warm-up, were held on 3 non-consecutive days for

16 weeks.

Drink the shake immediately after the exercise session

Health education class: every 2 weeks

Control: Rice milk (0.6 g protein) 1.0-1.2 g protein/kg/day

Int 1: Dairy shake (13.53 g protein, 7 g EAA) 1.3–2.1 g protein/kg/day

Int 2: Non-dairy protein shake (12 g protein, 7 g EAA) 1.0-1.3 g protein/kg/day

Significant decreases were

observed with Fat Mass only in the dairy supplement group.

Resistance training significantly increased lean mass in all

groups (p < 0.05) independently of supplementation

(1.9 kg, nondairy shake; 1.7 kg, dairy shake; 1.4

 kg, control).

Body weight

significantly increased in the non-dairy shake group

only (1.9 kg, p < 0.05).

No changes were observed for

body mass index.

Small number of participants were included in the group,

statistical power to investigate any potential underlying

mechanisms is limited.

Resistance training combined with a

milk-based post-exercise supplementation significantly

reduced fat mass (FM) and increased lean mass (LM)

No significant changes in biochemical profile (i.e. inflammatory marker).

*men only

Kim et al., 2016

[32]

Total (N = 139); Control (n = 34), Int 1 (n = 36),

Int 2 (n = 35)

Int 3 (n = 34)

Mean age=

Control (81.1 ± 5.1 y/o), Int 1 (80.9 ± 4.2)

Int 2 (81.4 ± 4.3)

Int 3 (81.2 ± 4.9)

Randomised controlled trial (RCT),

3 months

Control: Health education

Int 1: Exercise and nutrition supplement,

Int 2: Exercise

Int 3: Nutritional supplement

Community based, Japan

Sarcopenic obesity : body fat percent of

32% or greater, measured by dual x-ray energy absorptiometry (DXA,

Hologic QDR 4500 A), combined with skeletal muscle mass index less

than 5.67 kg/m2

;

Each exercise class was 60 min,

twice per week

Nutrition:

Protein supplementation & Tea catechin was taken daily

Edu class: every 2 weeks

Protein supplementation: 3 g leucine-enriched EAA

Tea catechin: 540 mg catechin

Education class: topic focused

including cognitive function, long-term

care insurance, etc. for elderly

Compared to control group, exercise (Ex) + nutrition (N) supplement group showed significant decreased in total body fat mass (p = 0.036) and increased stride (p = 0.038).

Total body fat mass decreased in all intervention groups with greatest decrease found in Ex + N (5.5%, p = 0.036).

Exercise group showed decreased in trunk fat (p = 0.014).

The Ex + N and Ex interventions were over four times as likely

to reduce body fat mass than the control group.

Catechin can reduce body fat.

Effects of exercise and nutrition alone were insufficient in

increasing muscle strength among sarcopenic elderly people.

No different in inflammatory biomarker.

*women only

Sammarco et al., 2017

[33]

Total (N = 18); Control (n = 9), Intervention (n = 9),

Mean age=

Control (58 ± 10y/o),

Intervention (53.9 ± 9)

Randomised controlled trial (RCT),

4 months

Control: Hypocaloric diet + placebo

Int:

Hypocaloric + high protein diet

Primary care setting, Italy

Obesity diagnosed as fat

mass > 34.8% and sarcopenia was defined when lean body mass was < 90% of the subject’s

ideal fat free mass

Adherence to diet through a 7-day dietary record, dietitians followed up via phone calls every 2 weeks

Control: low calorie diet (minus 10% from REE calorimetry; 0.8-1 g protein/kg/day)

Intervention 1: Low calorie + high protein diet (1.2–1.4 g protein/kg/day) with 15 g of protein of high biological value

for each main meal

Women with high-protein diet preserved lean body mass and improved in muscle strength compared to control group.

Weight significantly decreased in both groups.

Dietary protein enrichment may represent

a protection from the risk of sarcopenia following a hypocaloric diet (increased muscle strength score + 1.6 kg).

*women only

Kemmler et al., 2017

[34]

Total (N = 100); Control (n = 34), Int 1 (n = 33),

Int 2 (n-=33)

Mean age=

Control (76.9 ± 5.1y/o),

Int 1 (77.1 ± 4.3),

Int 2 (78.1 ± 5.1)

Randomised controlled trial (RCT),

4 months

Control: Non-intervention

Int 1:

WB-EMS + protein supplementation

Int 2: Isolated protein supplementation

Community based, German

Sarcopenia:EWGSOP

Obesity: A percentage body fat

ratio of > 27% (PBF) representing obesity

WB-EMS: 1.5 times per week, from 14 to 20 min after week 4 (4s electromuostimulation 4s rest)

Protein supplement: Take with water, each time not more than 40 g (no specific time on intake)

Protein supplement + Vit D: Whey protein powder to achieve protein intake of 1.7-1.8 g/kg/day (per 100 g: 80 g whey protein, 9 g L-leucine, 57 g EAA)

Handgrip strength increased in the WB-EMS group (1.90 kg; P,0.001; P = 0.050 vs. control).

Skeletal muscle mass increased significantly

in both groups (P,0.001 and P = 0.043) and decreased significantly in the control group (p = 0.033).

Both intervention groups loss body fat (Int 1: 2.1%; Int 2: 1.1%), p < 0.001.

No adverse effects of WB-EMS or protein supplementation were found.

*men only

Kemmler et al., 2018

[35]

Total (N = 100); Control (n = 34), Int 1 (n = 33),

Int 2 (n-=33)

Mean age=

Control (76.9 ± 5.1y/o),

Int 1 (77.1 ± 4.3),

Int 2 (78.1 ± 5.1)

Randomised controlled trial (RCT),

4 months

Control: Non-intervention

Int 1:

WB-EMS + protein supplementation

Int 2:

Isolated protein supplementation

Community based, German

Sarcopenia:EWGSOP

Obesity: A percentage body fat

ratio of > 27% (PBF) representing obesity

WB-EMS: 1.5 times per week, from 14 to 20 min after week 4 (4s electromuostimulation 4s rest)

Protein supplement: Take with water, each time not more than 40 g (no specific time on intake)

Protein supplement + Vit D: Whey protein powder to achieve protein intake of 1.7-1.8 g/kg/day (per 100 g: 80 g whey protein, 9 g L-leucine, 57 g EAA)

No mention in this article.

Total body fat was reduced significantly in the protein group (− 3.6 ± 7.2%; p = 0.005) and WB-EMS + P (− 6.7 ± 6.2%; p < 0.001), but not in the control group (+ 1.6 ± 7.1%; p = 0.19).

Trunk fat and waist circumference were decreased in intervention group (p < 0.001).

Moderate-high dosed of whey protein supplementation, especially when combined with WB-EMS, may be a

feasible choice to address obesity and cardiometabolic risk in older sarcopenic obese adults.

Treatment group showed improved in HDL-c but not statistic diff in TG and LDL-c level.

*men only

Nabuco et al., 2019

[36]

Total (N = 26); Control (n = 13), Intervention (n = 13),

Mean age=

Control (70.1 ± 3.9 y/o),

Intervention (68.0 ± 4.2)

Randomised controlled trial (RCT),

3 months

Control: Placebo + supervised resistance training

Intervention: Protein supplement + supervised resistance training

Community, Brazil

Sarcopenic: Appendicular lean soft tissue ALST < 15.02 kg

Obesity: body fat mass ≥ 35%

Protein: Consumed only on training day

Resistance exercise: (8 exercises, 3 × 8–12 rep, 3 times a week)

Protein: 35 g of whey protein (1.0 g protein/kg/day)

Intervention group presented greater increased in ALST (p < 0.05) compared to control group.

Intervention group showed decreased in trunk fat mass (p < 0.05) compared to control group.

Both groups showed improved (p < 0.05) scores for muscle strength, functional capacity, and metabolism biomarkers (IL-6) but no significant different between groups.

Resistance training increased HDL-c, reduced

glucose, TG, and CRP, without affecting LDL-c,

insulin.

*women only

Camajani et al., 2022

[37]

Total (N = 16);

Mean age = 60 y/o (50–70 years)

Pre-post pilot study,45 days

Intervention: Low calories diet + protein supplementation

Primary care, Italy

Sarcopenia: EWGSOP2

Obesity: Fat mass > 38%, according to NHANES III

Low calories diet: 1000 kcal/day (28% protein; 32% fat, 30% carbohydrate)

Protein: taken at 5pm daily

Protein: 18 g whey protein (4.1 g of leucine); 5 mg vitamin D3; 1.38 g protein/kg/day

Women preserved total lean

body mass and significantly improved their muscle strength, as measured by handgrip

(15.3 vs. 20.1 Kg), and their muscle function.

A significant reduction in

BMI (37.6 vs. 35.7 Kg/m2

) and waist circumference (107 vs. 102.4 cm).

Significant

decreased in total trunk fat (p = 0.049).

No significant different in biomarkers.

No significant adverse effects were recorded.

Significant increased in BUN, slight increased in serum creatine and mild reduction in eGFR were found.

*women only