Sarcopenic obesity often coexists with metabolically associated fatty liver disease (MASLD) and type 2 diabetes mellitus (T2DM). The factors that determine whether dietary supplements can increase or preserve muscle mass in this population are not well established. This study examined the effect of a diabetes-specific dietary supplement containing beta-hydroxy-beta-methylbutyrate (HMB) on total body muscle mass measured by densitometry after 6 months of treatment in patients with T2DM who also met criteria for sarcopenic obesity and MASLD.
Primary aims included assessing the change in whole-body muscle mass after 6 months of supplementation and identifying linear correlations between the magnitude of muscle mass change and baseline variables including age, appendicular lean mass index, and metabolic markers such as hemoglobin A1c, C-peptide, and triglycerides. The investigators also evaluated the predictive value of those baseline parameters for the likelihood of muscle mass increase.
This cross-sectional study enrolled 48 patients with type 2 diabetes aged 55–84 years (40 female, 8 male; mean age 72.48 ± 8.26 years). A control group of 20 age-similar individuals without diabetes or MASLD and without significant comorbidities was included for comparison. Liver steatosis was confirmed by transient elastography. Total body muscle mass and body composition parameters were determined by densitometry.
Baseline laboratory and body composition measures reported for the patient cohort included: body mass index 27.80 ± 4.63, hemoglobin A1c 6.27 ± 0.73, degree of steatosis 289 ± 42 dB/m, appendicular muscle mass index 6213 ± 786 g/m², android fat ratio 47.59 ± 9.80%, and total fat ratio 41.82 ± 9.31%.
Participants received the HMB-containing, diabetes-specific dietary supplement for a duration of 6 months. The study design and analyses used simple linear regression to identify associations between muscle mass change and baseline parameters, and logistic regression to evaluate predictors of muscle mass change. No additional details about the specific supplement formulation, dose, adherence measures, or concurrent lifestyle interventions were reported in the abstract.
After 6 months of supplementation, 28 of the 48 patients exhibited an increase in total muscle mass. Within that subgroup, 16 patients increased muscle mass up to 5% of their baseline value, 8 patients increased by more than 5%, and 4 patients increased by more than 10%. The remaining 20 patients experienced a slight decrease in muscle mass, with all decreases limited to up to 5% of baseline.
At the group level the authors report that changes in muscle mass did not reach statistical significance. The distribution of individual responses showed substantial variability, with a notable proportion maintaining or modestly increasing muscle mass during the treatment period.
Correlation analysis using simple linear regression identified the following significant relationships between baseline parameters and the degree of muscle mass increase:
No significant associations were observed between muscle mass change and any reported body composition parameters (for example, appendicular muscle mass index, android fat ratio, total fat ratio).
Logistic regression analysis identified age as a statistically significant negative predictor of muscle mass change (odds ratio 0.87; 95% confidence interval 0.77–0.99; p = 0.04). Triglycerides emerged as a borderline negative predictor (odds ratio 0.21; 95% confidence interval 0.04–1.03; p = 0.05).
The investigators conclude that administration of an HMB-containing dietary supplement led to increased or maintained muscle mass in a meaningful fraction of participants, but cohort-level changes did not achieve statistical significance. Individual responses varied, and higher age and higher triglyceride levels were associated with less favorable muscle mass change.
The authors characterize the study outcome as negative because group-level statistical significance was not reached. They explicitly note important limitations that constrain interpretation: a relatively small sample size and the cross-sectional nature of the analysis. The abstract does not report details on supplement dosing, exact composition, adherence monitoring, concomitant therapies, or whether the control group received any placebo or comparator intervention; these details were not provided in the source abstract.
Given these limitations, the authors recommend larger prospective studies to confirm whether HMB-containing nutritional support can reliably increase or preserve lean mass in patients with T2DM, sarcopenic obesity, and MASLD, and to further evaluate the predictive roles of age, triglycerides, and C-peptide in treatment responsiveness.