Effect of vitamin D supplementation, omega 3 fatty acid supplementation, or a simple home exercise program on muscle mass and incident sarcopenia over 3 years The DO HEALTH randomized clinical trial

Authors: EGGIMANN, ANNA - University Of Zurich; REZENDE COSTA MOLINO, CAROLINE - University Of Zurich; FREYSTATTER, GREGOR - University Of Zurich; VELLAS, BRUNO - University Of Toulouse; KANIS, JOHN - University Of Sheffield Medical School; RIZZOLI, RENE - Geneva University Hospital; KRESSIG, RETO - University Of Basel; ARMBRECHT, GABRIELE - Berlin Institute Of Health; DA SALVA, JOSE - University Of Coimbra; DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; LANG, WEI - University Of Zurich; GAGESCH, MICHAEL - University Of Zurich; EGLI, ANDREAS - University Of Zurich; BISCHOFF- FERRARI, HEIKE - University Of Zurich

Submitted to: Journal of the American Medical Association
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/21/2024
Publication Date: 11/20/2024
Citation: Eggimann, A.K., Rezende Costa Molino, C.D., Freystatter, G., Vellas, B., Kanis, J.A., Rizzoli, R., Kressig, R.W., Armbrecht, G., Da Salva, J.A., Dawson-Hughes, B., Lang, W., Gagesch, M., Egli, A., Bischoff- Ferrari, H. 2024. Effect of vitamin D supplementation, omega 3 fatty acid supplementation, or a simple home exercise program on muscle mass and incident sarcopenia over 3 years The DO HEALTH randomized clinical trial. Journal of the American Medical Association. https://doi.org/10.1001/jama.2020.16909.
DOI: https://doi.org/10.1001/jama.2020.16909

Interpretive Summary: Muscle mass declines by 0.7 to 0.8% per year in older adults and low muscle mass is a strong predictor of falls, functional impairment and hospital admissions. Low vitamin D levels and lack of physical activity promote muscle loss. The purpose of this study was to determine whether supplementation with vitamin D (2000 IU), marine omega-3s (1g / day), and/or a simple home exercise program altered change in muscle mass in older adults. We performed a 3-year randomized, double-blind, placebo-controlled trial in 2157 community dwelling, generally healthy and active adults aged 70 years and older. Change in muscle mass was assessed by DXA. Among generally healthy, physically active older adults, muscle mass was not improved by treatment of daily 200 0IU vitamin D, daily 1g of omega-3s, or a simple home exercise program. These findings apply only to active older people, and it remains to be determined whether these interventions would be effective in more vulnerable older adults at high risk for falls or in institutionalized older people.

Technical Abstract: AbstractBackground We aimed to investigate the effect of daily supplemental vitamin D (2000 IU), daily supplemental marine omega-3s (1g / day) and a 3-weekly simple home exercise program (SHEP), alone or in combination, on change of muscle mass and incident sarcopenia among generally healthy older adults. Methods We performed a 3-year randomized, double-blind, placebo-controlled trial with a 2 x 2 x 2 factorial design among 2157 community-dwelling, generally healthy and active adults aged 70 years and older, from 2012 and November 2018 (DO-HEALTH). Participants were randomized to 2000 IU/d of vitamin D and/or 1 g/d of marine omega-3s and/or a simple home exercise program (3x per week). The outcome of change in muscle mass over three years was calculated in all participants who underwent DXA (n=1495) using mixed effect models. Incident sarcopenia based on the definition by the Sarcopenia Definitions and Outcomes Consortium over three years was analyzed in all participants who were non-sarcopenic at baseline (n=1940) using multivariate logistic regression model. Results Among 1495 participants (mean age 74.9 (sd 4.4); 63.3% women; 80.5% were at least moderately physically active at baseline) mean gait speed at baseline was 1.2 m/sec (0.3), mean muscle mass at baseline was 6.65 (SD 0.95) in women and 8.01 (SD 0.88) kg/m2 61 in men. At year 3, average change of muscle mass was -0.09 (sd 0.34) kg/m2(-1.35%) in women and -0.17 (sd 0.33) kg/m2 63 (-2.0%) in men. None of treatments individually or in combination had a benefit on change in muscle mass compared to control over three years, with omega-3s showing a small protective effect on muscle mass at year 1 only (-0.021 vs. no-omega-3s -0.066 kg/m2 66 , p=0.001). Of 1940 non-sarcopenic participants at baseline (mean age 74.8 (sd 4.3); 61.4% women; mean gait speed at baseline 4 1.2 (0.2) m/sec), 88 (4.5%) developed incident sarcopenia over 3 year follow-up. None of treatments individually or in combination reduced the odds of incident sarcopenia compared with placebo. Conclusion Among generally healthy, physically active older adults, both muscle mass and incidence of sarcopenia were not improved by treatment of daily 2000IU vitamin D, daily 1g of omega-3s, or a simple home exercise program compared with control over 3 years.