A Systematic Review, Meta-Analysis and Meta-Regression of the Effect of Protein Supplementation on Resistance Training-Induced Gains in Muscle Mass and Strength in Healthy Adults

Protein supplementation added 2.49 kg to one-repetition-maximum strength and 0.30 kg of fat-free mass over resistance training alone, with no further fat-free mass gain above a total intake of 1.62 g/kg/day.
Summary

The authors pooled 49 randomized controlled trials covering 1,863 healthy adults who resistance trained for at least six weeks. Adding a protein supplement produced small extra gains in strength, fat-free mass and muscle fiber size. The benefit fell with increasing age, was larger in people who were already trained, and stopped once total protein intake reached about 1.6 g per kg of body weight per day.

Context Note
Gains were small in absolute terms and stopped above 1.62 g/kg/day of total protein. Useful for setting an honest expectation.

Study breakdown

Why this study was done

Taking a protein supplement alongside weight training is standard practice among lifters, and it has also been recommended for older people to slow age-related muscle loss. Earlier reviews and meta-analyses had reached conflicting conclusions about whether the supplement adds anything on top of the training itself, which the authors put down to differing inclusion rules. They ran a larger analysis, and asked: is there a daily protein intake beyond which supplementing stops adding anything?

How it was run

The authors systematically searched Medline, Embase, CINAHL and SportDiscus up to January 2017. Training had to last at least 6 weeks with sessions at least twice a week, and at least one group had to receive a protein supplement not combined with other muscle-building agents such as creatine or HMB. Participants had to be healthy and not calorie-restricted. After screening 3056 studies, 49 trials with 1863 participants were included. Meta-regressions used four covariates decided in advance: baseline protein intake, protein dose, age and training status.

What they found

Protein supplementation added a small amount on top of training across every outcome:

  • One-repetition-maximum strength: 2.49 kg (95% CI 0.64 to 4.33), about 9% on top of the average training-induced gain of 27 plus or minus 22 kg.
  • Fat-free mass: 0.30 kg (95% CI 0.09 to 0.52), about 27% on top of the 1.1 plus or minus 1.2 kg gained from training alone.
  • Muscle fiber cross-sectional area: 310 square micrometers (95% CI 51 to 570), about 38%.

Increasing age reduced it (minus 0.01 kg per year, 95% CI minus 0.02 to 0.00, p = 0.002), and being already resistance-trained increased it (0.75 kg, 95% CI 0.09 to 1.40, p = 0.03). Split by training status, the gain was 1.05 kg in trained participants (95% CI 0.61 to 1.50, p below 0.0001) but 0.15 kg and not statistically significant in untrained ones (95% CI minus 0.02 to 0.31, p = 0.08). The break point analysis put the plateau in fat-free mass gains at a total intake of 1.62 g/kg/day, with a wide confidence interval of 1.03 to 2.20, and the authors note the segmental fit was not statistically significant (p = 0.079). Post-exercise protein dose did not affect results.

Limitations

The senior author states he has received grant support, travel expenses and honoraria for presentations from the US National Dairy Council, and that this agency has supported trials included in the analysis. Research in older people was thin: only 13 studies met inclusion criteria in people over 45, and only 2 gave a post-exercise dose the authors consider optimal. The average supplemental dose given to older participants was 20 plus or minus 18 g per day, which the authors call surprisingly low, so the null result in older people may reflect underdosing rather than a real absence of effect. The covariate analyses are described as hypothesis generating.

What it means in practice

The honest summary is that resistance training does most of the work and protein supplementation adds a small increment on top: about 2.5 kg on a one-rep max and about 0.3 kg of fat-free mass on average. The increment appears larger in people who already train and smaller as age rises, and it appears to stop adding once total daily protein reaches somewhere around 1.6 g/kg/day, though that estimate is imprecise. This analysis covers healthy adults eating at or above their energy needs. It does not apply to people in a calorie deficit, and the older-adult findings are weak enough that they should not be read as evidence that protein does not help older people.

Study Type
Meta-Analysis
Published
2018
British Journal of Sports Medicine
Participants
49 studies, 1,863 healthy adults, resistance training of 6 weeks or longer
Dose Studied
Supplement doses varied by trial. Gains in fat-free mass stopped once total protein intake passed 1.62 g per kg per day.
Health Focus
Strength & Power
Ingredients
Protein

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