The effect of protein and essential amino acid supplementation on muscle strength and performance in patients with chronic heart failure: a systematic review

Simon Nichols, Gordon McGregor, Abdallah Al-Mohammad, Ali N. Ali, Garry Tew, Alasdair F. O’Doherty

    Research output: Contribution to journalReview articlepeer-review

    20 Citations (Scopus)
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    Purpose: Critically low skeletal muscle mass and strength, observed in 20% of people with chronic heart failure (CHF), reduces functional capacity, quality of life (QoL) and survival. Protein and essential amino acid (EAA) supplementation could be a viable treatment strategy to prevent declines in muscle strength and performance, and subsequently improve QoL and survival. This systematic review (PROSPERO: CRD42018103649) aimed to assess the effect of dietary protein and/or EAA supplementation on muscle strength and performance in people with CHF. Methods: Searches of PubMed, MEDLINE and Embase identified studies that reported changes in strength or muscle performance following protein and/or EAA supplementation in patients with CHF. Following PRISMA guidelines and using predefined inclusion/exclusion criteria relating to participants, intervention, control, outcome and study design, two reviewers independently screened titles, abstracts and full manuscripts for eligibility. Risk of bias was assessed using Cochrane Risk of Bias Tool (RCTs) or Mixed Methods Appraisal Tool (cohort studies). Data were extracted for analysis using predefined criteria. Results: Five randomised controlled trials (RCT) and one cohort study met our inclusion criteria. All RCTs had a high risk of bias. The methodological quality of the cohort study was moderate. Heterogeneity of extracted data prevented meta-analyses, qualitative synthesis was therefore performed. Data from 167 patients with CHF suggest that protein and/or EAA supplementation does not improve strength, but may increase six-minute walk test distance, muscle mass and QoL. Conclusions: The limited quality of the studies makes firm conclusions difficult, however protein and/or EAA supplementation may improve important outcome measures related to sarcopenia. High-quality randomised controlled studies are needed.

    Original languageEnglish
    Pages (from-to)1785-1801
    Number of pages17
    Journaleuropean journal of nutrition
    Issue number5
    Early online date28 Oct 2019
    Publication statusPublished - Aug 2020

    Bibliographical note

    This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.


    • Amino acids
    • Cachexia
    • Diet
    • Frailty
    • Heart failure
    • Muscles
    • Sarcopenia

    ASJC Scopus subject areas

    • Medicine (miscellaneous)
    • Nutrition and Dietetics


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