BACKGROUND: Prior research has highlighted the synergistic impact of protein supplementation on muscle function post-exercise in adults; however, evidence supporting the combined effects were less robust and inconsistent on those with protein insufficiency. This investigation aims to explore efficacy of protein-enriched soup coupled with exercise on muscle health and metabolism in middle-aged and older adults with suboptimal protein intake. METHODS: An open-label, 12-week, randomized controlled trial involving participants with insufficient protein intake (< 1.0 g/kg/day) was done. The intervention group consumed protein-enriched soup (24 to 30 g protein daily) and 1-h weekly exercise, while controls received health education. Assessments included laboratory tests, functional assessments, and body composition. RESULTS: In this trial, 97 out of 100 randomized participants (mean age 64.65 +/- 4.84 years, 81.8% female) completed the study (47 in intervention group and 50 in control group). Compared results of baselines, at 1 and 3 months of intervention, significant improvements in waist circumference (83.48 +/- 10.22 versus 82.5 +/- 9.88 versus 82.37 +/- 9.42 cm, p for trend = 0.046), 6-min walking distance (525.65 +/- 58.46 versus 534.47 +/- 51.87 versus 552.02 +/- 57.66 m, p for trend = 0.001), five-time sit-to-stand time (7.63 +/- 1.63 versus 6.81 +/- 1.8 versus 6.4 +/- 1.42 s, p for trend < 0.001), grip strength (26.74 +/- 6.54 versus 27.53 +/- 6.99 versus 28.52 +/- 7.09 kg, p for trend < 0.001), and MNA score (26.8 +/- 2.14 versus 27.73 +/- 1.74 versus 27.55 +/- 1.72, p for trend < 0.001) were discerned within the intervention group. The intervention demonstrated a significant reduction in serum triglyceride (105.32 +/- 49.84 versus 101.36 +/- 42.58 versus 93.43 +/- 41.49 mg/dL, p for trend = 0.023), increased HDL-C (60.04 +/- 16.21 versus 60 +/- 17.37 versus 62.55 +/- 18.27 mg/dL, p for trend = 0.02), and DHEA-S levels (97.11 +/- 54.39 versus 103.39 +/- 56.75 versus 106.83 +/- 60.56 mug/dL, p for trend = 0.002). Serum myostatin did not differ in both groups, but serum leptin levels significantly increased (9118.88 +/- 5811.68 versus 11508.97 +/- 7151.08 versus 11220.80 +/- 7190.71 pg/mL, p for trend = 0.016) in controls. The intervention group showed greater improvements in 6 min walking distance (beta 0.71, 95% CI 6.88 to 40.79, p = 0.006), five-time sit-to-stand test (beta -0.87, 95% CI -1.59 to -0.15, p = 0.017), MNA score (beta 0.96, 95% CI 0.20 to 1.71, p = 0.013), serum triglycerides (beta -15.01, 95% CI -27.83 to -2.20, p = 0.022), LDL-C (beta -9.23, 95% CI -16.98 to -1.47, p = 0.020), and DHEA-S levels (beta 9.98, 95% CI 0.45 to 19.51, p = 0.04) than controls. CONCLUSIONS: Protein-enriched soup with weekly exercise over 12 weeks significantly improved physical performance, lipid profile, and DHEA-S levels among middle-aged and older adults with inadequate protein intake, while studies assessing long-term benefits of the intervention are needed.

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