2. Real case sharing:

An 85-year-old woman with longstanding diabetes (since 1993) and osteoporosis presented to the clinic for unintentional weight loss (from 50kg to 43kg) and decline in walking speed. She was short in stature (height 144cm) and lived a sedentary lifestyle.

Other major past medical history included coronary artery disease and chronic kidney disease(stage 3b) for which she was on an SGLT-2 inhibitor. She was diagnosed to have possible sarcopenia by a small calf circumference (< 33cm), elevated 5-time chair stand test (≥12secs) and borderline low handgrip strength (18kg). 

Due to fear of worsening glycemic control, she restricted both carbohydrates and protein intake in her diet. Her body weight didn't increase despite repeated counselling on diet and exercise.

• Treatment goal: 
  • Prevent further weight loss and maintain normal body weight 
  • Prevent sarcopenia 
  • Improve muscle function and stamina 
• Treatment strategy: 
  • Dietary counselling to increase protein intake for muscle rebuilding 
  • No approved medication available for sarcopenia 
  • Oral nutritional supplements with HMB (2 servings/day) are recommended to improve nutritional status regarding energy level and protein intake and to increase muscle mass. (Protein intake should be assessed on a case-by-case basis according to the CKD status.) 
• Clinical outcome: 
  • After 60 days of ONS + HMB (2 servings of 1.5g CaHMB per day) intervention, the patient’s nutritional status and muscle function were significantly improved: