Trial compares effects of HMB-enriched supplement on malnourished cirrhotic patients

By Asia Sherman

- Last updated on GMT

Related tags Hmb Muscle Liver

© iStock
© iStock
Supplementation with β-Hydroxy-β-methylbutyrate (HMB) led to improved muscle strength and liver status in patients with cirrhosis and malnutrition, a study published in Nutrients shows.

Since its discovery 20 years ago, the naturally occurring leucine metabolite has been incorporated in supplements used to promote muscle-building, increase physical activity and prevent muscle loss, but the authors of the study note that HMB’s health benefits could be more far reaching.  

“Mounting evidence supports that supplementation with HMB can increase muscle mass and strength and reduce muscle damage during resistance exercises, as well as prevent muscle loss in the elderly,” ​they stated.

“However, there are few clinical reports of the effects of supplements enriched with HMB on other muscle-wasting diseases.”

The study – which expands the research into the effects of HMB on cirrhotic patients – was conducted at the University Hospital Miguel Servet in Zaragoza, Spain with support from the Fondo Europeo de Desarrollo Regional (FEDER), the Instituto de Salud Carlos III and the regional government of Aragón.

Study design

Considering findings that HMB may be effective in disorders characterized by increased proteolysis such as cachexia weight loss associated with AIDS or cancer, the researchers hypothesised that HMB supplementation would improve fat-free mass and muscle function in malnourished patients with decompensated cirrhosis.

“To test this hypothesis, we implemented a double-blind controlled trial to investigate the effects of an HMB-enriched oral nutritional supplement on changes in body composition and liver status,” ​they explained.  

“Another treatment with an oral nutritional supplement devoid of HMB and with similar macronutrient composition was used as control.”

The trial selected 43 randomised participants to receive twice-daily doses of either 220 mL of the HMB-enriched Ensure Plus Advance or 220 mL of Ensure Plus High Protein as control. Both have similar macronutrient compositions and were provided by Abbott Laboratories.

The research team assessed liver function, plasma biochemistry analyses and physical condition assessment at baseline, then after six weeks and at the end of the 12-week test period. A total of 34 patients completed the clinical trial. 

Analyses included parameters of nutrition (plasma proteins, albumin, prealbumin, folic acid and vitamin B12), hematimetric indices (hemoglobin, INR and blood cell count), cardiovascular risk markers (triglycerides, total cholesterol, HDL cholesterol, LDL cholesterol, apolipoprotein A, apolipoprotein B and lipoprotein, bone turnover markers (vitamin D and osteocalcin), as well as other metabolic and liver functionality markers (ferritin, transferrin, C reactive protein, urea, creatinine, bilirubin, alkaline phosphatase and ammonia). 


The study observed an improvement in liver function and an increase in body mass index and fat mass content in both groups, as well as a decrease in serum concentrations of LDL cholesterol and apolipoprotein B. Neither group registered a change in the fat-free mass.

“There was no significant difference between the two treatments with respect to changes in body composition, liver disease status or in preventing muscle strength decline,” ​the study noted.

“However, we observed an upward trend in handgrip strength and a downward trend in minimal hepatic encephalopathy in the HMB group.” 

Despite these findings, the study notes that non-HMB supplements should preferentially be used in cirrhotic patients as precaution until larger trials are performed to confirm or refute the changes in liver function tests observed.


Source: Nutrients ​2022, 14​, 2344

Publication online:

'Randomized Clinical Trial: Effects of β-Hydroxy-β-Methylbutyrate (HMB)-Enriched vs. HMB-Free Oral Nutritional Supplementation in Malnourished Cirrhotic Patients'

Authors: Silvia Espina et al.

Related topics Research Supplements

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