Synergistic Effect of Increased Total Protein Intake and Strength Training on Muscle Strength: A Dose-Response Meta-analysis of Randomized Controlled Trials

Background Protein supplementation augments muscle strength gain during resistance training. Although some studies focus on the dose-response relationship of total protein intake to muscle mass or strength, the detailed dose-response relationship between total protein intake and muscle strength increase is yet to be clarified, especially in the absence of resistance training. Objective We aimed to assess the detailed dose-response relationship between protein supplementation and muscle strength, with and without resistance training. Design Systematic review with meta-analysis. Data Sources PubMed and Ichushi-Web (last accessed on March 23, 2022). Eligibility Criteria Randomized controlled trials investigating the effects of protein intake on muscle strength. Synthesis Methods A random-effects model and a spline model. Results A total of 82 articles were obtained for meta-analyses, and data from 69 articles were used to create spline curves. Muscle strength increase was significantly augmented only with resistance training (MD 2.01%, 95% CI 1.09-2.93) and was not augmented if resistance training was absent (MD 0.13%, 95% CI - 1.53 to 1.79). In the dose-response analysis using a spline model, muscle strength increase with resistance training showed a dose-dependent positive association with total protein intake, which is 0.72% (95% CI 0.40-1.04%) increase in muscle strength per 0.1 g/kg body weight [BW]/d increase in total protein intake up to 1.5 g/kg BW/d, but no further gains were observed thereafter. Conclusion Concurrent use of resistance training is essential for protein supplementation to improve muscle strength. This study indicates that 1.5 g/kg BW/d may be the most appropriate amount of total protein intake for maintaining and augmenting muscle strength along with resistance training.