Background/Purpose: Medical nutrition therapy significantly impacts cardiovascular risk and overall health, but effects on muscle diseases remain unclear. This systematic review evaluates nutritional interventions’ safety and efficacy on muscle disease outcomes.

Methods: A multidisciplinary team conducted a PRISMA-guided systematic review registered on Prospero. Database searches yielded 107 full-text articles, with 52 meeting inclusion criteria after screening. Four reviewers assessed bias risk, with team review for appropriateness (Figure 1.1).

Results: For inflammatory myopathies, investigations primarily centered on creatine supplementation and branched-chain amino acids (Figure 2). The most notable finding came from a study demonstrating that creatine supplementation combined with exercise significantly improved aggregate functional performance time in patients with polymyositis and dermatomyositis, with a median decrease of 13% compared to only 3% in the placebo group (p = 0.029).Studies involving congenital muscle disorders and muscular dystrophies examined a wider spectrum of interventions, including various dietary patterns, specific nutrients, supplements, and antioxidants. These studies assessed diverse outcomes from muscle strength and exercise capacity to body composition, functional tests, and quality of life measurements. Several interventions showed promising results, particularly creatine supplementation in Duchenne muscular dystrophy, which increased maximal voluntary contraction by 15% and doubled fatigue resistance (p < 0.05). Additionally, ketogenic diets demonstrated improvement in fatty acid oxidation by 60% and increased maximal exercise capacity by approximately 20% in patients with McArdle disease (Table 1).In critical illness myopathy, research investigating HMB-enriched whey protein supplementation and high-protein dietary interventions generally showed positive trends in outcomes. However, it should be noted that several of these results did not reach statistical significance, highlighting the need for more robust studies in this area.Quality assessment of the included studies revealed varying levels of methodological rigor, with 32% of studies classified as low risk of bias, 45% raising some concerns, and 22% determined to be at high risk of bias, underscoring the need for more rigorously designed trials in this field (Figure 1.2,1.3).

Conclusion: While nutrition therapy benefits other medical fields, evidence for muscle diseases remains limited. Promising interventions include physiologic creatine, high-protein diets, ketogenic diets, and supplements (CoQ, resveratrol, L-carnitine), which improved endurance/strength in some populations. Methodological concerns highlight the need for larger, better-designed multicenter trials with standardized outcomes. More research exists on non-inflammatory versus inflammatory myopathies. Given these uncertainties, dietary guidance should be tailored to specific disease features and comorbidities.

Figure 1. Workflow chart and Risk of Bias

Figure 2. Interventions and common outcome measurements

Table 1. Summary of Nutritional Interventions and Outcomes in Muscle Diseases across included studies

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/systematic-review-nutritional-interventions-in-muscle-diseases/