Effect of Plant Versus Animal Protein on Muscle Mass, Strength, Physical Performance, and Sarcopenia: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract Context Dietary protein is recommended for sarcopenia—a debilitating condition of age-related loss of muscle mass and strength that affects 27% of older adults. The effects of protein on muscle health may depend on protein quality. Objective The aim was to synthesize randomized controlled trial (RCT) data comparing plant with animal protein for muscle health. Data Sources Forty-three eligible RCTs were sourced from Medline, Embase, Scopus, Web of Science, and CENTRAL databases. Data Extraction Four reviewers (R.J.R.-M., S.F.B., N.A.W., D.L.) extracted data from RCTs (study setting, population, intervention characteristics, outcomes, summary statistics) and conducted quality assessment using the Cochrane Risk of Bias 2.0. Data Analysis Standardized mean differences (SMDs) (95% CIs) were combined using a random-effects meta-analysis and forest plots were generated. I2 statistics were calculated to test for statistical heterogeneity. Conclusion Thirty RCTs (70%) were eligible for meta-analysis and all examined muscle mass outcomes. Compared with animal protein, plant protein resulted in lower muscle mass following the intervention (SMD = –0.20; 95% CI: –0.37, –0.03; P = .02), with stronger effects in younger (<60 years; SMD = –0.20; 95% CI: –0.37, –0.03; P = .02) than in older (≥60 years; SMD = –0.05; 95% CI: –0.32, 0.23; P = .74) adults. There was no pooled effect difference between soy and milk protein for muscle mass (SMD = –0.02; 95% CI: –0.20, 0.16; P = .80) (n = 17 RCTs), yet animal protein improved muscle mass compared with non-soy plant proteins (rice, chia, oat, and potato; SMD = –0.58; 95% CI: –1.06, –0.09; P = .02) (n = 5 RCTs) and plant-based diets (SMD = –0.51; 95% CI: –0.91, –0.11; P = .01) (n = 7 RCTs). No significant difference was found between plant or animal protein for muscle strength (n = 14 RCTs) or physical performance (n = 5 RCTs). No trials examined sarcopenia as an outcome. Animal protein may have a small beneficial effect over non-soy plant protein for muscle mass; however, research into a wider range of plant proteins and diets is needed. Systematic Review Registration PROSPERO registration no. CRD42020188658.