Effects of vitamins C and E supplementation combined with 12-week resistance training in older women with sarcopenia: A randomized, double-blind, placebo-controlled trial.

2025-08-22
Medicine 104(34)
- Xu Liu
- Bo Chen
- Yutian Jin
- Feiyan Zhong
- Yunjuan Zhang
- Yu Li
- Yun Zhang
- Runhong Cui
- Bing Wu
- Cui Li
- Sheng Xu
- Xiaohong Chen

PubMed: 40859523
DOI: 10.1097/md.0000000000043976

Study Design

Type: Randomized Controlled Trial (RCT)
Population: Sixty older women with sarcopenia (60-75 years)
Methods: Randomized to antioxidant supplementation group (1000 mg/d vitamin C and 335 mg/d vitamin E) or placebo group following the same elastic-band RT program
Duration: 12 weeks

Background

Resistance training (RT) is a fundamental sarcopenia treatment, but its efficacy may be enhanced by nutritional strategies. This study investigated whether combining RT with vitamins C and E supplementation yields additive benefits in sarcopenia patients.

Methods

Sixty older women with sarcopenia (60-75 years) were randomized to an antioxidant supplementation group (AS; 1000 mg/d vitamin C and 335 mg/d vitamin E) or a placebo group (PLA) following the same elastic-band RT program. Muscle mass, muscle strength, physical performance, oxidative stress-related indices (reduced glutathione [GSH] and oxidized glutathione [GSSG], GSH/GSSG ratio, malondialdehyde, and protein carbonyl), and pro-inflammatory factors (interleukin-6 [IL-6] and tumor necrosis factor-alpha) were evaluated at baseline and after the 12-week intervention.

Results

After 12 weeks, muscle mass, strength, and physical performance significantly increased (P < .05) in both the AS and PLA groups. However, the AS group had higher increases in arm lean mass (Δ = 0.96 vs 0.59 kg; P = .003, d = 0.74), skeletal muscle mass index (Δ = 0.71 vs 0.42 kg/m²; P = .004, d = 0.71), handgrip strength (Δ = 3.66 vs 1.16 kg; P = .047, d = 0.51), and knee extension strength (Δ = 2.28 vs 1.02 kg; P < .001, d = 0.89) than the PLA group. There were no differences in physical performance between the RT conditions over time. Regarding blood parameters, the AS group had increased GSH (P < .001, d = 1.52) and GSH/GSSG ratio (P < .001, d = 1.52), and reduced GSSG (P < .001, d = 0.96) and malondialdehyde (P < .001, d = 1.65) compared to the PLA group. The serum levels of IL-6 and tumor necrosis factor-alpha significantly decreased in the PLA and AS groups, but IL-6 was lower in the AS group than in the PLA group (P < .001, d = 1.16).

Conclusion

Vitamins C and E supplementation combined with RT for 12 weeks resulted in superior adaptations in muscle mass and strength compared with RT with placebo, and the underlying mechanism could be related to the alleviation of oxidative stress and inflammation.

Research Insights

Vitamin C→Improved Physical Performance
There were no differences in physical performance between the RT conditions over time.
Effect
Neutral
Effect size
Small
Dose
335 mg/d
Vitamin C→Increased Glutathione Disulfide Ratio
GSH/GSSG ratio (P < .001, d = 1.52)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin C→Increased Glutathione Level
the AS group had increased GSH (P < .001, d = 1.52)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin C→Increased Handgrip Strength
handgrip strength (Δ = 3.66 vs 1.16 kg; P = .047, d = 0.51)
Effect
Beneficial
Effect size
Moderate
Dose
335 mg/d
Vitamin C→Increased Knee Extension Strength
knee extension strength (Δ = 2.28 vs 1.02 kg; P < .001, d = 0.89)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin C→Increased Lean Mass
the AS group had higher increases in arm lean mass (Δ = 0.96 vs 0.59 kg; P = .003, d = 0.74)
Effect
Beneficial
Effect size
Moderate
Dose
335 mg/d
Vitamin C→Increased Muscle Mass
the AS group had higher increases in arm lean mass (Δ = 0.96 vs 0.59 kg; P = .003, d = 0.74), skeletal muscle mass index (Δ = 0.71 vs 0.42 kg/m²; P = .004, d = 0.71)
Effect
Beneficial
Effect size
Moderate
Dose
335 mg/d
Vitamin C→Increased Muscle Strength
handgrip strength (Δ = 3.66 vs 1.16 kg; P = .047, d = 0.51), and knee extension strength (Δ = 2.28 vs 1.02 kg; P < .001, d = 0.89) than the PLA group
Effect
Beneficial
Effect size
Moderate
Dose
335 mg/d
Vitamin C→Increased Skeletal Muscle Mass Index
skeletal muscle mass index (Δ = 0.71 vs 0.42 kg/m²; P = .004, d = 0.71)
Effect
Beneficial
Effect size
Moderate
Dose
335 mg/d
Vitamin C→Reduced Inflammation
IL-6 was lower in the AS group than in the PLA group (P < .001, d = 1.16)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin C→Reduced Interleukin-6 Levels
IL-6 was lower in the AS group than in the PLA group (P < .001, d = 1.16)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin C→Reduced Malondialdehyde
reduced malondialdehyde (P < .001, d = 1.65)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin C→Reduced Oxidative Stress
the AS group had increased GSH (P < .001, d = 1.52) and GSH/GSSG ratio (P < .001, d = 1.52), and reduced GSSG (P < .001, d = 0.96) and malondialdehyde (P < .001, d = 1.65) compared to the PLA group
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin C→Reduced Oxidized Glutathione Level
reduced GSSG (P < .001, d = 0.96)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin C→Reduced Tumor Necrosis Factor Alpha
The serum levels of IL-6 and tumor necrosis factor-alpha significantly decreased in the PLA and AS groups
Effect
Neutral
Effect size
Small
Dose
335 mg/d
Vitamin E→Improved Physical Performance
There were no differences in physical performance between the RT conditions over time.
Effect
Neutral
Effect size
Small
Dose
335 mg/d
Vitamin E→Increased Glutathione Disulfide Ratio
GSH/GSSG ratio (P < .001, d = 1.52)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin E→Increased Glutathione Level
the AS group had increased GSH (P < .001, d = 1.52)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin E→Increased Handgrip Strength
handgrip strength (Δ = 3.66 vs 1.16 kg; P = .047, d = 0.51)
Effect
Beneficial
Effect size
Moderate
Dose
335 mg/d
Vitamin E→Increased Knee Extension Strength
knee extension strength (Δ = 2.28 vs 1.02 kg; P < .001, d = 0.89)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin E→Increased Lean Mass
the AS group had higher increases in arm lean mass (Δ = 0.96 vs 0.59 kg; P = .003, d = 0.74)
Effect
Beneficial
Effect size
Moderate
Dose
335 mg/d
Vitamin E→Increased Muscle Mass
the AS group had higher increases in arm lean mass (Δ = 0.96 vs 0.59 kg; P = .003, d = 0.74), skeletal muscle mass index (Δ = 0.71 vs 0.42 kg/m²; P = .004, d = 0.71)
Effect
Beneficial
Effect size
Moderate
Dose
335 mg/d
Vitamin E→Increased Muscle Strength
handgrip strength (Δ = 3.66 vs 1.16 kg; P = .047, d = 0.51), and knee extension strength (Δ = 2.28 vs 1.02 kg; P < .001, d = 0.89) than the PLA group
Effect
Beneficial
Effect size
Moderate
Dose
335 mg/d
Vitamin E→Increased Skeletal Muscle Mass Index
skeletal muscle mass index (Δ = 0.71 vs 0.42 kg/m²; P = .004, d = 0.71)
Effect
Beneficial
Effect size
Moderate
Dose
335 mg/d
Vitamin E→Reduced Inflammation
IL-6 was lower in the AS group than in the PLA group (P < .001, d = 1.16)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin E→Reduced Interleukin-6 Levels
IL-6 was lower in the AS group than in the PLA group (P < .001, d = 1.16)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin E→Reduced Malondialdehyde
reduced malondialdehyde (P < .001, d = 1.65)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin E→Reduced Oxidative Stress
the AS group had increased GSH (P < .001, d = 1.52) and GSH/GSSG ratio (P < .001, d = 1.52), and reduced GSSG (P < .001, d = 0.96) and malondialdehyde (P < .001, d = 1.65) compared to the PLA group
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin E→Reduced Oxidized Glutathione Level
reduced GSSG (P < .001, d = 0.96)
Effect
Beneficial
Effect size
Large
Dose
335 mg/d
Vitamin E→Reduced Tumor Necrosis Factor Alpha
The serum levels of IL-6 and tumor necrosis factor-alpha significantly decreased in the PLA and AS groups
Effect
Neutral
Effect size
Small
Dose
335 mg/d