Sarcopenia is a progressive loss of muscle strength and muscle mass occurring with aging, and is associated with a number of poorer health outcomes (such as falls, injuries, reduced overall survival, cognitive decline, and metabolic disorders). Physical inactivity and poor nutrition are important risk factors in the development of sarcopenia, and this review highlights the evidence for exercise (one of the most important and effective strategies in combatting age-related muscle loss) as well as nutrition in sarcopenia. Targeted supplementation with fatty acids (including omega-3 fatty acids and monounsaturated fatty acids), silkworm pupae extract, probiotics, and curcumin are also reviewed. Vitamin D status is also important to muscle health, and interventions including vitamin D supplementation are discussed.
Get full access to this article
View all access options for this article.
References
1.
YuanS, LarssonSC. Epidemiology of sarcopenia: Prevalence, risk factors, and consequences. Metabolism, 2023; 144:155533.
2.
LarssonL, DegensH, LiM, et al.Sarcopenia: Aging-related loss of muscle mass and function. Physiol Rev, 2019; 99:427–511.
3.
SiragoG, PiccaA, CalvaniR, et al.Mammalian target of rapamycin (mTOR) signaling at the crossroad of muscle fiber fate in sarcopenia. Int J Mol Sci, 2022; 23:23.
4.
YoonMS. mTOR as a key regulator in maintaining skeletal muscle mass. Front Physiol, 2017; 8:788.
5.
ZengZ, LiangJ, WuL, et al.Exercise-induced autophagy suppresses sarcopenia through Akt/mTOR and Akt/FoxO3a signal pathways and AMPK-mediated mitochondrial quality control. Front Physiol, 2020; 11:583478.
6.
AscenziF, BarberiL, DobrowolnyG, et al.Effects of IGF-1 isoforms on muscle growth and sarcopenia. Aging Cell, 2019; 18:e12954.
7.
NaseebMA, VolpeSL. Protein and exercise in the prevention of sarcopenia and aging. Nutr Res, 2017; 40:1–20.
8.
JaliliC, TalebiS, BagheriR, et al.The association between dietary inflammatory index and aging biomarkers/conditions: A systematic review and dose-response meta-analysis. J Nutr Health Aging, 2023; 27:378–390.
9.
DiaoH, YanF, HeQ, et al.Association between dietary inflammatory index and sarcopenia: A meta-analysis. Nutrients, 2023; 15:219.
10.
VarmaK, AmalrajA, DivyaC, et al.The efficacy of the novel bioavailable curcumin (cureit) in the management of sarcopenia in healthy elderly subjects: A Randomized, Placebo-Controlled, Double-Blind Clinical Study. J Med Food, 2021; 24:40–49.
11.
VolpiE, NazemiR, FujitaS. Muscle tissue changes with aging. Curr Opin Clin Nutr Metab Care, 2004; 7:405.
12.
WilkinsonDJ, PiaseckiM, AthertonPJ. The age-related loss of skeletal muscle mass and function: Measurement and physiology of muscle fibre atrophy and muscle fibre loss in humans. Ageing Res Rev, 2018; 47:123.
13.
DivarisE, AnagnostisP, GkekasNK, et al.Early menopause and premature ovarian insufficiency may increase the risk of sarcopenia: A systematic review and meta-analysis. Maturitas, 2023; 175:107782.
14.
StuckAK, BasileG, FreystaetterG, et al.Predictive validity of current sarcopenia definitions (EWGSOP2, SDOC, and AWGS2) for clinical outcomes: A scoping review. J Cachexia Sarcopenia Muscle, 2023; 14:71.
15.
StuckAK, TsaiLT, FreystaetterG, et al.Comparing prevalence of sarcopenia using twelve sarcopenia definitions in a Large Multinational European Population of Community-Dwelling Older Adults. J Nutr Health Aging, 2023; 27:205–212.
16.
LeeDY, ShinS. Association of sarcopenia with osteopenia and osteoporosis in Community-Dwelling Older Korean Adults: A cross-sectional study. J Clin Med, 2022; 11:129.
17.
HuangT, LiC, ChenF, et al.Prevalence and risk factors of osteosarcopenia: A systematic review and meta-analysis. BMC Geriatr, 2023; 23:39.
18.
DreyM, SieberCC, BertschT, et al.Osteosarcopenia is more than sarcopenia and osteopenia alone. Aging Clin Exp Res, 2016; 28:895–899.
19.
MontiE, TagliaferriS, ZampieriS, et al.Effects of a 2-year exercise training on neuromuscular system health in older individuals with low muscle function. J Cachexia Sarcopenia Muscle, 2023; 14:794.
20.
SenEI, EyigorS, Dikici YagliM, et al.Effect of home-based exercise program on physical function and balance in older adults with sarcopenia: A Multicenter Randomized Controlled Study. J Aging Phys Act, 2021; 29:1010–1017.
21.
ShenY, ShiQ, NongK, et al.Exercise for sarcopenia in older people: A systematic review and network meta-analysis. J Cachexia Sarcopenia Muscle, 2023; 14:1199–1211.
22.
GengQ, ZhaiH, WangL, et al.The efficacy of different interventions in the treatment of sarcopenia in middle-aged and elderly people: A network meta-analysis. Medicine, 2023; 102:E34254.
23.
ZhaoH, ChengR, SongG, et al.The effect of resistance training on the rehabilitation of elderly patients with sarcopenia: A meta-analysis. Int J Environ Res Public Health, 2022; 19:15491.
24.
ParkSH, RohY. Which intervention is more effective in improving sarcopenia in older adults? A systematic review with meta-analysis of randomized controlled trials. Mech Ageing Dev, 2023; 210:11773.
25.
HurstC, RobinsonSM, WithamMD, et al.Resistance exercise as a treatment for sarcopenia: Prescription and delivery. Age Ageing, 2022; 51:1–10.
26.
FerhiH, Gaied ChortaneS, DurandS, et al.Effects of physical activity program on body composition, physical performance, and neuromuscular strategies during walking in older adults with sarcopenic obesity: Randomized Controlled Trial. Healthcare (Basel), 2023; 11:2294.
27.
SheoranS, VintsWAJ, ValatkevičienėK, et al.Strength gains after 12 weeks of resistance training correlate with neurochemical markers of brain health in older adults: A randomized control 1H-MRS study. Geroscience, 2023; 45:1837–1855.
28.
de Sá SouzaH, de MeloCM, PiovezanRD, et al.Resistance training improves sleep and anti-inflammatory parameters in sarcopenic older adults: A Randomized Controlled Trial. Int J Environ Res Public Health, 2022; 19:16322.
29.
MathewsonSL, AzevedoPS, GordonAL, et al.Overcoming protein-energy malnutrition in older adults in the residential care setting: A narrative review of causes and interventions. Ageing Res Rev, 2021; 70:101401.
30.
MorleyJE, ArgilesJM, EvansWJ, et al.Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc, 2010; 11:391.
31.
NormanK, HaßU, PirlichM. Malnutrition in older adults—Recent advances and remaining challenges. Nutrients, 2021; 13:2764.
32.
HengeveldLM, BoerJMA, GaudreauP, et al.Prevalence of protein intake below recommended in community-dwelling older adults: A meta-analysis across cohorts from the PROMISS consortium. J Cachexia Sarcopenia Muscle, 2020; 11:1212.
33.
BorkentJ, MandersM, NijhofA, et al.Too low protein and energy intake in nursing home residents. Nutrition, 2023; 110:112005.
34.
RondanelliM, NichettiM, PeroniG, et al.Where to find leucine in food and how to feed elderly with sarcopenia in order to counteract loss of muscle mass: Practical advice. Front Nutr, 2021; 7:622391.
35.
LeeSY, LeeHJ, LimJY. Effects of leucine-rich protein supplements in older adults with sarcopenia: A systematic review and meta-analysis of randomized controlled trials. Arch Gerontol Geriatr, 2022; 102:104758.
36.
GielenE, BeckwéeD, DelaereA, et al.Nutritional interventions to improve muscle mass, muscle strength, and physical performance in older people: An umbrella review of systematic reviews and meta-analyses. Nutr Rev, 2021; 79:121–147.
37.
KamińskaMS, RachubińskaK, GrochansS, et al.The impact of whey protein supplementation on sarcopenia progression among the elderly: A systematic review and meta-analysis. Nutrients, 2023; 15:2039.
38.
Cuyul-VásquezI, Pezo-NavarreteJ, Vargas-ArriagadaC, et al.Effectiveness of whey protein supplementation during resistance exercise training on skeletal muscle mass and strength in older people with sarcopenia: A systematic review and meta-analysis. Nutrients, 2023; 15:3424.
39.
BauerJM, VerlaanS, BautmansI, et al.Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: A randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc, 2015; 16:740–747.
40.
ChangMC, ChooYJ. Effects of whey protein, leucine, and vitamin d supplementation in patients with sarcopenia: A systematic review and meta-analysis. Nutrients, 2023; 15:521.
41.
NasimiN, SohrabiZ, NunesEA, et al.Whey protein supplementation with or without vitamin D on sarcopenia-related measures: A systematic review and meta-analysis. Adv Nutr, 2023; 14:762–773.
42.
VerlaanS, MaierAB, BauerJM, et al.Sufficient levels of 25-hydroxyvitamin D and protein intake required to increase muscle mass in sarcopenic older adults—The PROVIDE study. Clin Nutr, 2018; 37:551–557.
43.
YangA, LvQ, ChenF, et al.The effect of vitamin D on sarcopenia depends on the level of physical activity in older adults. J Cachexia Sarcopenia Muscle, 2020; 11:678–689.
44.
RemelliF, VitaliA, ZurloA, et al.Vitamin D deficiency and sarcopenia in older persons. Nutrients, 2019; 11:2861.
45.
KojimaK, IshikawaH, WatanabeS, et al.A randomized, double-blind, controlled trial assessing if medium-chain triglycerides in combination with moderate-intensity exercise increase muscle strength in healthy middle-aged and older adults. Nutrients, 2023; 15:3275.
46.
YoshinoJ, SmithGI, KellySC, et al.Effect of dietary n-3 PUFA supplementation on the muscle transcriptome in older adults. Physiol Rep, 2016; 4:e12785.
47.
AbeS, EzakiO, SuzukiM. Medium-chain triglycerides (8:0 and 10:0) are promising nutrients for sarcopenia: A randomized controlled trial. Am J Clin Nutr, 2019; 110:652–665.
48.
StrandbergE, PonsotE, Piehl-AulinK, et al.Resistance training alone or combined with N-3 PUFA-rich diet in older women: Effects on muscle fiber hypertrophy. J Gerontol A Biol Sci Med Sci, 2019; 74:489–493.
49.
SmithGI, AthertonP, ReedsDN, et al.Dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults: A randomized controlled trial. Am J Clin Nutr, 2011; 93:402–412.
50.
SmithGI, JulliandS, ReedsDN, et al.Fish oil-derived n-3 PUFA therapy increases muscle mass and function in healthy older adults. Am J Clin Nutr, 2015; 102:115–122.
51.
SadatA, BiswasT, CardosoMH, et al.Silkworm pupae as a future food with nutritional and medicinal benefits. Curr Opin Food Sci, 2022; 44:100818.
52.
ChoiJI, KweonHY, LeeYL, et al.Efficacy of silkworm pupae extract on muscle strength and mass in middle-aged and older individuals: A Randomized, Double-Blind, Placebo-Controlled Trial. J Nutr Health Aging, 2023; 27:578–585.
53.
ProkopidisK, GiannosP, KirwanR, et al.Impact of probiotics on muscle mass, muscle strength and lean mass: A systematic review and meta-analysis of randomized controlled trials. J Cachexia Sarcopenia Muscle, 2023; 14:30.
54.
TicinesiA, LauretaniF, MilaniC, et al.Aging gut microbiota at the cross-road between nutrition, physical frailty, and sarcopenia: Is there a gut–muscle axis?. Nutrients, 2017; 9:1303.
55.
RondanelliM, GasparriC, BarrileGC, et al.Effectiveness of a novel food composed of leucine, omega-3 fatty acids and probiotic Lactobacillus paracasei PS23 for the treatment of sarcopenia in elderly subjects: A 2-month randomized double-blind placebo-controlled trial. Nutrients, 2022; 14:4566.
56.
Saud GanySL, ChinKY, TanJK, et al.Curcumin as a therapeutic agent for sarcopenia. Nutrients, 2023; 15:2526.
57.
ChengL, SitJWH, ChanHYL, et al.Sarcopenia risk and associated factors among Chinese community-dwelling older adults living alone. Sci Rep, 2021; 11:1–12.
58.
TsaiS, Ting TanK, Jamie AngS-T, et al.Sarcopenia: Tilting the balance of protein homeostasis. Proteomics, 2020; 20:e1800411.
59.
MannickJB, LammingDW. Targeting the biology of aging with mTOR inhibitors. Nature Aging, 2023; 3:642–660.
60.
JosephGA, WangSX, JacobsCE, et al.Partial inhibition of mTORC1 in aged rats counteracts the decline in muscle mass and reverses molecular signaling associated with sarcopenia. Mol Cell Biol, 2019; 39:e00141-19.
61.
HamarslandH, NordengenAL, Nyvik AasS, et al.Native whey protein with high levels of leucine results in similar post-exercise muscular anabolic responses as regular whey protein: A randomized controlled trial. J Int Soc Sports Nutr, 2017; 14:43.
62.
DevriesMC, McGloryC, BolsterDR, et al.Leucine, not total protein, content of a supplement is the primary determinant of muscle protein anabolic responses in healthy older women. J Nutr, 2018; 148:1088–1095.
63.
LandiN, RagucciS, Di MaroA. Amino acid composition of milk from cow, sheep and goat raised in Ailano and Valle Agricola, two localities of ‘Alto Casertano’ (Campania Region). Foods, 2021; 10:2431.
