Nutritional Recommendations for the Management of Sarcopenia

doi:10.1016/j.jamda.2010.04.014

Journal of the American Medical Directors Association

Volume 11, Issue 6, July 2010, Pages 391-396

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https://doi.org/10.1016/j.jamda.2010.04.014 Get rights and content

The Society for Sarcopenia, Cachexia, and Wasting Disease convened an expert panel to develop nutritional recommendations for prevention and management of sarcopenia. Exercise (both resistance and aerobic) in combination with adequate protein and energy intake is the key component of the prevention and management of sarcopenia. Adequate protein supplementation alone only slows loss of muscle mass. Adequate protein intake (leucine-enriched balanced amino acids and possibly creatine) may enhance muscle strength. Low 25(OH) vitamin D levels require vitamin D replacement.

Section snippets

Recommendations

Aging is associated with physiological anorexia, decreased caloric intake, and weight loss,23, 24, 25, 26, 27 which in turn is associated with a decline in muscle mass and increased mortality. These facts suggest that a balanced caloric supplement may be useful in preventing or reversing sarcopenia as part of a multimodal therapeutic approach. A number of studies and 2 meta-analyses in older persons with malnutrition and/or illness have shown positive effects of nutritional supplementation.28,

Conclusion

Table 2 provides the recommendations for nutritional management of sarcopenia. Exercise (aerobic and resistance) represents the key intervention. Adequate protein intake (leucine-enriched amino acids and possibly creatine) has good evidence. Low vitamin D levels should be corrected.

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The onset of sarcopenia is intimately linked with aging, posing significant implications not only for individual patient quality of life but also for the broader societal healthcare framework. Early and accurate identification of sarcopenia and a comprehensive understanding of its mechanistic underpinnings and therapeutic targets paramount to addressing this condition effectively. This review endeavors to present a cohesive overview of recent advancements in sarcopenia research and diagnosis. We initially delve into the contemporary diagnostic criteria, specifically referencing the European Working Group on Sarcopenia in Older People (EWGSOP) 2 and Asian Working Group on Sarcopenia (AWGS) 2019 benchmarks. Additionally, we elucidate comprehensive assessment techniques for muscle strength, quantity, and physical performance, highlighting tools such as grip strength, chair stand test, dual-energy X-ray Absorptiometry (DEXA), bioelectrical impedance analysis (BIA), gait speed, and short physical performance battery (SPPB), while also discussing their inherent advantages and limitations. Such diagnostic advancements pave the way for early identification and unequivocal diagnosis of sarcopenia. Proceeding further, we provide a deep-dive into sarcopenia's pathogenesis, offering a thorough examination of associated signaling pathways like the Myostatin, AMP-activated protein kinase (AMPK), insulin/IGF-1 Signaling (IIS), and the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathways. Each pathway's role in sarcopenia mediation is detailed, underscoring potential therapeutic target avenues. From a mechanistic perspective, the review also underscores the pivotal role of mitochondrial dysfunction in sarcopenia, emphasizing elements such as mitochondrial oxidative overload, mitochondrial biogenesis, and mitophagy, and highlighting their therapeutic significance. At last, we capture recent strides made in sarcopenia treatment, ranging from nutritional and exercise interventions to potential pharmacological and supplementation strategies. In sum, this review meticulously synthesizes the latest scientific developments in sarcopenia, aiming to enhance diagnostic precision in clinical practice and provide comprehensive insights into refined mechanistic targets and innovative therapeutic interventions, ultimately contributing to optimized patient care and advancements in the field.
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Evidence regarding how dietary patterns (DPs) from mid- (60 years old) to later-life (over 80 years old) affect sarcopenia risk in old age is scarce.
We included 7267 participants aged ≥80 years from the Chinese Longitudinal Healthy Longevity Survey in 2018. The Simplified Healthy Eating Index (SHE index) based on nine dietary variables was used to measured DPs and changes in DPs, with a higher score indicating better diet quality. The term “Mid-life” DPs denoted dietary habits at the age of 60 whereas “Later-life” DPs referred to dietary habits acquired over 80 years old. Sarcopenia risk was evaluated using the SARC-CalF questionnaire. We applied multivariable adjusted logistic regression models to investigate the cross-sectional association between DPs in a life course and sarcopenia risk in 2018 after adjusting for potential confounders including sociodemographic characteristics, lifestyle risk factors, and unfavorable health conditions. Several sensitivity analyses were conducted to verify the robustness of the results.
We found that healthier DPs during both mid- and later-life were associated with a decreased odds of sarcopenia risk, with adjusted odds ratios (ORs) of 0.69 (95 % confidence interval [CI]: 0.54–0.88) and 0.84 (95 % CI: 0.71–0.99), respectively. The odds of sarcopenia risk were also decreased among those with healthier DPs over a period of 20 years (OR = 0.80, 95 % CI: 0.69–0.93). For each nutrient consumption, participants who had high-quality fish consumption both in mid- and later-life had a 23 % decreased odds of sarcopenia risk (OR = 0.77, 95 % CI: 0.67–0.88) compared with those who had low-quality fish consumption all the time. The results were largely unchanged in sensitivity analyses.
Our findings highlight the importance of maintaining healthy dietary habits throughout life to reduce the risk of sarcopenia in old age.
Effects of nutritional supplementation stabilizing muscle mass loss in older patients on hemodiafiltration
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Malnutrition is common in older individuals with end-stage renal disease on maintenance dialysis. Whether nutritional supplementation may improve skeletal muscle mass (SMM) and survival rate in this population is uncertain. We aimed to analyze the effect of a year of nutritional supplementation on muscle mass and survival rate in older patients on hemodiafiltration.
In this observational study, older patients (≥65 years old) on maintenance hemodiafiltration were selected to receive nutritional counselling + nutritional supplementation (N = 85, Supp+) or nutritional counselling alone (N = 47, Supp-) and followed for 1 year. The outcomes were a change in SMM and sarcopenia diagnosis. The secondary outcome was 1-year mortality rate. Nutritional parameters included calf circumference, body mass index, anthropometric measurements, subjective global assessment, and handgrip strength (HGS). Data were evaluated using GLM for repeated measures with adjustment for covariates (age and diabetes).
Malnutrition was found in 50.8% of patients. At baseline, patients from the Supp+ group were older and had worse nutritional parameters including hand grip strength, calf circumference, anthropometric findings and sarcopenia (all p values < 0.05). During the follow-up, there was no significant change in sarcopenia (from 50.8% to 58.3%, p = 0.108), and there was a more pronounced decrease in the SMM index in the Supp-group (p = 0.049), with a significant intervention interaction (p = 0.030). Twenty deaths occurred, 7 (35%) in the Supp- and 13 (65%) in the Supp+ group (p = 0.540). SMM index (relative risk 0.90, p = 0.030) and age (relative risk 1.07, p = 0.046) were independently associated with higher mortality rates.
Nutritional supplementation in older and malnourished individuals undergoing hemodiafiltration mitigates the loss of the SMM index and benefits survival rate.
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ReviewNutritional Recommendations for the Management of Sarcopenia

Section snippets

Recommendations

Conclusion

Nutrition

Exp Gerontol

J Am Med Dir Assoc

J Nutr Health Aging

J Nutr Health Aging

Clin Nutr

J Nutr Health Aging

J Lab Clin Med

Study. Am J Clin Nutr

Gastroenterol Clin North Am

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Nutrition

Clin Nutr

Clin Nutr

J Am Med Dir Assoc

Am J Clin Nutr

Am J Clin Nutr

J Am Diet Assoc

Exp Gerontol

J Nutr Health Aging

Am J Clin Nutr

Metabolism

Mol Aspects Med

J Am Med Dir Assoc

J Am Med Dir Assoc

J Am Med Dir Assoc

Mol Aspects Med

Transl Res

J Am Med Dir Assoc

Ageing Res Rev

What is sarcopenia?

J Gerontol A Biol Sci Med Sci

Sarcopenia: Current concepts

J Gerontol A Biol Sci Med Sci

Loss of appendicular muscle mass and loss of muscle strength in young postmenopausal women

J Gerontol A Biol Sci Med Sci

Sarcopenia =/= dynapenia

J Gerontol A Biol Sci Med Sci

Development and validation of a short portable sarcopenia measure in the African American Health Project

J Gerontol A Biol Sci Med Sci

Age-associated changes in skeletal muscles and their effect on mobility: An operational diagnosis of sarcopenia

J Appl Physiol

Frailty: Toward a clinical definition

J Am Med Dir Assoc

Developing novel therapeutic approaches to frailty

Curr Pharm Des

Frailty in older adults: Evidence for a phenotype

J Gerontol A Biol Sci Med Sci

Epidemiology of sarcopenia among the elderly in New Mexico

Am J Epidemiol

The healthcare costs of sarcopenia in the United States

J Am Geriatr Soc

Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly

Obes Res

Nutritional management in long-term care: Development of a clinical guideline. Council for Nutritional Strategies in Long-Term Care

J Gerontol A Biol Sci Med Sci

Weight loss in older persons: New therapeutic approaches

Curr Pharm Des

Eating habits and appetite control in the elderly: The anorexia of aging

Int Psychogeriatr

Effect of exogenous cholecystokinin (CCK)-8 on food intake and plasma CCK, leptin, and insulin concentrations in older and young adults: Evidence for increased CCK activity as a cause of the anorexia of aging

J Clin Endocrinol Metab

Protein and energy supplementation in elderly people at risk from malnutrition

Cochrane Database Syst Rev

Are oral nutritional supplements of benefit to patients in the community? Findings from a systematic review

Curr Opin Clin Nutr Metab Care

Review
Nutritional Recommendations for the Management of Sarcopenia