Special nutrition intervention is required for muscle protective efficacy of physical exercise in elderly people at highest risk of sarcopenia

Comparative Efficacy of Different Protein Supplements on Muscle Mass, Strength, and Physical Indices of Sarcopenia among Community-Dwelling, Hospitalized or Institutionalized Older Adults Undergoing Resistance Training: A Network Meta-Analysis of Randomized Controlled Trials

Aging-related sarcopenia exerts harmful impacts on muscle mass, strength, and physical mobility. Protein supplementation has been demonstrated to augment efficacy of resistance training (RT) in elderly. This study compared the relative effects of different protein supplements on muscle mass, strength, and mobility outcomes in middle-aged and older individuals undergoing RT. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) examining the efficacy of protein supplement plus RT in untrained community-dwelling adults, hospitalized, or institutionalized residents who suffered acute or chronic health conditions. Network meta-analysis (NMA) was performed using a frequentist method for all analyses. Treatment effects for main outcomes were expressed as standard mean difference (SMD) with 95% confidence interval (CI). We used the surface-under-the cumulative-ranking (SUCRA) scores to rank probabilities of effect estimation among all identified treatments. Meta-regression analyses were performed to identify any relevant moderator of the treatment efficacy and results were expressed as β with 95% credible interval (CrI). We finally included 78 RCTs (5272 participants) for analyses. Among the six protein sources identified in this NMA, namely whey, milk, casein, meat, soy, and peanut, whey supplement yielded the most effective treatments augmenting efficacy of RT on muscle mass (SMD = 1.29, 95% CI: 0.96, 1.62; SUCRA = 0.86), handgrip strength (SMD = 1.46, 95% CI: 0.92, 2.00; SUCRA = 0.85), and walking speed (SMD = 0.73, 95% CI: 0.39, 1.07; SUCRA = 0.84). Participant's health condition, sex, and supplementation dose were significant factors moderating the treatment efficacy on muscle mass (β = 0.74; 95% CrI: 0.22, 1.25), handgrip strength (β = -1.72; 95% CrI: -2.68, -0.77), and leg strength (β = 0.76; 95% CrI: 0.06, 1.47), respectively. Our findings suggest whey protein yields the optimal supplements to counter sarcopenia in older individuals undergoing RT.

Nutritional Intervention Improves Muscle Mass and Physical Performance in the Elderly in the Community: A Systematic Review and Meta-Analysis

Nutritional supplements have been extensively used as health interventions for the elderly. However, with the spread of COVID-19, no consensus exists on whether nutritional interventions could improve muscle mass and physical activity in community-dwelling older adults. To conduct a systematic review and meta-analysis to explore the effects of different nutritional interventions on muscle mass and physical performance in the elderly, we searched PubMed, Web of Science, Elsevier, and Cochrane databases from their founding dates to December 2023. The meta-analysis was performed using RevMan5.3 software. Only randomized controlled trials (RCTs) were considered, and the overall mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval (CI) was calculated. There were 33 studies comprising 3579 elderly persons meeting the inclusion criteria. Comprehensive analysis suggested that the intervention effect of fat-free mass (FFM), appendix skeletal muscle mass (ASMM), handgrip strength (HGS), gait speed, and short physical performance battery (SPPB) score was higher in the nutritional supplement group than in the control group. The results of subgroup analysis demonstrated that protein supplementation (SMD = 0.82, p < 0.0001) had an optimal effect on ASMM (SMD = 0.89, p < 0.0001) and FFM (MD = 2.09, p < 0.0001) in the elderly. Vitamin D supplementation (SMD = 0.52, p < 0.0001) had a marginal effect on ASMM, and energy supplementation (SMD = 0.39, p = 0.0005) had the lowest effect. Moreover, nutritional interventions had the most significant impact on HGS (MD = 1.06, p < 0.0001) and TUG (MD = 0.14, p < 0.0001) in individuals aged 65-75 years old, with positive effects on FFM (MD = 1.62, p < 0.0001) and HGS (MD = 0.82, p < 0.0001) when compared to healthy elderly individuals, and had greater effect on ASMM (SMD = 0.69, p < 0.0001) than on the elderly with sarcopenia. Nutritional supplements can enhance muscle mass and physical performance in the elderly, while protein is recommended for muscle function. The golden period for implementing nutritional interventions to improve muscle function is before the age of 75 years. However, the impact of nutritional interventions varies with age and population. Given the limited evidence on nutritional interventions, more detailed and high-quality studies are highly warranted in the future.

Prevalence of sarcopenia was higher in women than in men: a cross-sectional study from a rural area in eastern China

Background

There were limited studies specifically evaluating whether the difference of the prevalence of sarcopenia exists in men and women in older adults from rural areas in China. The aim of this study was to compare the prevalence of sarcopenia between men and women in a rural area in eastern China and to explore the underlying causes.

Methods

This study included 1,105 participants aged 60-89 years. Muscle mass was measured by bio-electrical impedance analysis. Hand grip strength was measured by Jamar Hydraulic Hand Dynamometer. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia-2019 Consensus. Data were analyzed using log-binomial and linear regression.

Results

The prevalence of sarcopenia was 21.7% in women and 12.9% in men among the study cohort. After adjusting for age, education level, number of diseases, income level, smoking, drinking, and eating habits, proportion of people with sarcopenia was 1.49-fold greater in women than in men (PR = 1.49, 95% CI [1.01-2.26], P = 0.055).

Conclusions

The prevalence of sarcopenia in elderly women in this rural area of eastern China is higher than in men, suggesting that women in rural areas in China seem to be more vulnerable for sarcopenia, thus early screening and prevention need to be provided for them to address such gender disparity in health.

Effects of Protein-Rich Nutritional Composition Supplementation on Sarcopenia Indices and Physical Activity during Resistance Exercise Training in Older Women with Knee Osteoarthritis

Older adults with knee osteoarthritis (KOA) are at high risk of sarcopenia. Protein-rich nutritional composition supplementation (PS) combined with resistance exercise training (RET) improves muscle gains and facilitates physical activity in older adults. However, whether PS augments the effects of RET on muscle mass and PA in patients with KOA remains unclear. Therefore, this study identified the effects of PS on sarcopenic indices and PA in older women with KOA subjected to an RET program. Eligible older women aged 60–85 years and diagnosed as having KOA were randomly assigned to either the experimental group (EG) or the control group (CG). Both groups performed RET twice a week for 12 weeks. The EG received additional PS during this period. Outcome measures included appendicular lean mass index, walking speed, physical activity, and scores on the Western Ontario and McMaster Universities Osteoarthritis Index—WOMAC). All measures were tested at baseline and after intervention. With participant characteristics and baseline scores as covariates, analysis of variance was performed to identify between-group differences in changes in all outcome measures after intervention. Statistical significance was defined as p < 0.05. Compared with the CG, the EG achieved greater changes in appendicular lean mass index (adjusted mean difference (aMD) = 0.19 kg/m², p < 0.01), physical activity (aMD = 30.0 MET-hour/week, p < 0.001), walking speed (aMD = 0.09 m/s, p < 0.05), and WOMAC global function (aMD = −8.21, p < 0.001) after intervention. In conclusion, PS exerted augmentative effects on sarcopenic indices, physical activity, and perceived global WOMAC score in older women with KOA through 12 weeks of RET.

Taurine Reverses Oxidative Damages and Restores the Muscle Function in Overuse of Exercised Muscle

Exercise-induced oxidative stress is linked with the expression level of endogenous antioxidants, but these antioxidants cannot overcome all oxidative stress-related damages in the cells, particularly when cells are under physiological stress. Sometimes, compounds are needed for cellular function, which are produced/activated within the cells, and these compounds can be synthesized by performing exercise, especially high-performance exercise. Taurine is a sulfur-containing amino acid used for various physiological functions. However, its synthesis and accumulation under the oxidative environment may be compromised. Recently, we have shown that taurine level is increased during exercise performance with a decrease in oxidative damage in overused muscles. Other studies have also shown that short-term supplementation with taurine increased physiological performance during severe work intensities, suggesting the role of taurine in improving muscle performance during exercise. However, its precursor cysteine is used in the synthesis of other compounds like GSH and Coenzyme A, which are important for regulating the redox system and energy homeostasis. It is, therefore, important to understand whether taurine synthesis within the cells can blunt the activity of other compounds that are beneficial in preventing oxidative damage during intense exercise. Furthermore, it is important to understand whether taurine supplementation can prevent the conditions observed in the physiological stress of muscles. This review discusses how taurine synthesis could alter exercise-induced ROS generation and the relationship between the physiological stress of muscle and subsequent improvements in exercise performance.

The Effects of Cow-Milk Protein Supplementation in Elderly Population: Systematic Review and Narrative Synthesis

BACKGROUND

To review currently available evidence on the effect of cow-milk proteins supplementation (CPS) on health in the elderly.

METHODS

Five electronic databases (Pubmed, Web of Science, Embase, Cochrane Library, ClinicalTrials.gov) were searched for studies about CPS among older people. All types of publications were included, with the exception of systematic reviews, meta-analyses, opinion letters, editorials, case reports, conference abstracts and comments. An additional search in Google Scholar and a manual review of the reference lists were performed.

RESULTS

Overall, 103 studies were included. Several studies explored the role of CPS in the preservation or improvement of muscle mass among healthy subjects (40 studies) and pre-frail, frail or sarcopenic patients (14), with evidence of beneficial effects. Other studies assessed the effect of CPS on bones (12), cardiovascular disease (8), inflamm-aging (7), chronic pulmonary disease (4), neurocognitive function (4), and vaccines (2), with weak evidence of positive effects. Seven studies in the field of protein metabolism investigated the role of CPS as an important contributor to nutritional needs. Other investigational areas are considered in the last five studies.

CONCLUSIONS

The beneficial effects of CPS in achieving aged-related nutritional goals, in preserving muscle mass and in recovering after hospitalization may be particularly relevant in the elderly.

Preoperative Treatment of Malnutrition and Sarcopenia in Cardiac Surgery: New Frontiers

Cardiac surgery is performed more often in a population with an increasing number of comorbidities. Although these surgeries can be lifesaving, they disturb homeostasis and may induce a temporary overall loss of physiologic function. The required postoperative intensive care unit and hospital stay often lead to a mid- to long-term decline of nutritional and physical status, mental health, and health-related quality of life. Prehabilitation before elective surgery might be an opportunity to optimize the state of the patient. This article discusses current evidence and potential effects of preoperative optimization of nutrition and physical status before cardiac surgery.

Impact of Nutrition Therapy and Rehabilitation on Acute and Critical Illness: A Systematic Review

There have been no reviews describing the efficacy of the combination of both rehabilitation and nutritional treatments. This systematic review aimed to assess the effects of nutritional therapy on patients with an acute and critical illness undergoing rehabilitation. Online searches using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, EMBASE (ELSEVIER), and Ichu-shi Web databases identified 986 articles, and 16 additional articles were found through other sources. Each trial assessed for the risk of bias using the Cochrane Collaboration's tool, and the quality of the body of evidence with The Grading of Recommendations Assessment, Development and Evaluation approach. Two randomized controlled trials were included in this review. Jones et al reported that with an enhanced rehabilitation program, there was no effect of nutritional intervention on quality of life (standardized mean difference [SMD] 0.55, 95% confidence intervals [CI] -0.05 to 1.15; P = 0.12). However, Hegerova et al reported positive effects of physical therapy and oral supplements on muscle mass (0.65; 95% CI, 0.36 to 0.93; P < 0.00001) and activities of daily living (SMD 0.28, 95% CI 0.00 to 0.56; P = 0.05). Strengthened nutritional intervention with enhanced rehabilitation treatment for patients with acute and critical illness may possibly be effective for increasing muscle mass, as well as for improving activities of daily living within a short period after discharge.

The Role of Muscle Mass Gain Following Protein Supplementation Plus Exercise Therapy in Older Adults with Sarcopenia and Frailty Risks: A Systematic Review and Meta-Regression Analysis of Randomized Trials

Aging and frailty are associated with a high risk of lean mass (LM) loss, which leads to physical disability and can be effectively alleviated by protein supplementation (PS) and muscle strengthening exercise (MSE). In this study, the associations between LM gain and PS + MSE efficacy (measured using physical outcomes) in elderly patients with a high risk of sarcopenia or frailty were identified. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) reporting the efficacy of PS + MSE in elderly patients with sarcopenia or frailty. The included RCTs were analyzed using meta-analysis and risk of bias assessment. We finally included 19 RCTs in this meta-analysis with a median (range/total) Physiotherapy Evidence Database score of 7/10 (5-9/10). The PS + MSE group exhibited significant improvements in the whole-body LM (standard mean difference (SMD) = 0.66; p < 0.00001), appendicular LM (SMD = 0.35; p < 0.00001), leg strength (SMD = 0.65; p < 0.00001), and walking capability (SMD = 0.33; p = 0.0006). Meta-regression analyses showed that changes in appendicular LM were significantly associated with the effect sizes of leg strength (β = 0.08; p = 0.003) and walking capability (β = 0.17; p = 0.04), respectively. Our findings suggest that LM gain after PS + MSE significantly contributes to the efficacy of the intervention in terms of muscle strength and physical mobility in elderly patients with a high risk of sarcopenia or frailty.

Strategies for optimising musculoskeletal health in the 21st century

We live in a world with an ever-increasing ageing population. Studying healthy ageing and reducing the socioeconomic impact of age-related diseases is a key research priority for the industrialised and developing countries, along with a better mechanistic understanding of the physiology and pathophysiology of ageing that occurs in a number of age-related musculoskeletal disorders. Arthritis and musculoskeletal disorders constitute a major cause of disability and morbidity globally and result in enormous costs for our health and social-care systems.By gaining a better understanding of healthy musculoskeletal ageing and the risk factors associated with premature ageing and senescence, we can provide better care and develop new and better-targeted therapies for common musculoskeletal disorders. This review is the outcome of a two-day multidisciplinary, international workshop sponsored by the Institute of Advanced Studies entitled "Musculoskeletal Health in the 21st Century" and held at the University of Surrey from 30th June-1st July 2015.The aim of this narrative review is to summarise current knowledge of musculoskeletal health, ageing and disease and highlight strategies for prevention and reducing the impact of common musculoskeletal diseases.

Nutritional interventions in sarcopenia: where do we stand?

PURPOSE OF REVIEW

To document recent evidence regarding the role of nutrition as an intervention for sarcopenia.

RECENT FINDINGS

A review of seven randomized controlled trials (RCTs) on beta-hydroxy-beta-methylbutyrate (HMB) alone on muscle loss in 147 adults showed greater muscle mass gain in the intervention group, but no benefit in muscle strength and physical performance measures. Three other review articles examined nutrition and exercise as combined intervention, and suggest enhancement of benefits of exercise by nutrition supplements (energy, protein, vitamin D). Four trials reported on nutrition alone as intervention, mainly consisting of whey protein, leucine, HMB and vitamin D, with variable results on muscle mass and function. Four trials examined the combined effects of nutrition combined with exercise, showing improvements in muscle mass and function.

SUMMARY

To date, evidence suggests that nutrition intervention alone does have benefit, and certainly enhances the impact of exercise. Nutrients include high-quality protein, leucine, HMB and vitamin D. Long-lasting impact may depend on baseline nutritional status, baseline severity of sarcopenia, and long-lasting adherence to the intervention regime. Future large-scale multicentered RCTs using standardized protocols may provide evidence for formulating guidelines on nutritional intervention for sarcopenia. There is a paucity of data for nursing home populations.