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Nutrition and physical activity for the prevention and treatment of age-related sarcopenia

  • Ingvar Bosaeus (a1) and Elisabet Rothenberg (a2)


Sarcopenia, defined as loss of skeletal muscle mass and function, is associated with adverse outcomes such as physical disability, impaired quality of life and increased mortality. Several mechanisms are involved in the development of sarcopenia. Potentially modifiable factors include nutrition and physical activity. Protein metabolism is central to the nutritional issues, along with other potentially modifying nutritional factors as energy balance and vitamin D status. An increasing but still incomplete knowledge base has generated recent recommendations on an increased protein intake in the elderly. Several factors beyond the total amount of protein consumed emerge as potentially important in this context. A recent summit examined three hypotheses: (1) A meal threshold; habitually consuming 25–30 g protein at breakfast, lunch and dinner provides sufficient protein to effectively stimulate muscle protein anabolism; (2) Protein quality; including high-quality protein at each meal improves postprandial muscle protein synthesis; and (3) performing physical activity in close temporal proximity to a high-quality protein meal enhances muscle anabolism. Optimising the potential for muscle protein anabolism by consuming an adequate amount of high-quality protein at each meal, in combination with physical activity, appears as a promising strategy to prevent or delay the onset of sarcopenia. However, results of interventions are inconsistent, and well-designed, standardised studies evaluating exercise or nutrition interventions are needed before guidelines can be developed for the prevention and treatment of age-related sarcopenia.

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Corresponding author

* Corresponding author: I. Bosaeus, email


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1. Eurostat (2013) Key Figures on Europe: 2013 Digest of the Online Eurostat Yearbook, Eurostat Pocketbooks, 1830–7892. Luxembourg: Office for Official Publications of the European Communities.
2. Vaupel, JW (2010) Biodemography of human ageing. Nature 464, 536542.
3. Eurostat (2011) Europe in Figures: Eurostat Yearbook 2011. Luxembourg: Office for Official Publications of the European Communities.
4. World Health Organization (2002) Active Ageing. A Policy Framework. WHO/NMH/NPH/02·8. Geneva: World Health Organization, Noncommunicable Disease Prevention and Health Promotion Department.
5. Aihie Sayer, A, Osmond, C, Briggs, R et al. (1999) Do all systems age together? Gerontology 45, 8386.
6. Fried, LP, Tangen, CM, Walston, J et al. (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56, M146M156.
7. Evans, WJ, Morley, JE, Argiles, J et al. (2008) Cachexia: a new definition. Clin Nutr 27, 793799.
8. Rosenberg, IH (1997) Sarcopenia: origins and clinical relevance. J Nutr 127, 990S991S.
9. Cruz-Jentoft, AJ, Baeyens, JP, Bauer, JM et al. (2010) Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 39, 412423.
10. Muscaritoli, M, Anker, SD, Argiles, J et al. (2010) Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) ‘cachexia-anorexia in chronic wasting diseases’ and ‘nutrition in geriatrics’. Clin Nutr 29, 154159.
11. Deutz, NE, Bauer, JM, Barazzoni, R et al. (2014) Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr 33, 929936.
12. Prado, CM, Wells, JC, Smith, SR et al. (2012) Sarcopenic obesity: a critical appraisal of the current evidence. Clin Nutr 31, 583601.
13. Buffa, R, Floris, GU, Putzu, PF et al. (2011) Body composition variations in ageing. Coll Antropol 35, 259265.
14. Al Snih, S, Ottenbacher, KJ, Markides, KS et al. (2007) The effect of obesity on disability vs mortality in older Americans. Arch Intern Med 167, 774780.
15. Flicker, L, McCaul, KA, Hankey, GJ et al. (2010) Body mass index and survival in men and women aged 70 to 75. J Am Geriatr Soc 58, 234241.
16. Vischer, UM, Safar, ME, Safar, H et al. (2009) Cardiometabolic determinants of mortality in a geriatric population: is there a “reverse metabolic syndrome”? Diab Metab 35, 108114.
17. Batsis, JA, Singh, S, Lopez-Jimenez, F (2014) Anthropometric measurements and survival in older Americans: results from the third national health and nutrition examination survey. J Nutr Health Aging 18, 123130.
18. Gallagher, D, Ruts, E, Visser, M et al. (2000) Weight stability masks sarcopenia in elderly men and women. Am J Physiol 279, E366E375.
19. Newman, AB, Lee, JS, Visser, M et al. (2005) Weight change and the conservation of lean mass in old age: the Health, Aging and Body Composition Study. Am J Clin Nutr 82, 872878.
20. Visser, M, Pahor, M, Tylavsky, F et al. (2003) One- and two-year change in body composition as measured by DXA in a population-based cohort of older men and women. J Appl Physiol 94, 23682374.
21. Zamboni, M, Mazzali, G, Zoico, E et al. (2005) Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes 29, 10111029.
22. Guillet, C, Masgrau, A, Walrand, S et al. (2012) Impaired protein metabolism: interlinks between obesity, insulin resistance and inflammation. Obes Rev 13, Suppl 2, 5157.
23. Janssen, I, Heymsfield, SB, Wang, ZM et al. (2000) Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. J Appl Physiol 89, 8188.
24. Lee, SJ, Janssen, I, Heymsfield, SB et al. (2004) Relation between whole-body and regional measures of human skeletal muscle. Am J Clin Nutr 80, 12151221.
25. Kim, J, Heshka, S, Gallagher, D et al. (2004) Intermuscular adipose tissue-free skeletal muscle mass: estimation by dual-energy X-ray absorptiometry in adults. J Appl Physiol 97, 655660.
26. Lee, RC, Wang, Z, Heo, M et al. (2000) Total-body skeletal muscle mass: development and cross-validation of anthropometric prediction models. Am J Clin Nutr 72, 796803.
27. Janssen, I, Heymsfield, SB, Baumgartner, RN et al. (2000) Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol 89, 465471.
28. Kyle, UG, Genton, L, Hans, D et al. (2003) Validation of a bioelectrical impedance analysis equation to predict appendicular skeletal muscle mass (ASMM). Clin Nutr 22, 537543.
29. Tengvall, M, Ellegard, L, Malmros, V et al. (2009) Body composition in the elderly: reference values and bioelectrical impedance spectroscopy to predict total body skeletal muscle mass. Clin Nutr 28, 5258.
30. Sergi, G, De Rui, M, Veronese, N et al. (2015) Assessing appendicular skeletal muscle mass with bioelectrical impedance analysis in free-living Caucasian older adults. Clin Nutr 34, 667673.
31. Kyle, UG, Bosaeus, I, De Lorenzo, AD et al. (2004) Bioelectrical impedance analysis–part I: review of principles and methods. Clin Nutr 23, 12261243.
32. Batsis, JA, Mackenzie, TA, Barre, LK et al. (2014) Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III. Eur J Clin Nutr 68, 10011007.
33. Studenski, S, Perera, S, Patel, K et al. (2011) Gait speed and survival in older adults. JAMA 305, 5058.
34. Reijnierse, EM, Trappenburg, MC, Leter, MJ et al. (2015) The impact of different diagnostic criteria on the prevalence of Sarcopenia in healthy elderly participants and geriatric outpatients. Gerontology 61, 491496.
35. Cruz-Jentoft, AJ, Landi, F, Schneider, SM et al. (2014) Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing 43, 748759.
36. Kirkwood, TB (2008) A systematic look at an old problem. Nature 451, 644647.
37. Mathers, JC (2015) Impact of nutrition on the ageing process. Brit J Nutr 113, Suppl, S18S22.
38. Nordic Council of Ministers (2014) Nordic Nutrition Recommendations 2012. Integrating Nutrition and Physical Activity, 5th ed., vol. Nord 2014;002. Copenhagen: Narayana Press.
39. Institute of Medicine (2011) Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press.
40. Janssen, HC, Samson, MM & Verhaar, HJ (2002) Vitamin D deficiency, muscle function, and falls in elderly people. Am J Clin Nutr 75, 611615.
41. Weaver, CM & Fleet, JC (2004) Vitamin D requirements: current and future. Am J Clin Nutr 80, 1735S1739S.
42. Vieth, R, Ladak, Y & Walfish, PG (2003) Age-related changes in the 25-hydroxyvitamin D versus parathyroid hormone relationship suggest a different reason why older adults require more vitamin D. J Clin Endocrinol Metab 88, 185191.
43. Lamberg-Allardt, C, Brustad, M, Meyer, HE et al. (2013) Vitamin D – a systematic literature review for the 5th edition of the Nordic Nutrition Recommendations. Food Nutr Res 57. Available at:
44. Bischoff-Ferrari, HA, Giovannucci, E, Willett, WC et al. (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84, 1828.
45. Dawson-Hughes, B, Heaney, RP, Holick, MF et al. (2005) Estimates of optimal vitamin D status. Osteoporos Int 16, 713716.
46. Lips, P (2006) Vitamin D physiology. Prog Biophys Mol Biol 92, 48.
47. Visser, M, Deeg, DJ & Lips, P (2003) Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab 88, 57665772.
48. Glerup, H, Mikkelsen, K, Poulsen, L et al. (2000) Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int 66, 419424.
49. Mowe, M, Haug, E & Bohmer, T (1999) Low serum calcidiol concentration in older adults with reduced muscular function. J Am Geriatr Soc 47, 220226.
50. Stein, MS, Wark, JD, Scherer, SC et al. (1999) Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel. J Am Geriatr Soc 47, 11951201.
51. Bischoff-Ferrari, HA, Dawson-Hughes, B, Staehelin, HB et al. (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 339, b3692.
52. Girgis, CM, Clifton-Bligh, RJ, Hamrick, MW et al. (2013) The roles of vitamin D in skeletal muscle: form, function, and metabolism. Endocr Rev 34, 3383.
53. Cuthbertson, D, Smith, K, Babraj, J et al. (2005) Anabolic signaling deficits underlie amino acid resistance of wasting, aging muscle. FASEB J 19, 422424.
54. Guillet, C, Prod'homme, M, Balage, M et al. (2004) Impaired anabolic response of muscle protein synthesis is associated with S6K1 dysregulation in elderly humans. FASEB J 18, 15861587.
55. Rieu, I, Magne, H, Savary-Auzeloux, I et al. (2009) Reduction of low grade inflammation restores blunting of postprandial muscle anabolism and limits sarcopenia in old rats. J Physiol 587, 54835492.
56. Smith, GI, Julliand, S, Reeds, DN et al. (2015) Fish oil-derived n-3 PUFA therapy increases muscle mass and function in healthy older adults. Am J Clin Nutr 102, 115122.
57. Smith, GI, Atherton, P, Reeds, DN et al. (2011) Dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults: a randomized controlled trial. Am J Clin Nutr 93, 402412.
58. Bauer, J, Biolo, G, Cederholm, T et al. (2013) Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 14, 542559.
59. Pedersen, AN & Cederholm, T (2014) Health effects of protein intake in healthy elderly populations: a systematic literature review. Food Nutr Res 58. Available at:
60. Boirie, Y, Morio, B, Caumon, E et al. (2014) Nutrition and protein energy homeostasis in elderly. Mech Ageing Dev 136–137, 7684.
61. Rennie, MJ, Selby, A, Atherton, P et al. (2010) Facts, noise and wishful thinking: muscle protein turnover in aging and human disuse atrophy. Scand J Med Sci Sports 20, 59.
62. Moore, DR, Churchward-Venne, TA, Witard, O et al. (2015) Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men. J Gerontol A Biol Sci Med Sci 70, 5762.
63. Devries, MC & Phillips, SM (2015) Supplemental protein in support of muscle mass and health: advantage whey. J Food Sci 80, Suppl 1, A8A15.
64. Paddon-Jones, D, Campbell, WW, Jacques, PF et al. (2015) Protein and healthy aging. Am J Clin Nutr 101, 1339513455.
65. Dickinson, JM, Volpi, E & Rasmussen, BB (2013) Exercise and nutrition to target protein synthesis impairments in aging skeletal muscle. Exerc Sport Sci Rev 41, 216223.
66. Glover, EI, Phillips, SM, Oates, BR et al. (2008) Immobilization induces anabolic resistance in human myofibrillar protein synthesis with low and high dose amino acid infusion. J Physiol 586, 60496061.
67. Breen, L, Stokes, KA, Churchward-Venne, TA et al. (2013) Two weeks of reduced activity decreases leg lean mass and induces ‘anabolic resistance’ of myofibrillar protein synthesis in healthy elderly. J Clin Endocrinol Metab 98, 26042612.
68. Fiatarone, MA, O'Neill, EF, Ryan, ND et al. (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 330, 17691775.
69. Liu, CJ & Latham, NK (2009) Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev CD002759.
70. Breen, L, Philp, A, Shaw, CS et al. (2011) Beneficial effects of resistance exercise on glycemic control are not further improved by protein ingestion. PLoS ONE 6, e20613.
71. Lanza, IR, Short, DK, Short, KR et al. (2008) Endurance exercise as a countermeasure for aging. Diabetes 57, 29332942.
72. Yang, Y, Breen, L, Burd, NA et al. (2012) Resistance exercise enhances myofibrillar protein synthesis with graded intakes of whey protein in older men. Br J Nutr 108, 17801788.
73. Timmerman, KL, Dhanani, S, Glynn, EL et al. (2012) A moderate acute increase in physical activity enhances nutritive flow and the muscle protein anabolic response to mixed nutrient intake in older adults. Am J Clin Nutr 95, 14031412.
74. Cermak, NM, Res, PT, de Groot, LC et al. (2012) Protein supplementation augments the adaptive response of skeletal muscle to resistance-type exercise training: a meta-analysis. Am J Clin Nutr 96, 14541464.
75. Denison, HJ, Cooper, C, Sayer, AA et al. (2015) Prevention and optimal management of sarcopenia: a review of combined exercise and nutrition interventions to improve muscle outcomes in older people. Clin Interv Aging 10, 859869.
76. Finger, D, Goltz, FR, Umpierre, D et al. (2015) Effects of protein supplementation in older adults undergoing resistance training: a systematic review and meta-analysis. Sports Med 45, 245255.
77. Hickson, M (2015) Nutritional interventions in sarcopenia: a critical review. Proc Nutr Soc 74, 378386.
78. Malafarina, V, Uriz-Otano, F, Iniesta, R et al. (2013) Effectiveness of nutritional supplementation on muscle mass in treatment of sarcopenia in old age: a systematic review. J Am Med Dir Assoc 14, 1017.


Nutrition and physical activity for the prevention and treatment of age-related sarcopenia

  • Ingvar Bosaeus (a1) and Elisabet Rothenberg (a2)


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