Nutrition and physical activity countermeasures for sarcopenia: Time to get personal?

Abstract

Population ageing is a global phenomenon. It is regarded as a major cause of upward pressure on healthcare costs. One of the greatest threats to healthy, independent ageing is sarcopenia, the progressive loss of skeletal muscle mass and function with age. Physical inactivity and poor nutrition represent crucial and imminently modifiable risk factors for sarcopenia. Resistance exercise training is the most effective method for improving muscle mass and function in older adults. Evidence indicates that resistance training-induced improvements in muscle mass, strength and function may be further augmented by certain nutrients and nutritional strategies. Ageing is associated with a reduction in the anabolic sensitivity of skeletal muscle to dietary protein ingestion and accumulating evidence indicates that older adults require protein intakes 50%-100% higher than the recommended daily allowance (0.8 g/kg/day) to preserve muscle mass and function. Protein quality, the pattern of protein intake over the day (i.e. per-meal protein), specific amino acids (i.e. leucine) and other nutrients (i.e. vitamin D, longchain n-3 polyunsaturated fatty acids) are also key considerations. From the personalised nutrition perspective, it is now acknowledged that individual responses to nutrition/exercise interventions are highly variable, despite equivalent compliance, thus highlighting the inadequacy of a 'one-size-fits-all' approach. The application of personalised medicine to sarcopenia represents an exciting emerging field of research with the potential to dramatically improve patient outcomes. This approach makes use of recent developments in 'omics' technologies and aims to identify the factors (i.e. genes, key biomarkers, medical history, environment, lifestyle) that determine whether an individual is a higher or a lower responder to a particular intervention. This narrative review discusses current evidence regarding nutrition and exercise countermeasures for sarcopenia, with a specific emphasis on recent developments in personalised approaches.

Efficacy of Nutritional Interventions as Stand-Alone or Synergistic Treatments with Exercise for the Management of Sarcopenia

“…It is well known that older adults frequently have health-related problems, which may compromise the capacity to perform exercise tasks. Furthermore, since it has been shown that individual responses to nutrition/exercise interventions may be quite variable, a personalized approach to counteract muscle decline seem to be promising [242]. As mentioned above, resistance training is the most effective type of exercise to counteract and/or reverse sarcopenia.…”

Making every calorie count

“…Sarcopenia, or age‐related skeletal muscle loss, is one of the most important causes of loss of independence in older adults, contributing to functional decline, disability, frailty and falls. Physical activity, particularly resistance exercise, and nutrition – particularly protein intake – are both important in slowing this process and reducing its impact (Murphy & Roche ). Muscle mass is estimated to fall by about 8% per decade beyond the age of 40 years, progressing to 15% per decade beyond 70 years of age.…”

The efficacy of essential amino acid supplementation for augmenting dietary protein intake in older adults: implications for skeletal muscle mass, strength and function

“…Sarcopenia also underpins frailty and the decline in functional capacity that compromises quality of life (6) , and is associated with a range of clinical disorders, such as osteoporosis and obesity (7) . Although the aetiology of sarcopenia is clearly multifactorial and not fully understood (8) , key underlying factors include morphological changes in skeletal muscle (9) , the loss of motor units (10) , physical inactivity (11) and, particularly prudent to this review, dietary protein and energy deficiencies (12) .…”

“…The combination of adequate dietary protein intake and muscle loading (i.e. resistance) exercise serves as the cornerstone for the management of sarcopenia in both institutionalised and non-institutionalised older adults (12–17) . Another key component of an effective countermeasure for sarcopenia includes adequate energy intake (18) , which is typically reduced with ageing (19) .…”