Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group
Open accessAbstract
The aging process is associated with gradual and progressive loss of muscle mass along with lowered strength and physical endurance. This condition, sarcopenia, has been widely observed with aging in sedentary adults. Regular aerobic and resistance exercise programs have been shown to counteract most aspects of sarcopenia. In addition, good nutrition, especially adequate protein and energy intake, can help limit and treat age-related declines in muscle mass, strength, and functional abilities. Protein nutrition in combination with exercise is considered optimal for maintaining muscle function. With the goal of providing recommendations for health care professionals to help older adults sustain muscle strength and function into older age, the European Society for Clinical Nutrition and Metabolism (ESPEN) hosted a Workshop on Protein Requirements in the Elderly, held in Dubrovnik on November 24 and 25, 2013. Based on the evidence presented and discussed, the following recommendations are made (a) for healthy older people, the diet should provide at least 1.0-1.2 g protein/kg body weight/day, (b) for older people who are malnourished or at risk of malnutrition because they have acute or chronic illness, the diet should provide 1.2-1.5 g protein/kg body weight/day, with even higher intake for individuals with severe illness or injury, and (c) daily physical activity or exercise (resistance training, aerobic exercise) should be undertaken by all older people, for as long as possible.
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Distributing protein intake throughout the day or pulse feeding at main meals could be beneficial for stimulating muscle protein synthesis in patients with sarcopenic obesity.
“Distributing protein intake throughout the day259 or pulse feeding at main meals260 could be beneficial for the stimulation of muscle protein synthesis in patients with sarcopenic obesity.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [259]
The “Protein intake pattern” section says pulse feeding may improve feeding-induced protein synthesis in older adults. The “Sarcopenic obesity and protein intake” section recommends increased protein intake for sarcopenic obesity, but does not specifically recommend pulse feeding or establish its benefit for protein synthesis in those patients. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn sarcopenic obesity, protein intake of ≥1.2 g/kg body weight per day, up to 1.5 g/kg/day during caloric restriction, distributed evenly across meals, optimizes anabolic signaling.
“Core interventions include a protein intake of ≥ 1.2 g/kg body Weight per day, up to 1.5 g/kg/day during caloric restriction, distributed evenly across meals to optimize anabolic signaling [118].”
From Precision obesity medicine: A phenotype-guided framework for pharmacologic therapy across the lifespan (2025) · cites this paper as [118]
The “Sarcopenic obesity and protein intake” section recommends moderate calorie restriction with increased protein intake, while “Amount of protein” reports a 1.2–1.4 g/kg/day target for healthy older adults—not a 1.2–1.5 g/kg/day prescription specifically during caloric restriction. “Protein intake pattern” says the optimal distribution across meals remains unclear and notes evidence favoring a single large protein meal, so the claim that even distribution optimizes anabolic signaling is not supported. (LLM, conf=0.88)
Experimental — accuracy not yet measuredImproving nutrition intake with high protein content and being physically active will not completely maintain muscle mass but will slow down loss of muscle and function.
“Improving nutrition intake with high protein content and being physically active will, therefore, not completely maintain muscle mass, but will slow down loss of muscle and function.153”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [153]
The “New insights in aging and declining muscle function” section says adequate protein helps limit age-related declines and that nutrition combined with exercise is optimal for maintaining muscle function. But the claim that these measures will not completely maintain muscle mass is not supported: the “Physical activity and exercise can maintain or enhance muscle mass” section reports that resistance exercise can reverse muscle loss in older adults. The cited passages have no page numbers in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredRecommendations for elevated protein intake (1.2-1.5 g/kg/day in adults with chronic disease, with higher targets up to ~1.6 g/kg/day during active weight loss), combined with resistance training, are supported by primary trial data and aligned international consensus statements, even though no trial has tested these specific targets in GLP-1 RA users.
“Recommendations for elevated protein intake (1.2–1.5 g/kg/day in adults with chronic disease, with higher targets up to ~1.6 g/kg/day during active weight loss), combined with resistance training, are supported by primary trial data and aligned international consensus statements addressing protein requirements in older adults, in chronic disease, and during intentional weight loss [68,69,70,78],”
From Adherence and Persistence with GLP-1-Based Therapies: International Real-World Evidence and the Role of Nutritional and Lifestyle Support—A Narrative Review (2026) · cites this paper as [69]
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredDaily amounts of 1.2-1.5 g/kg have been suggested for older persons with acute or chronic illness, and up to 2.0 g/kg body weight and day in case of severe illness, injury or malnutrition.
“Daily amounts of 1.2 -1.5 g/kg have been suggested for older persons with acute or chronic illness (17,18) and up to 2.0 g/kg BW and day in case of severe illness, injury or malnutrition (17).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [18]
The Abstract recommends 1.2–1.5 g protein/kg body weight/day for older people who are malnourished or at risk of malnutrition because of acute or chronic illness. It also recommends higher intake for severe illness or injury, but the passages in our copy do not specify an upper amount of 2.0 g/kg/day. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Levels of 1.2-1.5 g/kg BW/day have been suggested for older persons with acute or chronic illness, and up to 2.0 g/kg BW/day in case of severe illness, injury, or malnutrition.
“Levels of 1.2-1.5 g/kg BW/day have been suggested for older 511 persons with acute or chronic illness [37, 38] and up to 2.0 g/kg BW/day in case of severe 512 illness, injury, or malnutrition [37].”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [38]
The Abstract recommends 1.2–1.5 g/kg body weight/day for older people who are malnourished or at risk of malnutrition because of acute or chronic illness. It recommends even higher intake for severe illness or injury, but does not specify 2.0 g/kg/day or extend that higher recommendation to malnutrition alone. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe PROT-AGE international position paper recommends a minimum daily intake of 1.0-1.2 g/kg/day for healthy older adults and 1.2-1.5 g/kg/day for those with acute or chronic illness; corresponding ESPEN consensus recommendations align closely.
“The PROT-AGE international position paper, synthesizing nitrogen-balance and clinical-outcome studies, recommends a minimum daily intake of 1.0–1.2 g/kg/day for healthy older adults and 1.2–1.5 g/kg/day for those with acute or chronic illness [68]; corresponding ESPEN consensus recommendations align closely [69].”
From Adherence and Persistence with GLP-1-Based Therapies: International Real-World Evidence and the Role of Nutritional and Lifestyle Support—A Narrative Review (2026) · cites this paper as [69]
Daily amounts of 1.0-1.2 g/kg body weight have been suggested for healthy older persons by several expert groups.
“Daily amounts of 1.0 -1.2 g/kg BW have been suggested for healthy older persons by several expert groups (17)(18)(19).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [18]
After tracheostomy, the majority of patients returned to oral intake, but time to commencement of oral intake was correlated with increased time to decannulation, and increased time to decannulation correlated with increased hospital length of stay.
“After tracheostomy, a cohort study showed that the majority of the patients returned to oral intake, but the time to commencement of oral intake was correlated with increased time to decannulation and increased time to decannulation correlated with increased hospital length of stay (315).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [315]
Split into 3 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 3 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThere is evidence that supplementation with protein/amino acids helps to preserve muscle mass and function in older persons.
“Even though only a few available studies have investigated the effects of nutritional interventions on sarcopenic obesity, there is evidence that supplementation with protein/amino acids, in particular, helps to preserve muscle mass and function in older persons.44”
From Nutritional and exercise interventions in individuals with sarcopenic obesity around retirement age: a systematic review and meta-analysis (2023) · cites this paper as [44]
Experts and guidelines recommend a combination of moderate calorie restriction, increased protein intake, and exercise for the treatment of sarcopenic obesity.
“Experts and guidelines recommend a combination of moderate calorie restriction, increased protein intake, and exercise for the treatment of sarcopenic obesity.16,44,49,53,55”
From Nutritional and exercise interventions in individuals with sarcopenic obesity around retirement age: a systematic review and meta-analysis (2023) · cites this paper as [44]
For persons with acute or chronic illness, the ESPEN Expert Group recommends a protein intake of 1.2 to 1.5 g/kg/d.
“For persons with acute or chronic illness, the ESPEN Expert Group recommends a protein intake of 1.2 to 1.5 g/kg/d.44”
From Nutritional and exercise interventions in individuals with sarcopenic obesity around retirement age: a systematic review and meta-analysis (2023) · cites this paper as [44]
Older people have anabolic resistance, so a higher protein intake is needed to promote muscle protein synthesis.
“While in older people, a higher protein intake should be provided in order to promote muscle protein synthesis due to anabolic resistance.”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [149]
Increased dietary protein can prevent weight loss-induced sarcopenia.
“Increased dietary protein can prevent weight loss-induced sarcopenia.”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [149]
Older adults may be at high risk of low protein intake and inadequate essential amino acid consumption.
“For example, older adults might be at high risk of a low protein intake and inadequate consumption of essential amino acids89.”
From Sarcopenic obesity in older adults: a clinical overview (2024) · cites this paper as [89]
Unintended loss of muscle mass can impair resting metabolic rate, compromise physical function, and increase the risk of sarcopenia, especially in older adults or individuals with lower baseline muscle reserves.
“unintended loss of muscle mass can impair resting metabolic rate, compromise physical function, and increase the risk of sarcopenia, especially in older adults or individuals with lower baseline muscle reserves [27,28].”
From Unintended Consequences of Obesity Pharmacotherapy: A Nutritional Approach to Ensuring Better Patient Outcomes (2025) · cites this paper as [28]
Protein supplementation in combination with resistance-type muscle strengthening exercise is an efficient intervention for lean mass and strength gain in elderly individuals.
“PS in combination with resistance-type MSE has been identified as an efficient intervention for LM and strength gain in elderly individuals [11,13,15,19,59,64].”
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Self-citationThe role of nutrition in inflammaging
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Self-citation
- Authors
- Deutz, N. E. P., Bauer, J. M., Barazzoni, R., Biolo, G., Boirie, Y., Bosy-Westphal, A., Cederholm, T., Cruz-Jentoft, A., Krznariç, Z., Nair, K. S., Singer, P., Teta, D., Tipton, K., & Calder, P. C.
- Affiliations
- Texas A&M University (US)
- Carl von Ossietzky Universität Oldenburg (DE)
- University of Trieste (IT)
- Uppsala University (SE)
- Hospital Universitario Ramón y Cajal (ES)
- Mayo Clinic (US)
- Tel Aviv University (IL)
- Centre Hospitalier Universitaire Vaudois (CH)
- University of Stirling (GB)
- University Hospital Southampton NHS Foundation Trust (GB)
- Corresponding author
- Deutz, Nicolaas E.P.
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 33
- Issue
- 6
- Pages
- 929-936
- ISSN
- 0261-5614 (ISSN-L)
- PMC
- PMC4208946
- OpenAlex
- W2029230411
- Cited by
- 1,738
- References
- 99
- Citations by year
- 2026: 211 · 2025: 175 · 2024: 159 · 2023: 195 · 2022: 151 · 2021: 159 · 2020: 191 · 2019: 144 · 2018: 130 · 2017: 87 · 2016: 66 · 2015: 57 · 2014: 8 · 2013: 2 · 2012: 1
- FWCI
- 47.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- HAL (submittedVersion, other-oa)
- IRIS (submittedVersion)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion)
- Stirling Online Research Repository (University of Stirling) (submittedVersion, public-domain)
- ePrints Soton (University of Southampton) (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion, other-oa)
- Funders
- National Institutes of Health (UL1TR000135)
- National Heart, Lung, and Blood Institute (R01HL095903)
- National Institute of Diabetes and Digestive and Kidney Diseases (U24DK100469)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- protein intake, sarcopenia, aging, older adults, resistance training, aerobic exercise, muscle strength, muscle mass, malnutrition, protein requirements, energy intake
- MeSH terms
- Aged, Aging, Energy Intake, Diet, Dietary Proteins, Humans, Nutritional Requirements, Protein-Energy Malnutrition, Exercise, Muscle, Skeletal, Muscle Strength, Sarcopenia, Recommended Dietary Allowances
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