Cited by 1,738Nutrition and Health in AgingMuscle metabolism and nutritionClinical Nutrition and Gastroenterology

Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group

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Deutz, Nicolaas E.P., Bauer, Jürgen M., Barazzoni, Rocco, Biolo, Gianni, Boirie, Yves, Bosy-Westphal, Anja, Cederholm, Tommy, Cruz-Jentoft, Alfonso +6 more·2014·Clinical Nutrition

Abstract

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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Crossref · 10.1016/j.clnu.2014.04.007

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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)

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  • In 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)

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  • Improving 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)

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  • 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, 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]

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  • Daily 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)

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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.
Venue
Clinical Nutrition
Publisher
Elsevier BV
Published
2014-12
Volume
33
Issue
6
Pages
929-936
ISSN
0261-5614 (ISSN-L)
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
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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