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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 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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredIn the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“Increased dietary protein can prevent weight loss-induced sarcopenia.”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [149]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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Bax, M.-L., Buffière, C., Hafnaoui, N., Gaudichon, C., Savary‐Auzeloux, I., Dardevet, D. P., Santé-Lhoutellier, V., & Rémond, D. (2013) · PLoS ONE · doi:10.1371/journal.pone.0061252 · Cited by 133
Biomarker‐Calibrated Protein Intake and Physical Function in the Women's Health Initiative
Beasley, J. M., Wertheim, B. C., LaCroix, A. Z., Prentice, R. L., Neuhouser, M. L., Tinker, L. F., Kritchevsky, S. B., Shikany, J. M., Eaton, C. B., Chen, Z., et al. (2013) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12503 · Cited by 129
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Impaired protein metabolism: interlinks between obesity, insulin resistance and inflammation
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Optimizing protein intake in aging
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Efficacy of β-hydroxy-β-methylbutyrate supplementation in elderly and clinical populations
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Protein feeding pattern does not affect protein retention in young women
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Self-citationProtein intake and muscle strength in older persons: does inflammation matter?
Bartali, B., Frongillo, E. A., Stipanuk, M. H., Bandinelli, S., Salvini, S., Palli, D., Morais, J. A., Volpato, S., Guralnik, J. M., & Ferrucci, L. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2011.03833.x · Cited by 76
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Promoting access to innovation for frail old persons
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Self-citationChronic Kidney Disease in the Elderly
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Epidemiology of Muscle Mass Loss with Age
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Flagged first, then by citations
4 of the 99 references couldn’t be matched to a known paper.
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Sorted by citations
Cruz-Jentoft, A. J., & Sayer, A. A. (2019) · The Lancet · doi:10.1016/s0140-6736(19)31138-9 · Cited by 3,905
Self-citationESPEN guideline on clinical nutrition in the intensive care unit.
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Self-citationESPEN guidelines on nutrition in cancer patients
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ESPEN guidelines on definitions and terminology of clinical nutrition
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Self-citationESPEN guideline on clinical nutrition and hydration in geriatrics
Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Goisser, S., Hooper, L., Kiesswetter, E., Maggio, M., Raynaud-Simon, A., Sieber, C. C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.05.024 · Cited by 1,505
Self-citation
Metadata
- 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
- 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 (medical) › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › 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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