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Nutritional interventions to improve muscle mass, muscle strength, and physical performance in older people: an umbrella review of systematic reviews and meta-analyses.
Open accessAbstract
Context: Sarcopenia is a progressive and generalized skeletal muscle disorder associated with an increased risk of adverse outcomes such as falls, disability, and death. The Belgian Society of Gerontology and Geriatrics has developed evidence-based guidelines for the prevention and treatment of sarcopenia. This umbrella review presents the results of the Working Group on Nutritional Interventions. Objective: The aim of this umbrella review was to provide an evidence-based overview of nutritional interventions targeting sarcopenia or at least 1 of the 3 sarcopenia criteria (ie, muscle mass, muscle strength, or physical performance) in persons aged ≥ 65 years. Data sources: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed and Web of Science databases were searched for systematic reviews and meta-analyses reporting the effect of nutritional supplementation on sarcopenia or muscle mass, strength, or physical performance. Data extraction: Two authors extracted data on the key characteristics of the reviews, including participants, treatment, and outcomes. Methodological quality of the reviews was assessed using the product A Measurement Tool to Assess Systematic Reviews. Three authors synthesized the extracted data and generated recommendations on the basis of an overall synthesis of the effects of each intervention. Quality of evidence was rated with the Grading of Recommendations Assessment, Development and Evaluation approach. Data analysis: A total of 15 systematic reviews were included. The following supplements were examined: proteins, essential amino acids, leucine, β-hydroxy-β-methylbutyrate, creatine, and multinutrient supplementation (with or without physical exercise). Because of both the low amount and the low to moderate quality of the reviews, the level of evidence supporting most recommendations was low to moderate. Conclusions: Best evidence is available to recommend leucine, because it has a significant effect on muscle mass in elderly people with sarcopenia. Protein supplementation on top of resistance training is recommended to increase muscle mass and strength, in particular for obese persons and for ≥ 24 weeks. Effects on sarcopenia as a construct were not reported in the included reviews.
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“The methodological quality of each included review was assessed independently by two reviewers using the AMSTAR (A Measurement Tool to Assess Systematic Reviews) tool, which yields a score ranging from 1 to 11 that incorporates assessment of publication bias (Supplemental Appendix 4, Supplemental Digital Content, https://links.lww.com/MSS/D323) (18,19).”
From American College of Sports Medicine Position Stand. Resistance Training Prescription for Muscle Function, Hypertrophy, and Physical Performance in Healthy Adults: An Overview of Reviews (2026) · cites this paper as [18]
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“63,64 Protein supplementation on top of resistance training is recommended to increase muscle mass and strength.”
BackgroundDietary Protein and Physical Exercise for the Treatment of Sarcopenia
Nasso, R., D’Errico, A., Motti, M. L., Masullo, M., & Arcone, R. (2024) · Clinics and Practice · doi:10.3390/clinpract14040117 · Cited by 22
“Six AAs are defined as conditionally essential (Arginine, Cysteine, Glutamine, Glycine, Proline, and Tyrosine) because their synthesis can only occur under pathophysiological conditions (severe catabolic condition) or they cannot be produced in adequate amounts [103].”
BackgroundDupont, J., Wauters, E., Dedeyne, L., Vercauteren, L., Amini, N., Lapauw, L., Matthys, C., Verschueren, S., Tournoy, J., Koppo, K., et al. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-04007-9 · Cited by 23
“Malnutrition and low protein intake contribute to sarcopenia onset or progression [4], whereas nutritional supplementation (alone or combined with exercise) is currently the recommended treatment strategy for sarcopenia [5, 6].”
BackgroundSelf-citationWu, S., Guo, Y., Cao, Z., Nan, J., Zhang, Q., Hu, M., Ning, H., Huang, W., Xiao, L. D., & Feng, H. (2024) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2024.105470 · Cited by 21
Blankemeier, L., Yao, L., Long, J., Reis, E. P., Lenchik, L., Chaudhari, A. S., & Boutin, R. D. (2023) · American Journal of Roentgenology · doi:10.2214/ajr.23.29889 · Cited by 25
The nutritional support to prevent sarcopenia in the elderly
Giacosa, A., Barrile, G. C., Mansueto, F., & Rondanelli, M. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1379814 · Cited by 22
Double-Edge Effects of Leucine on Cancer Cells
Akbay, B., Omarova, Z., Трофимов, А. Н., Sailike, B., Karapina, O., Molnár, F., & Tokay, T. (2024) · Biomolecules · doi:10.3390/biom14111401 · Cited by 19
Adeva‐Andany, M. M., Fernández‐Fernández, C., López-Pereiro, Y., Calvo‐Castro, I., & Carneiro-Freire, N. (2021) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2021.06.025 · Cited by 19
Delaire, L., Courtay, A., Humblot, J., Aubertin‐Leheudre, M., Mourey, F., Racine, A. N., Gilbert, T., Niasse‐Sy, Z., & Bonnefoy, M. (2023) · Nutrients · doi:10.3390/nu15194100 · Cited by 32
Muscle strength and non-alcoholic fatty liver disease/metabolic-associated fatty liver disease
Hao, X., Zhang, K., Huang, X., Yang, F., & Sun, S. (2024) · World Journal of Gastroenterology · doi:10.3748/wjg.v30.i7.636 · Cited by 20
Development of meat products for the nutrition of the elderly
Абжанова, Ш. А., Baybolova, L. K., Zhaksylykova, G., Tayeva, A., & Kulazhanov, T. K. (2023) · Human Nutrition & Metabolism · doi:10.1016/j.hnm.2023.200201 · Cited by 17
Kositsawat, J., Duque, G., & Kirk, B. (2021) · Experimental Gerontology · doi:10.1016/j.exger.2021.111521 · Cited by 16
Optimizing clinical nutrition research: the role of adaptive and pragmatic trials
Orsso, C. E., Ford, K. L., Kiss, N. K., Trujillo, E. B., Spees, C., Hamilton‐Reeves, J. M., & Prado, C. M. M. (2023) · European Journal of Clinical Nutrition · doi:10.1038/s41430-023-01330-7 · Cited by 19
“As such, alterations in dietary patterns, food and/or supplement intake have been explored to improve nutritional status and minimize the impact of related conditions [7, 8].”
BackgroundSaadeh, M., Prinelli, F., Vetrano, D. L., Xu, W., Welmer, A., Dekhtyar, S., Fratiglioni, L., & Calderón‐Larrañaga, A. (2021) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-021-01192-x · Cited by 16
Trends in Nutrition Research for Sarcopenia: A Bibliometric Analysis
Wu, L., He, K., Fang, D., Qiu, X., Xiao, W., Lou, S., & Yong, R.-L. (2022) · Nutrients · doi:10.3390/nu14204262 · Cited by 16
Keogh, J. A. J., Keng, I., Dhillon, D., Bourgeault‐Gagnon, Y., Simunovic, N., & Ayeni, O. R. (2025) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2025.13075 · Cited by 16
Dowling, L., Lynch, D. H., Batchek, D. J., Sun, C., Mark‐Wagstaff, C., Jones, E. P., Prochaska, M. T., Huisingh-Scheetz, M. J., & Batsis, J. A. (2024) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18799 · Cited by 17
“47 In this present review, the majority of studies found no effect of nutritional interventions on different measures of physical function.”
BackgroundDemographic risk factors of pro-inflammatory diet: a narrative review
Pourmontaseri, H., & Khanmohammadi, S. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1448806 · Cited by 16
Cornelissen, V., Hanssen, H., Hurst, C., Knaier, R., Marqués‐Sulé, E., Moholdt, T. T., Neunhäeuserer, D., Norman, K., Pedretti, R. F. E., Salzwedel, A., et al. (2025) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaf432 · Cited by 14
Lv, Z., Zhao, Y., Cui, J., & Zhang, J. (2023) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2023.08.001 · Cited by 14
Bonilla, D. A., Stout, J. R., Candow, D. G., Jiménez‐García, J. D., Gómez-Miranda, L. M., Ortiz-Ortiz, M., Forbes, S. C., Ostojić, S. M., Vargas-Molina, S., & Kreider, R. B. (2024) · Frontiers in Physiology · doi:10.3389/fphys.2024.1496544 · Cited by 19
Nutritional support in a comprehensive program of prevention and treatment of sarcopenia
Kurmaev, D. P., Bulgakova, S. V., Treneva, E. V., Kosareva, O. V., Dolgikh, Y. A., Sharonova, L. A., & Сергеевна, Ч. И. (2023) · Russian Journal of Geriatric Medicine · doi:10.37586/2686-8636-1-2023-29-38 · Cited by 14
Bielecka-Dabrowa, A. M., Banach, M., Wittczak, A., Cicero, A. F. G., Kallel, A., Kubilius, R., Mikhailidis, D. P., Sahebkar, A., Stoian, A. P., Vinereanu, D., et al. (2023) · Archives of Medical Science · doi:10.5114/aoms/167799 · Cited by 15
Sabir, Z., Dierkes, J., Hjartåker, A., & Rosendahl-Riise, H. (2023) · European Journal of Nutrition · doi:10.1007/s00394-023-03206-9 · Cited by 15
“Sarcopenia predisposes affected individuals to an increased risk of falls, fractures, physical disability, and mortality [7, 9].”
BackgroundSarcopenia and aortic valve disease
Kumar, M., Pettinato, A. M., Ladha, F. A., Earp, J. E., Jain, V., Patil, S. P., Engelman, D. T., Robinson, P. F., Moumneh, M. B., Goyal, P., et al. (2024) · Heart · doi:10.1136/heartjnl-2024-324029 · Cited by 16
“41 As per the European Society for Clinical Nutrition and Metabolism, the older adult’s diet should provide at least 1.0–1.5 g protein/kg body weight/day, with 25–30 g protein allocated to each meal.”
BackgroundInfluentialRan, J., Yang, J., Li, N., Yang, J., Yang, W., Chen, M., Sun, P., & Liao, Y. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-06559-4 · Cited by 18
“Adequate protein ingestion during RT heightens the muscle’s anabolic sensitivity, improving net protein balance and, ultimately, lean-tissue accretion [44].”
Xie, C., Yan, R., & Tao, R. (2026) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-025-09436-8 · Cited by 15
“Nevertheless, while our findings suggest potential clinical benefits of combining amino acid supplementation with resistance training, current evidence is insufficient to support its widespread use in routine clinical settings [18].”
Ju, S.-H., Lee, E. J., Sim, B. C., Nga, H. T., Lee, H. Y., Tian, J., Cho, K. J., Park, H., Choi, D. E., Ham, Y. R., et al. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1069651 · Cited by 12
Madini, N., Vincenti, A., Beretta, A., Santero, S., Viroli, G., & Cena, H. (2024) · Nutrients · doi:10.3390/nu16234141 · Cited by 17
“Protein intake plays a central role in nutritional therapy for sarcopenia [39,108,112], with recommended levels ranging from 1.0 to 2.0 g/kg depending on disease severity and comorbidities [20].”
InfluentialLeucine Intake and Risk of Impaired Physical Function and Frailty in Older Adults
Vega-Cabello, V., Caballero, F. F., Rodríguez‐Artalejo, F., López‐García, E., & Struijk, E. A. (2022) · The Journals of Gerontology Series A · doi:10.1093/gerona/glac191 · Cited by 13
Weight strategy in older adults with obesity: calorie restriction or not?
Colleluori, G., & Villareal, D. T. (2022) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000879 · Cited by 16
“However, calorie restriction in older adults holds the potential risk of inducing muscle and bone loss, hence increasing the risk of frailty and disability [4,5].”
BackgroundChen, W., Shi, S., Tu, J., Liao, L., Liao, Y., Chen, K., Chen, L., & Huang, R. (2022) · BMC Public Health · doi:10.1186/s12889-022-14257-8 · Cited by 12
“Malnutrition and sarcopenia are closely related to premature death and cardiovascular mortality [9, 10].”
Background
Metadata
- Authors
- Gielen, E., Beckwée, D., Delaere, A., De Breucker, S., Vandewoude, M., Bautmans, I., the Sarcopenia Guidelines Development Group of the Belgian Society of Gerontology and Geriatrics (BSGG), Bautmans, I., Beaudart, C., Beckwée, D., Beyer, I., Bruyère, O., De Breucker, S., De Cock, A.-M., Delaere, A., de Saint-Hubert, M., De Spiegeleer, A., Gielen, E., Perkisas, S., & Vandewoude, M.
- Affiliations
- Department of Geriatrics, UZ Leuven, Leuven, Belgium
- Rehabilitation Sciences Research Department, Vrije Universiteit Brussel, Brussels, Belgium
- Frailty in Ageing Research Department, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Geriatrics, Erasme Hospital, Brussels, Belgium
- University of Antwerp (BE)
- Frailty in Ageing Research Department, Vrije Universiteit Brussel, Brussels, Belgium
- Vrije Universiteit Brussel (BE)
- Erasmus Hospital (BE)
- Venue
- Nutrition Reviews
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-01-07
- Volume
- 79
- Issue
- 2
- Pages
- 121-147
- ISSN
- 0029-6643 (ISSN-L)
- 1753-4887
- OpenAlex
- W3030753538
- Cited by
- 269
- References
- 62
- Citations by year
- 2026: 32 · 2025: 60 · 2024: 47 · 2023: 52 · 2022: 44 · 2021: 25
- FWCI
- 4.10
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Nutrition Reviews (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
- Lirias (submittedVersion, other-oa)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) (submittedVersion, other-oa)
- ORBi (University of Liège) (submittedVersion, other-oa)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Muscle metabolism and nutrition
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
- Keywords
- sarcopenia, dietary intervention, older adults, muscle mass, muscle strength, physical performance, protein supplementation, leucine, essential amino acids, creatine, beta-hydroxy-beta-methylbutyrate, resistance training, obesity
- MeSH terms
- Physical Functional Performance, Aged, Aged, 80 and over, Amino Acids, Essential, Creatine, Humans, Leucine, Valerates, Exercise, Muscle, Skeletal, Dietary Supplements, Muscle Strength, Sarcopenia
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