Cited by 270Nutrition and Health in AgingMuscle metabolism and nutritionMuscle Physiology and Disorders

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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.

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Gielen, Evelien, Beckwée, David, Delaere, Andreas, De Breucker, Sandra, Vandewoude, Maurits, Bautmans, Ivan, 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·2021·Nutrition Reviews

DOI 10.1093/nutrit/nuaa011

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Abstract

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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Combined Fried Frailty Scale and Mini Nutritional Assessment Identifies Cardiovascular Patients with Reduced Protein/Albumin Plasma Levels: A Cross-Sectional Study
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Effects of Taiji Stick exercise on strength, balance, and activities of daily living in older adults: a randomized controlled trial
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Can Dietary Supplements Support Muscle Function and Physical Activity? A Narrative Review
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Relevance and Safe Utilization of Amino Acids in Supplements for Human Nutrition: Lessons from Clinical and Preclinical Studies
Blachier, F. (2026) · Nutrients · doi:10.3390/nu18020296 · Cited by 5
Basics in clinical sports nutrition: Physical activity, muscle and clinical nutrition
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Frailty and menopause: A gateway to healthy aging
Monllor-Tormos, A., Artero, A., García‐Pérez, M. Á., Tarín, J. J., & Cano, A. (2026) · Maturitas · doi:10.1016/j.maturitas.2026.108931 · Cited by 3
Physical function management for elderly dialysis patients: prevention and improvement of frailty and disability
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“A recent systematic review reported no effects of supplementation with essential amino acids on muscle mass, muscle strength, or physical performance, whereas a significant effect of leucine on muscle mass was shown in subjects with sarcopenia as compared with healthy subjects [53].”
Background
Ophiocephalus striatus Extract Supplementation Decreases Serum IL-6 Levels in Older People with Sarcopenia—A Single-Center Experience
Riviati, N., Legiran, L., Saleh, I., Indrajaya, T., Ali, Z., Irfannuddin, I., & Probosuseno, P. (2024) · Geriatrics · doi:10.3390/geriatrics9020035 · Cited by 3
“Studies have shown that even slight increases in protein intake can lead to improved muscle mass and strength in this population [45].”
Background
Machine learning based on nutritional assessment to predict adverse events in older inpatients with possible sarcopenia
Liu, C., Huang, H., Chen, M., Zhu, M., & Yu, J. (2025) · Aging Clinical and Experimental Research · doi:10.1007/s40520-024-02916-2 · Cited by 3
“Nutritional intervention can improve muscle mass and functional status in older patients with sarcopenia [6–8 ].”
Impact of nutrition on long COVID
Thangaleela, S., & Wang, C. (2025) · Sports Medicine and Health Science · doi:10.1016/j.smhs.2025.09.002 · Cited by 3
Sarcopenia: Pathophysiology and Treatment Strategies
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Vidal‐Casariego, A., García‐Luna, P. P., González, F. V., Folgueras, T. M., Milla, S. P., Gómez, J. J. L., Navarro, I. G., Fernández, A. C., Quintana, T. C., Plaza, B. L., et al. (2023) · Journal of Functional Foods · doi:10.1016/j.jff.2023.105833 · Cited by 3
A mito-centric view on muscle aging and function
Burtscher, J., Strasser, B., & Burtscher, M. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1330131 · Cited by 3
Associations between serum cystatin C and fall reports in an Elderly population
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Prospects for the diagnosis and treatment of sarcopenia in the Philippines
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The association of n-3 fatty acid intake with muscle mass and strength in older adults: A cross-sectional analysis of the UK biobank data
Timraz, M., Guerrero‐Wyss, M., Quinn, T. J., Combet, E., Celis-Morales, C. A., & Gray, S. R. (2025) · The journal of nutrition health & aging · doi:10.1016/j.jnha.2025.100622 · Cited by 2
Nutritional impact of leucine-enriched supplements: Evaluating protein type through artificial intelligence (AI)-augmented muscle ultrasonography in hypercaloric, hyperproteic support
Gómez, J. J. L., González-Gutiérrez, J., Jáuregui, O. I., Cebriá, Á., Asensio, L., Primo, D., Fernández-Velasco, P., Pérez-López, P., Sahagún, R. J., Bargués, D. R., et al. (2025) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2025.07.1134 · Cited by 2
Association of habitual diet with skeletal muscle composition in a cross-sectional, population-based imaging study
Rospleszcz, S., Burger, T., Addin, N. S., Kiefer, L. S., Diallo, T. D., Wawro, N., Schlett, C. L., Bamberg, F., Peters, A., Gedrich, K., et al. (2025) · Nutrition Journal · doi:10.1186/s12937-025-01222-5 · Cited by 3
The potential of prehabilitation to enhance recovery in sarcopenic and frail older kidney transplant candidates: A narrative review
Bellafronte, N. T., Barril-Cuadrado, G., & Carli, F. (2026) · Ageing Research Reviews · doi:10.1016/j.arr.2026.103021 · Cited by 2
Introduction to Frailty in Older Adults with Cancer
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E-PROOF: E-intervention for protein intake and resistance training to optimize function: A study protocol
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Crosstalk between skeletal muscle ratio and cholesterol metabolism disorders: a cross-section study
Wang, Y., Hu, J., Shen, H., Liu, C., & Yang, L. (2024) · BMC Endocrine Disorders · doi:10.1186/s12902-024-01660-y · Cited by 2
“Research on sarcopenia has focused mainly on older and obese people [26, 27], with fewer studies on young and middle-aged people or people of normal weight.”
Background
Types, design, implementation, and evaluation of nutrition interventions in older people in Africa: A scoping review protocol
Manyara, A. M., Manyanga, T., Chingono, R., Naidoo, S., Mattick, K., Pearson, G. M. E., Babatunde, O. O., Naidoo, N., Ward, K. A., & Gregson, C. L. (2024) · PLoS ONE · doi:10.1371/journal.pone.0313036 · Cited by 2
Potential of edible insects as alternative protein source for the older adults
Ke, Y., Dai, Z., Zhao, Y., Yang, Y., Wu, H., Shang, H., Cholewa, J. M., Zanchi, N. E., & Xia, Z. (2025) · Current Research in Food Science · doi:10.1016/j.crfs.2025.101153 · Cited by 2
“…intake for young adults is insufficient to meet the actual protein requirements of the older adults, it is necessary to consume high-quality protein and essential amino acids (especially BCAAs) to support elderly health and prevent functional decline (Gielen et al., 2021; Hengeveld et al., 2018).”
Nutritional Supplementation for the Prevention of Muscle Atrophy in Older People
Edwards, H., Jones, H. S., Moseley, J., Marshall, T., El‐Khamisy, S. F., Aung, M. N., & Farrow, M. (2023) · Nutrition Today · doi:10.1097/nt.0000000000000606 · Cited by 2
“A recent systematic review and meta-analysis of nutritional interventions to improve muscle health in older people concluded that leucine had a significant effect on muscle mass in older sarcopenic individuals and that evidence was strongest among the interventions tested.(40)”
Background
Can Nutrition Contribute to a Reduction in Sarcopenia, Frailty, and Comorbidities in a Super-Aged Society?Preprint
Yoshida, S., Shiraishi, R., Nakayama, Y., & Taira, Y. (2023) · Preprints.org · doi:10.20944/preprints202306.2123.v1 · Cited by 1
Health and Nutrition Analysis in Older Adults in San José de Minas Rural Parish in Quito, Ecuador
Ordóñez-Araque, R., Caicedo-Jaramillo, C., Gálvez, M. M. G., & Proaño-Zavala, J. (2023) · Global Health · doi:10.1155/2023/1839084 · Cited by 1
“In this matter, a healthy diet is important in these age groups, as stated in the umbrella review by Gielen et al. [41], and protein supplementation, especially leucine, hand in hand with strength and resistance training can have a signifcant efect on muscle mass and strength.”
The importance of sarcopenia in critically ill patients in intensive care units
Vujadinović, S. T. (2023) · Galenika Medical Journal · doi:10.5937/galmed2308025t · Cited by 1
Effects of branched-chain amino acid-rich nutritional supplements combined with resistance training on body composition and body function in older patients with sarcopenia
Li, H., Zhang, R., Ma, Y., He, J., Li, G., Sun, J. P., & DuanyingLi (2025) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2025.106063 · Cited by 2
Relationship between eating awareness, physical fitness, and body composition in community-living older adults: a cross-sectional study
Cemali, Ö., Elmas, Ö., & Cemali, M. (2025) · BMC Public Health · doi:10.1186/s12889-025-25601-z · Cited by 1
“In a systematic review and meta-analysis study, it was concluded that a diet with appropriate, balanced and protein-rich nutri-ents helps older adults preserve their muscle mass [39].”
Serum branched-chain amino acids, dietary factors, and sarcopenia risk in older adults with and without diabetes mellitus
Li, S.-Y., Zhang, T., Leung, J. C. S., & Kwok, T. C. Y. (2026) · Clinical Nutrition · doi:10.1016/j.clnu.2026.106590 · Cited by 1
Fall risk, fall awareness, and social support among 825 community—dwelling older adults with functional limitations: a cross—sectional study
Xiao, L., Hu, R., Zou, X., & Wu, H. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1763697 · Cited by 1
“Third, effective utilization of available support (e.g., accessing health education and skill training) improves adherence to preventive measures and enhances self-management efficacy (52, 53).”
Influential
Outcomes in clinical trials on sarcopenia: a systematic review and meta-analysis
Rippl, M., Müller, K. J., Martini, S., Schmidmaier, R., Tausendfreund, O., Schluessel, S., Deißler, L., & Drey, M. (2026) · The journal of nutrition health & aging · doi:10.1016/j.jnha.2026.100821 · Cited by 1
Exercise and nutritional interventions for sarcopenia-related fall prevention in older adults: An umbrella review
Dharmansyah, D., Rahayuwati, L., Pramukti, I., & Mutyara, K. (2026) · The journal of nutrition health & aging · doi:10.1016/j.jnha.2026.100862 · Cited by 1
Impact of impaired branched-chain amino acid metabolism on kidney disease
Kitada, M., Sugahara, S., Yasuda‒Yamahara, M., Kume, S., & Araki, S. (2026) · Clinical Science · doi:10.1042/cs20260961 · Cited by 1
Effect of proteins, amino acids, and other nitrogenated supplements on the skeletal muscle mass in people living with HIV (PLWH): A systematic review
Quaresma, M. V. L. D. S., de Melo, C. M., & Ribeiro, S. M. L. (2022) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2022.07.001 · Cited by 1
How to Help My Older Patient With Obesity Lose Weight Safely When the Evidence Is Not Clear
Nowicki, K. N., Daugherty, J. E., Craven, K., & Kolasa, K. M. (2022) · Nutrition Today · doi:10.1097/nt.0000000000000568 · Cited by 1
Nutrition Management Across the Stroke Continuum of Care to Optimize Outcome and Recovery
Holdoway, A., Arsava, E. M., Ashford, S. A., Cereda, E., Dziewas, R., & Francisco, G. E. (2022) · The Journal of the International Society of Physical and Rehabilitation Medicine · doi:10.4103/ijprm.jisprm-000161 · Cited by 1
Nutrition in COVID-19 recovery
Grujić, V. R., Rodić-Vukmir, N., & Đermanović, M. (2023) · Vojnosanitetski pregled · doi:10.2298/vsp230512041r · Cited by 1
Can Leucine Supplementation Improve Frailty Index Scores?
Buigues, C., Theou, O., Fonfría-Vivas, R., Martínez‐Arnau, F. M., Rockwood, K. J., & Cauli, O. (2023) · Geriatrics · doi:10.3390/geriatrics8050102 · Cited by 1
“Leucine-enriched protein (not leucine alone) supplementation appears to show beneﬁts when co-administered with vitamin D, e.g., improvements in muscle mass and lower-extremity function among sarcopenic older adults [24,26].”
Background
Remote assistance-focused strength training and nutritional guidance in preventing frailty on body composition and muscle strength in community-dwelling Japanese older adults during COVID-19 pandemic
Izumi, S., Ujike, S., Shimosaka, A., Kitajo, T., Sawada, C., Yamamoto, S., Sako, K., & Suzuki, J. (2024) · The Journal of Physical Fitness and Sports Medicine · doi:10.7600/jpfsm.13.51 · Cited by 1
A INFLUÊNCIA DA ATIVIDADE FÍSICA NA PREVENÇÃO DA SARCOPENIA: UMA REVISÃO BIBLIOGRÁFICA
Bezerra, L. M. R., do Vale, E. S., Borlini, S. M., Júnior, V. L. R., Fernandes, L. F. A. G., Bento, D. M., de Castro, M. S., Lima, D. A. C., Kniphoff, I. D. S. O., & Oliveira, L. D. S. (2024) · RECIMA21 - Revista Científica Multidisciplinar · doi:10.47820/recima21.v5i5.5201 · Cited by 1
Frailty in Older Adults with Obesity and the Effect of Lifestyle Interventions
Colleluori, G., & Villareal, D. T. (2024) · Springer eBooks · doi:10.1007/978-3-031-57361-3_45 · Cited by 1
Effects of an Oral Nutritional Supplementation and Physical Exercise Intervention on Older Adults at Risk for Sarcopenia
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“The difference in muscle strength between young people and healthy older adults ages 60 to 80 years is 20–40%, and this difference increases to ≥ 50% when compared with those older than 80 years 3,24 .”
Background
Patrones dietéticos en el aumento de masa muscular en adultos mayores: Una revisión sistemática
Carrera, C. C., Álvarez, H. R. P., Castillo, M. M., & Javier, F. D. P. G. (2024) · RESPYN Revista de Salud Pública y Nutrición · doi:10.29105/respyn23.3-800 · Cited by 1

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)
ORCID: Gielen, Evelien
Vandewoude, Maurits
Beaudart, C
Beyer, I
Bruyère, O
Perkisas, S
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
DOI: 10.1093/nutrit/nuaa011
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: other-oa
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
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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Nutritional interventions to improve muscle mass, muscle strength, and physical performance in older people: an umbrella review of systematic reviews and meta-analyses.

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