The role of omega-3 in the prevention and treatment of sarcopenia

International Society of Sports Nutrition Position Stand: Long-Chain Omega-3 Polyunsaturated Fatty Acids

Position Statement: The International Society of Sports Nutrition (ISSN) presents this position based on a critical examination of the literature surrounding the effects of long-chain omega-3 polyunsaturated fatty acid (ω-3 PUFA) supplementation on exercise performance, recovery, and brain health. This position stand is intended to provide a scientific foundation for athletes, dietitians, trainers, and other practitioners regarding the effects of supplemental ω-3 PUFA in healthy and athletic populations. The following conclusions represent the official position of the ISSN: Athletes may be at a higher risk for ω-3 PUFA insufficiency.Diets rich in ω-3 PUFA, including supplements, are effective strategies for increasing ω-3 PUFA levels.ω-3 PUFA supplementation, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), has been shown to enhance endurance capacity and cardiovascular function during aerobic-type exercise.ω-3 PUFA supplementation may not confer a muscle hypertrophic benefit in young adults.ω-3 PUFA supplementation in combination with resistance training may improve strength in a dose- and duration-dependent manner.ω-3 PUFA supplementation may decrease subjective measures of muscle soreness following intense exercise.ω-3 PUFA supplementation can positively affect various immune cell responses in athletic populations.Prophylactic ω-3 PUFA supplementation may offer neuroprotective benefits in athletes exposed to repeated head impacts.ω-3 PUFA supplementation is associated with improved sleep quality.ω-3 PUFA are classified as prebiotics; however, studies on the gut microbiome and gut health in athletes are currently lacking.

Association of nut consumption and sarcopenia in Chinese older adults

Sarcopenia emerges as a predominant health concern among the older adults, it makes the identification of relational factors crucial. Nut, a universally consumed dietary component, is posited to confer benefits to the musculoskeletal system. This study aimed to elucidate the association between nut consumption and sarcopenia in Chinese older adults. Data concerning nut consumption and sarcopenia were sourced from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The analysis incorporated 14,281 participants furnishing valid responses. This research employed logistic regression to investigate the association between nut consumption and sarcopenia. A total of 14,181 older adults (mean age = 84.86 ± 11.47 years and 55.08% were female) were included in this study. This study found an inverse association between nut consumption and sarcopenia in Chinese older adults, with higher nut consumption associated with a lower prevalence of sarcopenia, even after controlling for confounders. Compared with the nut consumption group of occasionally/rarely or never, the adjusted ORs of sarcopenia for at least once per month, at least once per week, and almost every day were 0.78 (95% CI: 0.66, 0.91), 0.81 (95% CI: 0.69, 0.95), and 0.62 (95% CI: 0.51, 0.77), respectively. Moreover, the result also displayed there is a significant interaction of nut consumption with gender (P-value = 0.016). This study identified an inverse association between nut consumption and sarcopenia. Introducing nut into the dietary regimen might present an accessible approach to bolster musculoskeletal health among the older adults.

Effects of vitamin D3, omega-3 fatty acids and a simple home exercise program on change in physical activity among generally healthy and active older adults: The 3-year DO-HEALTH trial

OBJECTIVES

Physical function and physical activity (PA) are key drivers of health and autonomy at older age. We examined the effects of supplemental vitamin D3, supplemental marine omega-3 fatty acids (omega-3s), and a simple home exercise program (SHEP), alone or in combination, on change in physical function and PA among generally healthy older adults.

DESIGN

Multi-center, 2 × 2 × 2 factorial design, randomized controlled trial, follow-up of three years METHODS: Self-reported PA and physical function were pre-defined outcomes of the DO-HEALTH trial, which included older adults (≥70 years) free of major comorbidities. The interventions were vitamin D3 (2000 IU/d), marine omega-3s (1 g/d), and a SHEP (3 × 30 min/wk), applied alone or in combination in eight treatment arms. The outcomes were change in PA (self-reported total PA, metabolic equivalent [MET] h/wk) and physical function (five times sit-to-stand test, hand grip strength, gait speed) from baseline to 12, 24 and 36 months. Mixed effect models were used and adjusted for age, sex, BMI, prior fall, time and baseline level of the outcome.

RESULTS

All 2157 DO-HEALTH participants (mean age 75 years; 83% physically active; 59% vitamin D3 replete) were included. Baseline PA was 75 MET h/wk. Participants receiving omega-3s versus no omega-3s and randomized to SHEP versus control exercise did not differ in PA change over 3 years. However, participants receiving vitamin D3 compared to those receiving no vitamin D3 (Δadjusted means: -7.1 [95% CI -12.7, -1.5] MET h/wk, P = 0.01) showed a decline in PA. Results did not differ in subgroups by sex and age (70-74 yrs, ≥75 yrs). Vitamin D3, omega-3s or SHEP did not improve physical function.

CONCLUSION

Among generally healthy, active, and largely vitamin D3 replete adults aged 70 years and older, vitamin D3, omega-3s and SHEP, individually and in combination had no benefits on self-reported PA and objectively measured physical function. The detrimental effect of vitamin D supplementation on PA change needs further examination.

Effects of Long-Chain n-3 Fatty Acids Supplementation During Caloric Restriction on Body Composition in Overweight and Obese Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This systematic review aimed to determine whether caloric restriction-induced reduction in body fat and fat-free mass can be amended by supplementation with long-chain n-3 polyunsaturated fatty acids. Databases, including PubMed, Google Scholar, Web of Science, and EMBASE, were searched for papers published from the time the databases were created until November 1, 2023. Random-effects model meta-analyses were conducted using Review Manager 5.4.1 software. Statistical heterogeneity was assessed using the I 2. A standardized mean difference with a 95% confidence interval was calculated, and pooled effects were assessed. The initial search identified 1527 articles and 11 studies met the review inclusion criteria with 637 participants included. The participants' ages ranged between 18 and 61 years with a mean body mass index ranging between 27 and 36 kg/m2. The changes in fat-free mass (standardized mean difference = 0.12, 95% CI -0.14 to 0.37, p = 0.36; I 2:35%) and fat mass (standardized mean difference = - 0.01; 95% CI -0.25 to 0.24; p = 0.96; I 2: 46%) were not different between intervention and control groups. The current review indicates that long-chain n-3 polyunsaturated fatty acids supplementation during caloric restriction neither attenuates the decline in fat-free mass nor enhances the reduction in fat mass. Considering the small number of studies and interventions included, further research is needed to investigate the effectiveness of long-chain n-3 polyunsaturated fatty acids supplementation during caloric restriction.

Preliminary study on nutritional and exercise strategies to prevent and reverse sarcopenia in aging: an open-label single-arm trial

BACKGROUND AND OBJECTIVES

Sarcopenia is the progressive loss of muscle mass and strength that can adversely affect an individual's health and quality of life. The objective of this study was to evaluate the effectiveness of a combined nutritional and exercise intervention among older adults who were at risk of sarcopenia.

METHODS AND STUDY DESIGN

46 older adults were included in a 30±3 days intervention that combined oral nutritional supplements with resistance exercise. Parameters were measured at baseline (day 0) and after intervention (day 30±3), including routine parameters of sarcopenia, blood tests, and body measurements. The ITT analysis method was used, and the data were analysed using paired t-tests/paired Wilcoxon test, and ANOVA.

RESULTS

Among the 46 participants, there were no significant changes in hip circumference (HC), muscle mass of both lower limbs, appendicular skeletal muscle mass index (ASMI), and hemoglobin (Hb) after intervention. However, both hand grip strength (GS) significantly increased, as did muscle mass of both upper limbs and the total muscle strength. Blood tests showed a slight increase in albumin (ALB) levels and a significant increase in 25-OH-D levels, while the waist (WC) and calf circumferences (CC) also increased significantly after intervention. Somatic motor performance improved significantly in the 6-meter walk and 5 sit-ups tests.

CONCLUSIONS

The combined nutritional and exercise intervention was feasible and effective in improving muscle mass and strength, especially in the upper limbs, as well as somatic motor performance among older adults at risk of sarcopenia. It could be beneficial among three stages of sarcopenia.

Nutritional Supplements for Healthy Aging: A Critical Analysis Review

Background: Healthy aging is defined as survival to advanced age while retaining autonomy in activities of daily living, high societal participation, and good quality of life. Sarcopenia, insomnia, cognitive impairment, and changes in sensation can be key hinderances to healthy aging, but nutritional supplements may abate their impact. As research advances, an updated review on their efficacy on age-related conditions is warranted. Results: Sarcopenia can be mitigated through proper protein intake, supplements like creatine, and in certain situations Branched-Chain Amino Acids and Vitamin D, in adults over 65. Melatonin supplementation has moderate evidence for improving sleep, while valerian root lacks evidence. Magnesium, tart cherry, and kiwifruits have shown promising impacts on sleep in limited articles. Magnesium, Vitamin D, and B vitamin supplementation have been shown to improve cognition in those with mild cognitive impairment and Alzheimer's disease but require further study prior to recommendation. The Age-Related Eye Disease Study supplement combination is routinely recommended to reduce risk of progression to advance stages of age-related macular degeneration. Alpha-Lipoic Acid and Folate have been investigated for their roles in mitigating age-related hearing losses. Conclusions: Nutritional supplements and lifestyle changes may mitigate disabilities across multiple domains of age-related illnesses and promote healthy aging.

The cross-talk between the cGAS-STING signaling pathway and chronic inflammation in the development of musculoskeletal disorders

Musculoskeletal disorders (MSDs) comprise diverse conditions affecting bones, joints, and muscles, leading to pain and loss of function, and are one of the most prevalent and major global health concerns. One of the hallmarks of MSDs is DNA damage. Once accumulated in the cytoplasm, the damaged DNA is sensed by the cyclic GMP-AMP synthase (cGAS)/stimulator of interferon genes (STING) pathway, which triggers the induction of type I interferons and inflammatory cytokines. Thus, this pathway connects the musculoskeletal and immune systems. Inhibitors of cGAS or STING have shown promising therapeutic effects in the pre-clinical models of several MSDs. Systemic, chronic, low-grade inflammation (SCLGI) underlies the development and maintenance of many MSDs. Failure to resolve SCLGI has been hypothesized to play a critical role in the development of chronic diseases, suggesting that the successful resolution of SCLGI will result in the alleviation of their related symptomatology. The process of inflammation resolution is feasible by specialized pro-resolving mediators (SPMs), which are enzymatically generated from dietary essential polyunsaturated fatty acids (PUFAs). The supplementation of SPMs or their stable, small-molecule mimetics and receptor agonists has revealed beneficial effects in inflammation-related animal models, including arthropathies, osteoporosis, and muscle dystrophy, suggesting a translational potential in MSDs. In this review, we substantiate the hypothesis that the use of cGAS-STING signaling pathway inhibitors together with SCLG-resolving compounds may serve as a promising new therapeutic approach for MSDs.

Association between fish intake and incidence of sarcopenia in community-dwelling older adults after a 6-year follow-up: the Korean frailty and aging cohort study

Previous studies have suggested beneficial effects of n-3 polyunsaturated fatty acids on sarcopenia. However, the associations of dietary fish intake with the prevalence of sarcopenia are inconsistent, and those with the incidence of sarcopenia has not been studied. This study investigated the hypothesis that seafood and fish consumption is inversely associated with the subsequent incidence of sarcopenia. Using data from the Korean Frailty and Aging Cohort Study, 503 non-sarcopenic community-dwelling Korean adults aged 70-84 years were followed-up for 6 years. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 consensus. Dietary intake was assessed using two non-consecutive 24-h dietary recalls at baseline. The incidence of sarcopenia was 37.8% after the 6-year follow-up. The intake of oily fish was inversely associated with the incidence of sarcopenia (OR 0.99; 95% CI 0.98-1.00; p for trend = 0.046) and that of low gait speed (OR 0.98; 95% CI 0.97-1.00; p for trend = 0.016) after the 6-year follow-up, adjusting for confounding factors. Consumption of total seafood, fish, non-oily fish, or shellfish was not significantly associated with the incidence of sarcopenia or its parameters, such as muscle mass, handgrip strength, usual gait speed, 5-times sit-to-stand test, or the Short Physical Performance Battery. The findings demonstrate that the consumption of oily fish could be beneficial in preventing sarcopenia, particularly by improving usual gait speed in Korean community-dwelling older adults, suggesting oily fish as a strategy to reduce sarcopenia risk.

Differential effects of EPA and DHA on aging-related sarcopenia in mice and possible mechanisms involved

Sarcopenia frequently occurs with aging and leads to major adverse impacts in elderly individuals. The protective effects of omega-3 polyunsaturated fatty acids against aging-related sarcopenia have been demonstrated; however, the effect and underlying mechanism of EPA or DHA alone remain inconclusive. Hence, the present study was aimed to clarify the differential effects and possible mechanisms of EPA and DHA on aging-related sarcopenia. In this study, two-month-old and eighteen-month-old male C57BL/6J mice were fed with an AIN-93M diet and an AIN-93M diet containing 1% EPA or 1% DHA for 24 weeks, respectively. The results revealed that EPA and DHA supplementation effectively alleviated the decline in grip strength, skeletal muscle mass, and myofiber cross-sectional areas in aged mice, with EPA exhibiting a better effect against aging-related sarcopenia than DHA. The ROS scavenging role of EPA in aged skeletal muscle was also superior to that of DHA. Additionally, EPA showed a stronger role in improving protein turnover and myogenesis in aged skeletal muscle, as evidenced by suppressing the activation of FoxO3a and NF-κB, blunting the expression levels of muscle atrophy markers MAFbx and MuRF1, activating the PI3K/Akt/mTOR signaling pathway, and elevating MyoD expression. Moreover, EPA also revealed a better effect on inhibiting mitochondria- and endoplasmic reticulum stress-mediated apoptosis in aged skeletal muscle. Furthermore, EPA manifested a more pronounced effect on improving mitochondrial damage of aged skeletal muscle than DHA, and the reason might be due to its superior capability of regulating mitochondrial quality control, as clearly shown by enhancing mitochondrial biogenesis through the AMPK/PGC-1α-dependent pathway, restraining the loss of mitochondrial fusion and fission proteins including Opa1, Mfn2, and Fis1, and promoting mitophagy via the PINK1/Parkin-dependent pathway.

Effects of Supplemental Vitamin D3, Omega-3 Fatty Acids on Physical Performance Measures in the VITamin D and OmegA-3 TriaL

CONTEXT

Declining muscle strength and performance in older adults are associated with falls, fractures, and premature death.

OBJECTIVE

This work aimed to determine whether supplementation with vitamin D3 or omega-3 fatty acids vs placebo for 2 years improves physical performance measures.

METHODS

VITamin D and OmegA-3 TriaL (VITAL) was a double-blinded, placebo-controlled randomized trial of supplemental vitamin D3 and/or omega-3 fatty acids vs placebo in the prevention of cancer and cardiovascular disease in 25 871 US adults. This ancillary study was completed in a New England subcohort that had in-person evaluations at baseline and 2-year follow-up. This study was conducted with 1054 participants (age: men ≥50 and women ≥55 years) at the Center for Clinical Investigations in Boston. Interventions included a 2 × 2 factorial design of supplemental vitamin D3 (cholecalciferol, 2000 IU/day) and/or marine omega-3 fatty acids (1 g/day). Main outcome measures included 2-year changes in physical performance measures of grip strength, walking speed, standing balance, repeated chair stands, and Timed-up and Go (TUG).

RESULTS

At 2 years, all randomized groups showed worsening walking speeds and TUG. There were no differences in changes in grip strength, walking speeds, Short Physical Performance Battery (composite of walking speed, balance, and chair stands), and TUG between the vitamin D3-treated and the placebo-treated groups and between the omega-3-treated and the placebo-treated groups. Effects overall did not vary by sex, age, body mass index, or baseline measures of total or free 25-hydroxyvitamin D (25[OH]D) or plasma omega-3 index; TUG slightly worsened with vitamin D supplementation, compared to placebo, in participants with baseline total 25(OH)D levels above the median (P = .01; P for interaction = .04).

CONCLUSION

Neither supplemental vitamin D3 nor marine omega-3 fatty acids for 2 years improved physical performance in this generally healthy adult population.

Amino Acid and Essential Fatty Acid in Evacuation Shelter Food in the Noto Peninsula Earthquake: Comparison with the 2024 Simultaneous National Survey in Japan

BACKGROUND

On 1 January 2024, a 7.6 magnitude earthquake struck the Noto Peninsula. We entered the disaster area to provide relief and set up a makeshift clinic in an evacuation center to evaluate the quality and quantity of food provided there.

METHODS

This cross-sectional study, of mainly older adults, was conducted to analyze the amino acid and fatty acid composition of evacuation shelter meals in comparison with the results of the Japan National Survey, mainly focused on older adults. (1) We analyzed 11 evacuation foods using the "Duplicated Combination" Model and the digestible amino acid score (DIAAS) in relation to the half-life determined by the N-terminal amino acid proteins. (2) Linoleic acid (LA) and alpha-linolenic acid (ALA) levels were compared with European Food Safety Authority (EFSA) recommendations (3). The national survey of emergency food stocks in 198 hospitals and 189 social care institutions conducted in Jan 2024 was analyzed.

RESULTS

(1) DIAAS was less than 1.00 for all 11 foods provided and was considered inadequate, (2) the half-life of the protein, whose N-terminal valine has a half-life of 100 h, must be considered a possible deficiency when living in a shelter for more than a week, (3) LA and ALA levels were less than 40% of EFSA recommended, (4) the nationwide survey found that 80% of people have a three-day supply and data on amino acids and fatty acids were not available due to a lack of questionnaires.

CONCLUSION

Analysis of food in evacuation shelters after the Noto Peninsula earthquake revealed the quality of amino acids involved in shelter meals using DIAAS and the lack of LA and ALA for older adults. The "Duplicated Combination" model used in this analysis could be beneficial for developing improved nutrition plans in similar future scenarios, mainly for older adults.

Influence of diet and exercise on leukocyte telomere length, markers of oxidative stress and inflammation in rats

Telomere length is an important biomarker of biological aging and is affected by nutrition and physical activity. This study investigated the effects of diets with different fat contents and increased physical activity on certain pro/anti-inflammatory and oxidative stress markers and aging. The study is performed in a randomized, experimental, and controlled design with 48 rats, 8 weeks old, divided into 6 different groups (Control (C), exercise (E), unsaturated fat diet (USF), saturated fat diet (SF), unsaturated fat diet + exercise (USF + E), and saturated fat diet + exercise (SF + E)). The rats performed aerobic swimming exercise for 50 days and were fed a diet with different fat content. TAS, TOS, and MDA levels were determined by colorimetric analysis while 8-OHdG, IL-10, and TNF-α were determined by ELISA. Additionally, leukocyte telomere length is determined by the PCR method. Weight changes were also recorded. Plasma TOS, OSI, and TNF-α were lowest in the USF group and highest in the SF and SF + E groups. MDA, 8-OHdG and TG levels were highest in the SF group. The lowest IL-10 level was detected in group C. TL level was the highest in the USF group. There was also a moderate, negative, and significant correlation between telomeres and TOS, OSI, and TNF-α. The groups with the highest body weight gain were C, SF, and SF + E. Diets low in saturated fat or high in unsaturated fat, and physical activity were associated with leukocyte telomere length and alteration of oxidative and pro/anti-inflammatory markers.

Diet and exercise in frailty and sarcopenia. Molecular aspects

Function declines throughout life although phenotypical manifestations in terms of frailty or disability are only seen in the later periods of our life. The causes underlying lifelong function decline are the aging process "per se", chronic diseases, and lifestyle factors. These three etiological causes result in the deterioration of several organs and systems which act synergistically to finally produce frailty and disability. Regardless of the causes, the skeletal muscle is the main organ affected by developing sarcopenia. In the first section of the manuscript, as an introduction, we review the quantitative and qualitative age-associated skeletal muscle changes leading to frailty and sarcopenia and their impact in the quality of life and independence in the elderly. The reversibility of frailty and sarcopenia are discussed in the second and third sections of the manuscript. The most effective intervention to delay and even reverse frailty is exercise training. We review the role of different training programs (resistance exercise, cardiorespiratory exercise, multicomponent exercise, and real-life interventions) not only as a preventive but also as a therapeutical strategy to promote healthy aging. We also devote a section in the text to the sexual dimorphic effects of exercise training interventions in aging. How to optimize the skeletal muscle anabolic response to exercise training with nutrition is also discussed in our manuscript. The concept of anabolic resistance and the evidence of the role of high-quality protein, essential amino acids, creatine, vitamin D, β-hydroxy-β-methylbutyrate, and Omega-3 fatty acids, is reviewed. In the last section of the manuscript, the main genetic interventions to promote robustness in preclinical models are discussed. We aim to highlight the molecular pathways that are involved in frailty and sarcopenia. The possibility to effectively target these signaling pathways in clinical practice to delay muscle aging is also discussed.

Therapeutic strategies to modulate gut microbial health: Approaches for sarcopenia management

Sarcopenia is a progressive and generalized loss of skeletal muscle and functions associated with ageing with currently no definitive treatment. Alterations in gut microbial composition have emerged as a significant contributor to the pathophysiology of multiple diseases. Recently, its association with muscle health has pointed to its potential role in mediating sarcopenia. The current review focuses on the association of gut microbiota and mediators of muscle health, connecting the dots between the influence of gut microbiota and their metabolites on biomarkers of sarcopenia. It further delineates the mechanism by which the gut microbiota affects muscle health with progressing age, aiding the formulation of a multi-modal treatment plan involving nutritional supplements and pharmacological interventions along with lifestyle changes compiled in the review. Nutritional supplements containing proteins, vitamin D, omega-3 fatty acids, creatine, curcumin, kefir, and ursolic acid positively impact the gut microbiome. Dietary fibres foster a conducive environment for the growth of beneficial microbes such as Bifidobacterium, Faecalibacterium, Ruminococcus, and Lactobacillus. Probiotics and prebiotics act by protecting against reactive oxygen species (ROS) and inflammatory cytokines. They also increase the production of gut microbiota metabolites like short-chain fatty acids (SCFAs), which aid in improving muscle health. Foods rich in polyphenols are anti-inflammatory and have an antioxidant effect, contributing to a healthier gut. Pharmacological interventions like faecal microbiota transplantation (FMT), non-steroidal anti-inflammatory drugs (NSAIDs), ghrelin mimetics, angiotensin-converting enzyme inhibitors (ACEIs), and butyrate precursors lead to the production of anti-inflammatory fatty acids and regulate appetite, gut motility, and microbial impact on gut health. Further research is warranted to deepen our understanding of the interaction between gut microbiota and muscle health for developing therapeutic strategies for ameliorating sarcopenic muscle loss.

Late-onset primary muscle diseases mimicking sarcopenia

Sarcopenia is an age-related loss of skeletal muscle mass, strength, and function that causes various health problems. In contrast, late-onset primary myopathies, which occur in the older population, are caused by a variety of factors, including genetic mutations, autoimmune processes, and metabolic abnormalities. Although sarcopenia and primary myopathy are two distinct disease processes, their symptoms can overlap, making differentiation challenging. The diagnostic criteria for sarcopenia have evolved over time, and various criteria have been proposed by expert groups. Late-onset primary muscle diseases such as inclusion body myositis, sporadic late-onset nemaline myopathy, muscular dystrophies, distal myopathies, myofibrillar myopathies, metabolic myopathies, and mitochondrial myopathies share common pathogenic mechanisms with sarcopenia, further complicating the diagnostic process. Appropriate clinical evaluation, including detailed history-taking, physical examination, and diagnostic testing, is essential for accurate diagnosis and management. Treatment approaches, including exercise, nutritional support, and disease-specific therapies, must be tailored to the characteristics of each disease. Despite these differences, sarcopenia and primary myopathies require careful consideration in the clinical setting for proper diagnosis and management. This review outlines the evolution of diagnostic criteria and diagnostic items for sarcopenia, late-onset primary myopathies that should be differentiated from sarcopenia, common pathomechanisms, and diagnostic algorithms to properly differentiate primary myopathies. Geriatr Gerontol Int 2024; 24: 1099-1110.

Integrative Geriatric Oncology: A Review of Current Practices

PURPOSE OF REVIEW

This article aims to offer a comprehensive review of optimal integrative medicine practices for geriatric oncology patients. Given the aging population and the global rise in cancer incidence, it is crucial to identify evidence-based modalities and employ an integrated approach to enhance cancer outcomes and quality of life in older adults.

RECENT FINDINGS

It has been predicted that 20.5% (6.9 million) of new cancer cases in 2050 will occur in adults over 80 years old.1 The increasing focus on lifestyle factors in healthy aging has shed light on various overlooked areas of significance. Notably, anti-inflammatory diets and the promotion of a healthy gut microbiome have demonstrated significant impacts on overall health outcomes, bolstering the body's innate capacity to combat disease. This review delves into further evidence and extrapolation concerning integrative approaches and their influence on cancer outcomes and older adults quality of life. The complexity and unique nature of cancer in older adults requires a wide range of support from medical providers. Incorporating various integrative techniques as part of cancer treatment and side effect support can improve health outcomes and patient's quality of life. Familiarity with the lifestyle interventions and other topics explored in this review equips healthcare providers to offer tailored and holistic care to geriatric patients navigating cancer.

Association between Drug Therapy and Risk of Incident Frailty: A Systematic Review

Medication is a potential factor influencing frailty. However, the relationship between pharmaceutical treatments and frailty remains unclear. Therefore, we conducted the present systematic review to summarize the association between drug therapy and the risk of incident frailty in older adults. We systematically searched the MEDLINE electronic database for articles indexed between January 1, 2000, and December 31, 2021, for randomized controlled trials (RCTs) and cohort studies reporting frailty changes associated with drug therapy. A total of six RCTs and 13 cohort studies involving 211,948 participants were identified, and their treatments were categorized into six medication classes: analgesics, cardiometabolic medication, chemotherapy, central nervous system (CNS)-active medication, hormonal therapy, and nutritional supplements. While the analysis revealed that only CNS-active medications were associated with an elevated risk of frailty, other medication classes also affected frailty; however, this is not conclusively attributable to a class-wide effect.

Skeletal muscle dysfunction with advancing age

As a result of advances in medical treatments and associated policy over the last century, life expectancy has risen substantially and continues to increase globally. However, the disconnect between lifespan and 'health span' (the length of time spent in a healthy, disease-free state) has also increased, with skeletal muscle being a substantial contributor to this. Biological ageing is accompanied by declines in both skeletal muscle mass and function, termed sarcopenia. The mechanisms underpinning sarcopenia are multifactorial and are known to include marked alterations in muscle protein turnover and adaptations to the neural input to muscle. However, to date, the relative contribution of each factor remains largely unexplored. Specifically, muscle protein synthetic responses to key anabolic stimuli are blunted with advancing age, whilst alterations to neural components, spanning from the motor cortex and motoneuron excitability to the neuromuscular junction, may explain the greater magnitude of function losses when compared with mass. The consequences of these losses can be devastating for individuals, their support networks, and healthcare services; with clear detrimental impacts on both clinical (e.g., mortality, frailty, and post-treatment complications) and societal (e.g., independence maintenance) outcomes. Whether declines in muscle quantity and quality are an inevitable component of ageing remains to be completely understood. Nevertheless, strategies to mitigate these declines are of vital importance to improve the health span of older adults. This review aims to provide an overview of the declines in skeletal muscle mass and function with advancing age, describes the wide-ranging implications of these declines, and finally suggests strategies to mitigate them, including the merits of emerging pharmaceutical agents.

Omega-3 polyunsatured fatty acids and physical performance across the lifespan: a narrative review

Background and Aims

Physical performance is a major contributor of mobility and independence during older life. Despite a progressive decline in musculoskeletal function starts from middle age, several factors acting during the life-course can negatively influence musculoskeletal functional capacities. Lifestyle interventions incorporating nutrition and physical exercise can help maximizing the muscle functional capacities in early life as well as preserving them later in life. Among various dietary compounds, omega-3 polyunsaturated fatty acids (PUFAs) are gaining growing attention for their potential effects on muscle membrane composition and muscle function. Indeed, several pathways are enhanced, such as an attenuation of pro-inflammatory oxidative stress, mitochondrial function, activation of the mammalian target of rapamycin (mTOR) signaling and reduction of insulin resistance.

Methods

We performed a narrative review to explore the existing literature on the relationship between omega-3 PUFAs and physical performance across the life-course.

Results

Growing evidence from randomized controlled trials (RCTs) suggests beneficial effects of omega-3 PUFAs on muscle function, including physical performance parameters in mid to later life. On the other hand, despite a direct association in early life is not available in literature, some mechanisms by which omega-3 PUFAs may contribute to improved adult physical performance could be hypothesized.

Conclusion

Omega-3 PUFAs are gaining growing attention for their positive effect on muscle function parameters. The integration of physical function measures in future studies would be of great interest to explore whether omega-3 PUFAs could contribute to improved muscle function, starting from early life and extending throughout the lifespan. However, larger and high-quality RCTs are needed to fully elucidate the beneficial effects of omega-3 PUFAs supplementation on muscle mass and function.

Biological basis and treatment of frailty and sarcopenia

In an ageing society, the importance of maintaining healthy life expectancy has been emphasized. As a result of age-related decline in functional reserve, frailty is a state of increased vulnerability and susceptibility to adverse health outcomes with a serious impact on healthy life expectancy. The decline in skeletal muscle mass and function, also known as sarcopenia, is key in the development of physical frailty. Both frailty and sarcopenia are highly prevalent in patients not only with advanced age but also in patients with illnesses that exacerbate their progression like heart failure (HF), cancer, or dementia, with the prevalence of frailty and sarcopenia in HF patients reaching up to 50-75% and 19.5-47.3%, respectively, resulting in 1.5-3 times higher 1-year mortality. The biological mechanisms of frailty and sarcopenia are multifactorial, complex, and not yet fully elucidated, ranging from DNA damage, proteostasis impairment, and epigenetic changes to mitochondrial dysfunction, cellular senescence, and environmental factors, many of which are further linked to cardiac disease. Currently, there is no gold standard for the treatment of frailty and sarcopenia, however, growing evidence supports that a combination of exercise training and nutritional supplement improves skeletal muscle function and frailty, with a variety of other therapies being devised based on the underlying pathophysiology. In this review, we address the involvement of frailty and sarcopenia in cardiac disease and describe the latest insights into their biological mechanisms as well as the potential for intervention through exercise, diet, and specific therapies.

Cellular Basis of Adjuvant Role of n-3 Polyunsaturated Fatty Acids in Cancer Therapy: Molecular Insights and Therapeutic Potential against Human Melanoma

Human melanoma is a highly aggressive malignant tumor originating from epidermal melanocytes, characterized by intrinsic resistance to apoptosis and the reprogramming of proliferation and survival pathways during progression, leading to high morbidity and mortality rates. This malignancy displays a marked propensity for metastasis and often exhibits poor responsiveness to conventional therapies. Fatty acids, such as n-3 polyunsaturated fatty acids (PUFAs) docosahexaenoic and eicosapentaenoic acids, exert various physiological effects on melanoma, with increasing evidence highlighting the anti-tumorigenic, anti-inflammatory, and immunomodulatory properties. Additionally, n-3 PUFAs have demonstrated their ability to inhibit cancer metastatic dissemination. In the context of cancer treatment, n-3 PUFAs have been investigated in conjunction with chemotherapy as a potential strategy to mitigate severe chemotherapy-induced side effects, enhance treatment efficacy and improve safety profiles, while also enhancing the responsiveness of cancer cells to chemotherapy. Furthermore, dietary intake of n-3 PUFAs has been associated with numerous health benefits, including a decreased risk and improved prognosis in conditions such as heart disease, autoimmune disorders, depression and mood disorders, among others. However, the specific mechanisms underlying their anti-melanoma effects and outcomes remain controversial, particularly when comparing findings from in vivo or in vitro experimental studies to those from human trials. Thus, the objective of this review is to present data supporting the potential role of n-3 PUFA supplementation as a novel complementary approach in the treatment of malignant cancers such as melanoma.

The relationship between dietary intake of ω-3 and ω-6 fatty acids and frailty risk in middle-aged and elderly individuals: a cross-sectional study from NHANES

Background

Frailty is a complex clinical syndrome characterized by a decline in the functioning of multiple body systems and reduced adaptability to external stressors. Dietary ω-3 fatty acids are considered beneficial dietary nutrients for preventing frailty due to their anti-inflammatory and immune-regulating properties. However, previous research has yielded conflicting results, and the association between ω-6 fatty acids, the ω-6: ω-3 ratio, and frailty remains unclear. This study aims to explore the relationship between these factors using the National Health and Nutrition Examination Survey (NHANES) database.

Materials and methods

Specialized weighted complex survey design analysis software was employed to analyze data from the 2005-2014 NHANES, which included 12,315 participants. Multivariate logistic regression models and restricted cubic splines (RCS) were utilized to assess the relationship between omega intake and frailty risk in all participants. Additionally, a nomogram model for predicting frailty risk was developed based on risk factors. The reliability of the clinical model was determined by the area under the receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis (DCA).

Results

In dietary ω-3 intake, compared to the T1 group (≤1.175 g/d), the T3 group's intake level (>2.050 g/d) was associated with approximately 17% reduction in frailty risk in model 3, after rigorous covariate adjustments (odds ratio (OR) = 0.83, 95% confidence interval (CI): (0.70, 0.99)). In dietary ω-6 intake, the T2 group's intake level (>11.423, ≤19.160 g/d) was associated with a 14% reduction in frailty risk compared to the T1 group (≤11.423 g/d) (OR: 0.86, 95% CI: 0.75, 1.00, p = 0.044). RCS results indicated a non-linear association between ω-3 and ω-6 intake and frailty risk. Both ROC and DCA curves demonstrated the stability of the constructed model and the effectiveness of an omega-rich diet in reducing frailty risk. However, we did not find a significant association between the ω-6: ω-3 ratio and frailty.

Conclusion

This study provides support for the notion that a high intake of ω-3 and a moderate intake of ω-6 may contribute to reducing frailty risk in middle-aged and elderly individuals.

Novel dietary strategies to manage sarcopenia

PURPOSE OF REVIEW

Sarcopenia is a wasting disease, mostly age-related in which muscle strength and mass decline, such as physical performance. With aging, both lower dietary protein intake and anabolic resistance lead to sarcopenia. Moreover, aging and sarcopenia display low-grade inflammation, which also worsen muscle condition. In this review, we focused on these two main targets to study dietary strategies.

RECENT FINDINGS

The better understanding in mechanisms involved in sarcopenia helps building combined dietary approaches including physical activity that would slow the disease progression. New approaches include better understanding in the choice of quality proteins, their amount and schedule and the association with antioxidative nutrients.

SUMMARY

First, anabolic resistance can be countered by increasing significantly protein intake. If increasing amount remains insufficient, the evenly delivery protein schedule provides interesting results on muscle strength. Quality of protein is also to consider for decreasing risk for sarcopenia, because varying sources of proteins appears relevant with increasing plant-based proteins ratio. Although new techniques have been developed, as plant-based proteins display a lower availability, we need to ensure an adapted overall amount of proteins. Finally, specific enrichment with leucine from whey protein remains the dietary combined approach most studied and studies on citrulline provide interesting results. As cofactor at the edge between anabolic and antioxidative properties, vitamin D supplementation is to recommend. Antioxidative dietary strategies include both fibers, vitamins, micronutrients and polyphenols from various sources for positive effects on physical performance. The ω 3 -polyunsaturated fatty acids also display positive modifications on body composition. Gut microbiota modifiers, such as prebiotics, are promising pathways to improve muscle mass and function and body composition in sarcopenic patients. Nutritional interventions could be enhanced by combination with physical activity on sarcopenia. In healthy older adults, promoting change in lifestyle to get near a Mediterranean diet could be one of the best options. In sarcopenia adults in which lifestyle changes appears unprobable, specific enrichement potentialized with physical activity will help in the struggle against sarcopenia. Longitudinal data are lacking, which makes it hard to draw strong conclusions. However, the effects of a physical activity combined with a set of nutrition interventions on sarcopenia seems promising.

Restoration of epigenetic impairment in the skeletal muscle and chronic inflammation resolution as a therapeutic approach in sarcopenia

Sarcopenia is an age-associated loss of skeletal muscle mass, strength, and function, accompanied by severe adverse health outcomes, such as falls and fractures, functional decline, high health costs, and mortality. Hence, its prevention and treatment have become increasingly urgent. However, despite the wide prevalence and extensive research on sarcopenia, no FDA-approved disease-modifying drugs exist. This is probably due to a poor understanding of the mechanisms underlying its pathophysiology. Recent evidence demonstrate that sarcopenia development is characterized by two key elements: (i) epigenetic dysregulation of multiple molecular pathways associated with sarcopenia pathogenesis, such as protein remodeling, insulin resistance, mitochondria impairments, and (ii) the creation of a systemic, chronic, low-grade inflammation (SCLGI). In this review, we focus on the epigenetic regulators that have been implicated in skeletal muscle deterioration, their individual roles, and possible crosstalk. We also discuss epidrugs, which are the pharmaceuticals with the potential to restore the epigenetic mechanisms deregulated in sarcopenia. In addition, we discuss the mechanisms underlying failed SCLGI resolution in sarcopenia and the potential application of pro-resolving molecules, comprising specialized pro-resolving mediators (SPMs) and their stable mimetics and receptor agonists. These compounds, as well as epidrugs, reveal beneficial effects in preclinical studies related to sarcopenia. Based on these encouraging observations, we propose the combination of epidrugs with SCLI-resolving agents as a new therapeutic approach for sarcopenia that can effectively attenuate of its manifestations.

Prevalence and clinical outcomes of sarcopenia in patients with esophageal, gastric or colorectal cancers receiving preoperative neoadjuvant therapy: A meta-analysis

Objective

To investigate the prevalence of sarcopenia and its impact on clinical outcomes in patients with esophageal, gastric, or colorectal cancer (EC, GC, and CRC) receiving neoadjuvant therapy through Meta-analysis.

Methods

We searched the PubMed, Embase databases, and Cochrane Library for the prevalence of sarcopenia and its impact on clinical outcomes in EC, GC, or CRC patients treated with neoadjuvant therapy (NAT) from inception to November 2022. The primary endpoints were the prevalence of sarcopenia and overall survival in patients with EC, GC, or CRC treated with NAT. Secondary outcomes included recurrence-free survival, total postoperative complications, grade 3-4 chemotherapy toxicity, and 30-day mortality after surgery.

Results

Thirty-one retrospective studies with 3651 subjects were included. In a fixed-effects model, the prevalence of muscle loss was higher in patients with EC, GC, or CRC at 50% (95% CI ​= ​42% to 58%). The results of the multivariate analysis showed that preoperative patients with sarcopenia had a 1.91 times shorter overall survival (95% CI ​= ​1.61-2.27) and a 1.77 times shorter recurrence-free survival time (95% CI ​= ​1.33-2.35) than patients without sarcopenia, and that patients with sarcopenia had a higher risk of total postoperative complications than patients without sarcopenia OR ​= ​1.27 (95% CI ​= ​1.03-1.57). However, the two groups had no statistical difference in grade 3-4 chemotherapy toxicity (P ​= ​0.84) or 30-d postoperative mortality (P ​= ​0.88).

Conclusions

The prevalence of sarcopenia in patients with EC, GC, or CRC during NAT is high, and it is associated with poorer clinical outcomes. Clinicians should closely monitor the changes in patients' body composition and guide patients to carry out a reasonable diet and appropriate exercise to improve their poor prognosis and quality of life.

Systematic review registration

CRD42023387817.

Nutrient Intake and Its Association with Appendicular Total Lean Mass and Muscle Function and Strength in Older Adults: A Population-Based Study

Treatment options for sarcopenia are currently limited, and primarily rely on two main therapeutic approaches: resistance-based physical activity and dietary interventions. However, details about specific nutrients in the diet or supplementation are unclear. We aim to investigate the relationship between nutrient intake and lean mass, function, and strength. Data were derived from the Gothenburg H70 birth cohort study in Sweden, including 719,70-year-olds born in 1944 (54.1% females). For independent variables, the diet history method (face-to-face interviews) was used to estimate habitual food intake during the preceding three months. Dependent variables were gait speed (muscle performance), hand grip strength (muscle strength), and the appendicular lean soft tissue index (ALSTI). Linear regression analyses were performed to analyze the relationship between the dependent variables and each of the covariates. Several nutrients were positively associated with ALSTI, such as polyunsaturated fatty acids (DHA, EPA), selenium, zinc, riboflavin, niacin equivalent, vitamin B12, vitamin D, iron, and protein. After correction for multiple comparisons, there were no remaining correlations with handgrip and gait speed. Findings of positive correlations for some nutrients with lean mass suggest a role for these nutrients in maintaining muscle volume. These results can be used to inform clinical trials to expand the preventive strategies and treatment options for individuals at risk of muscle loss and sarcopenia.

Pathophysiological-Based Nutritional Interventions in Cirrhotic Patients with Sarcopenic Obesity: A State-of-the-Art Narrative Review

In recent decades, following the spread of obesity, metabolic dysfunction has come to represent the leading cause of liver disease. The classical clinical presentation of the cirrhotic patient has, therefore, greatly changed, with a dramatic increase in subjects who appear overweight or obese. Due to an obesogenic lifestyle (lack of physical activity and overall malnutrition, with an excess of caloric intake together with a deficit of proteins and micronutrients), these patients frequently develop a complex clinical condition defined as sarcopenic obesity (SO). The interplay between cirrhosis and SO lies in the sharing of multiple pathogenetic mechanisms, including malnutrition/malabsorption, chronic inflammation, hyperammonemia and insulin resistance. The presence of SO worsens the outcome of cirrhotic patients, affecting overall morbidity and mortality. International nutrition and liver diseases societies strongly agree on recommending the use of food as an integral part of the healing process in the comprehensive management of these patients, including a reduction in caloric intake, protein and micronutrient supplementation and sodium restriction. Based on the pathophysiological paths shared by cirrhosis and SO, this narrative review aims to highlight the nutritional interventions currently advocated by international guidelines, as well as to provide hints on the possible role of micronutrients and nutraceuticals in the treatment of this multifaceted clinical condition.

Causal associations of plasma omega-3 polyunsaturated fatty acids with sarcopenia-related traits: a two-sample Mendelian randomization study

OBJECTIVE

To evaluate the causal effect of plasma omega-3 polyunsaturated fatty acids (PUFAs) on sarcopenia-related traits (lean mass, grip strength and walking pace) utilizing two-sample Mendelian randomization (MR) approach.

METHODS

Based on genome-wide association study (GWAS) summary statistics, we performed two-sample MR applying the inverse variance weighted (IVW) as the primary method, supplemented with four additional sensitivity analyses. Furthermore, multivariable MR (MVMR) was applied to assess these associations independent of alcohol drinking, type 2 diabetes (T2D), triglycerides (TG), estimated glomerular filtration rate (eGFR) and C-reactive protein (CRP).

RESULTS

In univariable MR, the IVW analysis suggested no significant causal effect of genetically determined plasma omega-3 PUFAs on fat-free mass (right leg: β = 0.01, 95% CI = -0.02 to 0.05, P = 0.375; left leg: β = 0.01, 95% CI = -0.02 to 0.04, P = 0.446; right arm: β = 0.01, 95% CI = -0.02 to 0.05, P = 0.376; left arm: β = 0.01, 95% CI = -0.02 to 0.04, P = 0.384; trunk:β = 0.02, 95% CI = -0.02 to 0.06, P = 0.283; whole: β = 0.01, 95% CI = -0.03 to 0.04, P = 0.631), grip strength (right hand: β = -0.01, 95% CI = -0.03 to 0.01, P = 0.387; left hand: β = -0.01, 95% CI = -0.02 to 0.01, P = 0.553) and walking pace (β = 0.00, 95% CI = -0.01 to 0.02, P = 0.575), and sensitive analysis generated similar non-significant results. Furthermore, the MVMR revealed no independent causal association.

CONCLUSIONS

Genetically determined plasma omega-3 PUFAs have no causal effect on sarcopenia-related traits.

Nutrition Interventions on Muscle-Related Components of Sarcopenia in Females: A Systematic Review of Randomized Controlled Trials

Sarcopenia is a skeletal muscle disease categorized by low muscle strength, muscle quantity or quality, and physical performance. Sarcopenia etiology is multifaceted, and while resistance training is widely agreed upon for prevention and treatment, disease progression is also highly related to poor diet. The incidence of sarcopenia appears sex-specific and may be increased in females, which is problematic because dietary quality is often altered later in life, particularly after menopause. Identifying effective nutrition or supplementation interventions could be an important strategy to delay sarcopenia and related comorbidities in this vulnerable population. This systematic review examined randomized controlled trials (RCTs) of nutrition strategies on muscle-related components of sarcopenia in middle-aged and older females. A protocol was registered (PROSPERO CRD42022382943) and a systematic search of MEDLINE and CINAHL was undertaken. RCTs from 2013 to 2023 that assessed nutrition-only interventions on muscle mass, muscle strength, and physical function in female participants were included. Fourteen RCTs were included based on selection criteria. Study designs and interventions were heterogeneous in supplementation type and amount, age, and duration. Six RCTs reported beneficial effects of protein, Vitamin D, Vitamin D and Magnesium (Mg), and fish oil on muscle protein synthesis, muscle strength, and/or muscle function. Eight studies that examined various protein interventions, VitD alone, Mg alone, and dairy derivatives did not demonstrate any effect. Exercise appeared to modulate results in several studies. Nutrition interventions alone are likely to have a limited but positive effect on muscle-related components of sarcopenia in females. Current evidence suggests that a combination of dietary intervention and exercise is likely to be key to preventing and treating sarcopenia in middle aged and older females and there is a need for well-designed nutrition based studies in this population.

Research trends and hotspots of exercise for people with sarcopenic: A bibliometric analysis

This study aimed to analyze the trends and themes in exercise and sarcopenia research using a bibliometric approach. The Web of Science citation database was used to identify papers published on exercise and sarcopenia. The retrieved data on institutions, journals, countries, authors, journal distribution, and keywords were analyzed scientometric ally using CiteSpace and VOSviewer. 2895 papers were included according to our specified inclusion criteria eventually. The data showed an upward trend in the number of published articles on exercise and sarcopenia. The countries with the highest number of publications were the United States, Japan, and England; research institutions were mainly composed of universities in Europe and the United States, and high-producing authors formed major collaborative teams, but cross-geographical and cross-institutional collaboration was not apparent; research was closely focused on 3 aspects: resistance exercise, resistance combined with other forms of exercise, and exercise combined with nutritional supplementation, of which resistance exercise was a particular focus; and recently, the research hotspots were mainly the effects of exercise on grip strength. The most cited articles were consensus guidelines published by the working group on sarcopenia in the elderly from different continents. The prevention and rehabilitation of sarcopenia in the elderly are gaining attention. Current primary exercise therapies for sarcopenia and exercise combined with nutritional supplementation have significant advantages and the potential to delay muscle decay. This suggests a promising area for future research that could benefit from further advances.

The relationship between the quantity and type of macronutrients in diet and frailty in older outpatients

BACKGROUND AND AIM

The aim of this study is to determine the relationship between the quantity and type of macronutrients in the diet and frailty.

MATERIAL AND METHODS

A total of 106 patients were included in the study. Exclusion criteria included patients with pacemakers, edema, advanced dementia, acute infectious and inflammatory disease, and those using oral or enteral nutritional supplements. Frailty was assessed using the Fried Frailty Phenotype. Three-day dietary records were taken, 2 days on weekdays and 1 day on weekends. The Nutrition Information System (BeBis) 8.2 full version program was used to analyze the average energy and nutrient values of the consumed foods. Insufficient protein and energy intake were defined as taking less than 1 or 1.2 g/kg/day for protein and less than 30 kcal/kg/day for energy, respectively.

RESULTS

The mean age of the participants was 74.3 (± 6.75), and 68.9% (n = 73) of them were women. 26.4% (n = 28) of the patients were classified as frail. There was no difference between the energy consumption of < 30 kcal/kg/day in the frail and non-frail groups. Protein consumption of less than 1.2 g/kg/day had a significant relationship with frailty. There was no significant difference between the consumed plant/animal protein ratio and frailty, but plant protein, polyunsaturated fatty acids, and fiber intake were significantly lower in frail patients. Decreased consumption of polyunsaturated fatty acids (PUFAs), advanced age, and increased number of medications were identified as independently associated factors with frailty.

CONCLUSION

This study found that frailty was associated with less than 1.2 g/kg/day protein consumption, lower fiber, and PUFA consumption.

The role of nutrition in the prevention of sarcopenia

Sarcopenia is a common skeletal muscle disorder characterized by a loss of muscle mass and impaired muscle function that is associated with poor health outcomes. Although nutrition is considered an important factor in the etiology of sarcopenia, the preventive potential of diet, specifically the extent to which differences in habitual patterns of diet and/or nutrient intakes impact risk of its development, is poorly understood. This narrative review considered research evidence on dietary patterns and nutrient intakes in mid- (<60 y) and young-older (60-70 y) adulthood to evaluate how they relate to age-related changes in muscle mass and function. A key finding was that current evidence on adult diet and sarcopenia risk in older age is limited and fragmented, with different outcomes reported across studies (for example, lean mass, strength) and few reporting links to incident diagnosed sarcopenia. As these outcomes are not interchangeable, it challenges collation of the evidence, leaving many gaps in understanding. There is also limited information about adult (<70 y) diet and few longitudinal studies with repeated dietary assessments to enable definition of cumulative exposures across adulthood. However, despite these limitations, findings from studies of dietary patterns already provide reasonably consistent messages about the benefits of diets of higher quality in earlier adulthood for later physical performance, although whole-diet intervention trials are urgently needed to understand their potential. In comparison, there is little evidence of benefits of higher intakes of individual nutrients in earlier adulthood for later muscle mass and function. Although these gaps need to be addressed in future research, there may already be sufficient data to promote messages about diet quality more widely - that healthier diets of higher quality across adulthood, with known benefits for a range of health outcomes, are also linked to the effective preservation of muscle mass and function.

Current Nutritional and Pharmacological Approaches for Attenuating Sarcopenia

Sarcopenia is characterized by a gradual slowing of movement due to loss of muscle mass and quality, decreased power and strength, increased risk of injury from falls, and often weakness. This review will focus on recent research trends in nutritional and pharmacological approaches to controlling sarcopenia. Because nutritional studies in humans are fairly limited, this paper includes many results from nutritional studies in mammals. The combination of resistance training with supplements containing amino acids is the gold standard for preventing sarcopenia. Amino acid (HMB) supplementation alone has no significant effect on muscle strength or muscle mass in sarcopenia, but the combination of HMB and exercise (whole body vibration stimulation) is likely to be effective. Tea catechins, soy isoflavones, and ursolic acid are interesting candidates for reducing sarcopenia, but both more detailed basic research on this treatment and clinical studies in humans are needed. Vitamin D supplementation has been shown not to improve sarcopenia in elderly individuals who are not vitamin D-deficient. Myostatin inhibitory drugs have been tried in many neuromuscular diseases, but increases in muscle mass and strength are less likely to be expected. Validation of myostatin inhibitory antibodies in patients with sarcopenia has been positive, but excessive expectations are not warranted.

Implementation and Core Components of a Multimodal Program including Exercise and Nutrition in Prevention and Treatment of Frailty in Community-Dwelling Older Adults: A Narrative Review

Increasing disability-free life expectancy is a crucial issue to optimize active ageing and to reduce the burden of evitable medical costs. One of the main challenges is to develop pragmatic and personalized prevention strategies in order to prevent frailty, counteract adverse outcomes such as falls and mobility disability, and to improve quality of life. Strong evidence reports the effectiveness of exercise interventions to improve various physical parameters and muscle function that are cornerstones of frailty. Other findings also suggest that the interactions between nutrition and physical exercise with or without health behavior promotion prevent the development of frailty. Multimodal programs, including structured exercise, adequate dietary intervention and health behavior promotion, appear increasingly consensual. However, in order for implementation in real-life settings, some pitfalls need to be addressed. In this perspective, structuring and tailoring feasible, acceptable and sustainable interventions to optimize exercise training responses are essential conditions to warrant short, medium and long-term individual benefits. The different components of exercise programs appear to be fairly consensual and effective. However, specific composition of the programs proposed (frequency, intensity, type, time, volume and progressiveness) have to be tailored to individual characteristics and objectives in order to improve exercise responses. The intervention approaches, behavioral strategies and indications for these programs also need to be refined and framed. The main objective of this work is to guide the actions of healthcare professionals and enable them to widely and effectively implement multimodal programs including exercise, nutrition and behavioral strategies in real-life settings.

Genetically Predicted Levels of Serum Metabolites and Risk of Sarcopenia: A Mendelian Randomization Study

Metabolites' connection to sarcopenia through inflammation and mitochondrial dysfunction is presumed, but their impact remains unclear due to limitations in conventional observational studies caused by confounding bias and reverse causation. We conducted a Mendelian randomization (MR) analysis to elucidate the association of serum metabolites with sarcopenia and its related traits, i.e., appendicular lean mass and grip strength. Genetic instruments to proxy the serum metabolites were extracted from the most comprehensive genome-wide association study on the topic published so far. The corresponding summary statistics for the associations of genetic instruments with outcomes were calculated from the UK Biobank (n = 324,976 participants). The primary analyses were assessed by an inverse-variance weighted (IVW) method. The weighted median and MR-PRESSO methods were used as sensitive analyses. Fourteen genetically predicted serum metabolites were associated with the risk of sarcopenia (PIVW < 0.05). Two metabolites showed the overlapped association with sarcopenia and its related traits, which were isovalerylcarnitine (sarcopenia: odds ratio [OR] = 4.00, 95% confidence interval [CI] = 1.11~14.52, PIVW = 0.034; appendicular lean mass: β = -0.45 kg, 95% CI = -0.81~-0.09, PIVW = 0.015; grip strength: β = -1.51 kg, 95% CI = -2.31~-0.71, PIVW = 2.19 × 10-4) and docosapentaenoate (sarcopenia: OR = 0.16, 95% CI = 0.03~0.83, PIVW = 0.029; appendicular lean mass: β = -0.45 kg, 95% CI = 0.08~0.81, PIVW = 0.016). Twenty-seven metabolites were suggestive associated with appendicular lean mass or grip strength. This MR study provided evidence for the potential effects of metabolites on sarcopenia.

Non-pharmacological interventions for community-dwelling older adults with possible sarcopenia or sarcopenia: a scoping review

BACKGROUND

Sarcopenia is a progressive, age-related muscle disease that, if left untreated, imposes significant personal, social, and economic burdens.

OBJECTIVE

To compile and document the nature and extent of existing studies exploring non-pharmacological interventions as a strategy to prevent or treat possible sarcopenia or sarcopenia in community-dwelling older adults.

METHOD

Thirteen databases were searched up from January 2010 to March 2023 and filters were limited to English and Chinese language. Studies with older adults (≥60 y) in the community were included. The review was conducted and reported according to the PRISMA-ScR guidance and seven stages of methodology framework. A descriptive synthesis of trial characteristics and effectiveness was conducted.

RESULTS

A total of 59 studies were included in the analysis. Most studies were RCTs. Few studies enrolled older adults with possible sarcopenia. The 70-79 age group has been studied more than any other age group. Six intervention types were identified, including exercise-only, nutrition-only, health education-only, traditional Chinese medicine-only, multicomponent intervention and control type. Majority of exercise-only interventions received resistance-based exercise. In nutrition-only category, overall food intervention or nutrients intervention was more than dietary pattern. Moreover, exercise plus nutrition was the main sub-type in multicomponent interventions. Health education-only and traditional Chinese medicine-only interventions were less frequently identified. Most studies had high and moderate compliance.

CONCLUSION

There is evidence for the effectiveness of exercise and exercise plus nutrition interventions in improving muscle strength and physical performance, whereas the effectiveness of other intervention types or their combinations requires additional research.

SCOPING REVIEW REGISTRATION

Open Science Framework (OSF) Registration DOI 10.17605/OSF.IO/RK3TE.

Physical activity and dietary considerations for prostate cancer patients: future research directions

This review considers current evidence on physical activity and dietary behaviours in the context of prostate cancer prevention and survivorship outcomes. Prostate cancer is the second most common cancer amongst men, with over 1⋅4 million newly diagnosed cases globally each year. Due to earlier detection via screening and advances in treatments, survival rates are amongst the highest of all cancer populations. However, hormone treatments (i.e. androgen deprivation therapy) can lead to undesirable body composition changes, increased fatigue and reduced health-related quality of life, which can impair the overall wellbeing of men living with and beyond prostate cancer. Existing research has only provided limited evidence that physical activity and nutrition can impact a man's risk of prostate cancer but cohort studies suggest they can influence survival outcomes after diagnosis. Additionally, data from observational and intervention studies suggest that habitual physical activity (or structured exercise) and healthy diets can help to ameliorate hormone-related treatment side-effects. Current physical activity guidelines state that prostate cancer patients should complete at least three sessions of moderate-intensity aerobic exercise per week, along with two resistance exercise sessions, but dietary guidelines for prostate cancer patients are less well defined. In conclusion, regular physical activity and nutritional interventions may improve survival outcomes and attenuate some adverse side-effects of hormone treatments in men with prostate cancer. However, further research is required to improve our understanding of the health impacts of physical activity (including structured exercise) and nutrition in relation to prostate cancer prevention and survivorship.

Attenuation of diabetes-mediated muscle atrophy in rats by fish oil enriched omega-3 polyunsaturated fatty acids supplementation

Diabetes is associated with an increased risk of muscle wasting/atrophy, which adversely affects quality of life. We hypothesized that long term supplementation of fish oil may have protective effects against sarcopenia or muscle atrophy in streptozotocin (STZ) and high-fat (HF) diet-induced diabetic rat model. Wistar rats at age of 7 weeks were injected with saline or STZ to induce hyperglycemia. After one week, they were fed on a normal control diet or HF diet with/without supplementation of fish oil for 18 weeks. Feeding diabetic rats with a fish oil-enriched diet alleviated body weight loss and the impaired glucose tolerance using OGTT test. Although fish oil did not improve the decreased muscle mass, the muscle atrophy induced by diabetes was attenuated by fish oil in gastrocnemius, soleus, tibialis anterior, and extensor digitorum longus muscles. Fish oil supplementation reversed the decreased expression of phospho (p)-AKT, pmTOR, and p-p70s6k, which are molecules related to protein synthesis. Besides, protein degradation-related signaling pathways were inhibited by fish oil, such as increasing p-FoxO1 and decreasing Atrogin-1 and MURF1 protein expression. Fish oil down-regulated the expression of autophagy-related molecules including ATG5, p62, and LC3B II/I ratio, which may result in less muscle atrophy. Inflammation-related signaling regulators including TNF-α, NF-κB, AGEs, and RAGE were suppressed by fish oil supplementation as well. Moreover, the down-regulated p-AMPKα, SIRT1, and PGC-1 in diabetic rats were counteracted by fish oil, which may improve mitochondrial function and further block FoxO action. These data suggest that long-term fish oil supplementation exerts protective effects against diabetes-induced muscle atrophy, which may in turn ameliorate insulin resistance and impaired glucose tolerance.

The Role of Nutrition in the Treatment of Sarcopenia in Old Patients: From Restoration of Mitochondrial Activity to Improvement of Muscle Performance, a Systematic Review

Sarcopenia is an age-related disease characterized by loss of muscle strength, mass and performance. Malnutrition contributes to sarcopenia pathogenesis. The aim of this systematic review is to analyze existing evidence on the efficacy of nutritional supplementation on muscle and mitochondrial health among sarcopenic or malnourished older adults. We included randomized controlled trials (RCTs) assessing the effect of branched-chain amino acid (BCAA), vitamin D and/or omega-3 polyunsaturated fatty acid (PUFA) on muscle mass, strength and performance and/or on mitochondrial activity and redox state in older sarcopenic and/or malnourished adults. The literature search was on MEDLINE, Embase and Cochrane Central, restricted to articles published in the last 10 years (2012-2022). Twelve RCTs with a total of 1337 subjects were included. BCAA with vitamin D significantly ameliorates appendicular muscle mass (4 RCTs), hand grip strength (4 RCTs), gait speed (3 RCTs), short physical performance battery (3 RCTs) or chair stand test (3 RCTs) among six out of nine RCTs. BCAA alone (2 RCTs) or PUFA (1 RCT) were not effective in improving muscle health. Mitochondrial function was significantly improved by the administration of BCAA alone (1 RCT) or in association with vitamin D (1 RCT). In conclusion, BCAA in association with vitamin D may be useful in the treatment of sarcopenia and boost mitochondrial bioenergetic and redox activity. PROSPERO CRD42022332288.

Evaluation of pea/rice and amylopectin/chromium as an alternative protein source to improve muscle protein synthesis in rats

BACKGROUND

A preclinical study reported that the combination of an amylopectin/chromium complex (ACr) of branched-chain amino acids (BCAA) significantly enhanced muscle protein synthesis (MPS). This study was conducted to determine the effects of the addition of ACr complex to a pea/rice (PR) protein on MPS, insulin, muslin levels, and the mTOR pathway in exercised rats.

METHODS

Twenty-four rats were divided into three groups: (i) exercise (Ex); (ii) Ex + PR 1:1 blend (0.465 g/kg BW); (iii) Ex + PR + ACr (0.155 g/kg BW). On the day of single-dose administration, after the animals were exercised at 26/m/min for 2 h, the supplement was given by oral gavage. The rats were injected with a bolus dose (250 mg/kg BW, 25 g/L) of deuterium-labeled phenylalanine to determine the protein fractional synthesis rate (FSR) one h after consuming the study product.

RESULTS

The combination of PR and ACr enhanced MPS by 42.55% compared to the Ex group, while Ex + PR alone increased MPS by 30.2% over the Ex group (p < 0.0001) in exercised rats. Ex + PR plus ACr significantly enhanced phosphorylation of mTOR and S6K1 (p < 0.0001), and 4E-BP1 (p < 0.001) compared to the Ex (p < 0.0001). PR to ACr also significantly increased insulin and musclin levels (p < 0.0001) in exercised rats. Additionally, compared to Ex + PR alone, Ex + PR + ACr enhanced mTOR (p < 0.0001) and S6K1 (p < 0.0001) levels.

CONCLUSION

These data suggested that PR + ACr may provide an alternative to animal proteins for remodeling and repairing muscle by stimulating MPS and mTOR signaling pathways in post-exercised rats. More preclinical and clinical human studies on combining pea/rice and amylopectin/chromium complex are required.

Eicosapentaenoic acid and branched-chain amino acids fortified complete nutrition drink improved muscle strength in older individuals with inadequate protein intake

Background

Elevated inflammation and negative nutritional balance contribute to sarcopenia, a progressive loss of muscle mass, strength, and function. This study investigated the effect of energy supplementation and the combination of anti-inflammatory factor (eicosapentaenoic acid; EPA) and muscle-synthesis promotor (branched-chain amino acids; BCAA) on body composition, muscle, and inflammatory biomarkers in elderly with inadequate protein intake.

Methods

A randomized blinded placebo-controlled trial was conducted on 84 elderly with inadequate protein intake. The participants were randomly assigned into four groups receiving a complete nutrition drink; (1) control formula, (2) fortified with 2.2 g EPA, (3) with 2.2 g EPA and 5 g BCAA (2:1:1 of Leu: Ile: Val), and (4) with 2.2 g EPA plus 5g BCAA (4:1:1 of Leu: Ile: Val). Each subject consumed two sachets of the drink to gain 500 kcal/day and performed arm muscle exercises for 3 weeks. Body compositions and handgrip strength were measured using BIA and a dynamometer, respectively. Plasma EPA and BCAA levels were determined using LC-MS/MS to ensure compliance. Muscle protein biomarkers including histidine, β-alanine, and carnosine were measured using LC-MS/MS. Serum inflammatory (IL-6) and anti-inflammatory cytokines (IL-10) were measured by using ELISA.

Results

No symptoms and signs of adverse events were observed. The right arm muscle mass and handgrip strength were significantly increased after consuming a complete nutrition drink fortified with EPA + BCAA 2:1:1 and 4:1:1 of Leu: Ile: Val (p < 0.05 and p < 0.01, respectively. Consistently, consuming such combinatory formula non-significantly elevated carnosine with reduced histidine, and increased IL-10 with decreased IL-6. All relevant intervention groups showed a significant increase in plasma levels of BCAA and EPA.

Conclusion

Consuming a complete nutrition drink fortified with 2.2g EPA and 5g BCAA 2:1:1 or 4:1:1 of Leu: Ile: Val for 3 weeks may increase right arm muscle mass and strength in elderly with inadequate protein intake. The tendency of increased dipeptide (carnosine)/decreased free amino acid (histidine) suggests a shift toward muscle protein synthesis. The trend of decreased inflammatory/increased anti-inflammatory cytokines suggests an anti-inflammatory effect. Future long-term studies are warranted to confirm the combinatory effect of BCAA and EPA in the prevention of sarcopenia.

Clinical trial registration

Thailand Clinical Trial Registry No. TCTR20230116005.

A Brief Narrative Review of the Underlying Mechanisms Whereby Omega-3 Fatty Acids May Influence Skeletal Muscle: From Cell Culture to Human Interventions

Skeletal muscle is essential for human locomotion as well as maintaining metabolic homeostasis. Age-related reduction in skeletal muscle mass, strength, and function (i.e., sarcopenia) is a result of pathophysiological processes that include inflammation, alteration of molecular signaling for muscle protein synthesis and degradation, changes in insulin sensitivity, as well as altered skeletal muscle satellite cell activity. Finding strategies to mitigate skeletal muscle loss with age is deemed paramount as the percentage of the population continues to shift towards having more older adults with sarcopenia. Recent research indicates omega-3 fatty acid supplementation can influence anabolic or catabolic pathways in skeletal muscle. Our brief review will provide a synopsis of some underlying mechanisms that may be attributed to omega-3 fatty acid supplementation's effects on skeletal muscle. We will approach this review by focusing on cell culture, animal (pre-clinical models), and human studies evaluating omega-3 fatty acid supplementation, with suggestions for future research. In older adults, omega-3 fatty acids may possess some potential to modify pathophysiological pathways associated with sarcopenia; however, it is highly likely that omega-3 fatty acids need to be combined with other anabolic interventions to effectively ameliorate sarcopenia.

A Narrative Review of Non-Pharmacological Strategies for Managing Sarcopenia in Older Adults with Cardiovascular and Metabolic Diseases

This narrative review examines the mechanisms underlying the development of cardiovascular disease (CVD) and metabolic diseases (MDs), along with their association with sarcopenia. Furthermore, non-pharmacological interventions to address sarcopenia in patients with these conditions are suggested. The significance of combined training in managing metabolic disease and secondary sarcopenia in type II diabetes mellitus is emphasized. Additionally, the potential benefits of resistance and aerobic training are explored. This review emphasises the role of nutrition in addressing sarcopenia in patients with CVD or MDs, focusing on strategies such as optimising protein intake, promoting plant-based protein sources, incorporating antioxidant-rich foods and omega-3 fatty acids and ensuring sufficient vitamin D levels. Moreover, the potential benefits of targeting gut microbiota through probiotics and prebiotic fibres in sarcopenic individuals are considered. Multidisciplinary approaches that integrate behavioural science are explored to enhance the uptake and sustainability of behaviour-based sarcopenia interventions. Future research should prioritise high-quality randomized controlled trials to refine exercise and nutritional interventions and investigate the incorporation of behavioural science into routine practices. Ultimately, a comprehensive and multifaceted approach is essential to improve health outcomes, well-being and quality of life in older adults with sarcopenia and coexisting cardiovascular and metabolic diseases.

The Effects of Vitamin D Supplementation on Musculoskeletal Health: The VITAL and DO-Health Trials

Previous clinical trials and systematic reviews on the effects of supplemental vitamin D on musculoskeletal outcomes are conflicting. In this paper, we review the literature and summarize the effects of a high daily dose of 2 000 IU vitamin D on musculoskeletal outcomes in generally healthy adults, in men (≥50 years) and women (≥55 years) in the 5.3-year US VITamin D and OmegA-3 TriaL (VITAL) trial (n = 25 871) and women and men (≥70 years) in the 3-year European DO-HEALTH trial (n = 2 157). These studies found no benefit of 2 000 IU/d of supplemental vitamin D on nonvertebral fractures, falls, functional decline, or frailty. In VITAL, supplementation with 2 000 IU/d of vitamin D did not reduce the risk of total or hip fractures. In a subcohort of VITAL, supplemental vitamin D did not improve bone density or structure (n = 771) or physical performance measures (n = 1 054). In DO-HEALTH, which investigated additive benefits of vitamin D with omega-3 and a simple home exercise program, the 3 treatments combined showed a significant 39% decreased odds of becoming prefrail compared to the control. The mean baseline 25(OH)D levels were 30.7 ± 10 ng/mL in VITAL and 22.4 ± 8.0 ng/mL in DO-HEALTH and increased to 41.2 ng/mL and 37.6 ng/mL in the vitamin D treatment groups, respectively. In generally healthy and vitamin D-replete older adults not preselected for vitamin D deficiency or low bone mass or osteoporosis, 2 000 IU/d of vitamin D had no musculoskeletal health benefits. These findings may not apply to individuals with very low 25(OH)D levels, gastrointestinal disorders causing malabsorption, or those with osteoporosis.

Association of muscle wasting with mortality risk among adults: A systematic review and meta-analysis of prospective studies

The relationship between muscle wasting and mortality risk in the general population remains unclear. Our study was conducted to examine and quantify the associations between muscle wasting and all-cause and cause-specific mortality risks. PubMed, Web of Science and Cochrane Library were searched until 22 March 2023 for main data sources and references of retrieved relevant articles. Prospective studies investigating the associations of muscle wasting with risks of all-cause and cause-specific mortality in the general population were eligible. A random-effect model was used to calculate the pooled relative risk (RR) and 95% confidence intervals (CIs) for the lowest versus normal categories of muscle mass. Subgroup analyses and meta-regression were performed to investigate the potential sources of heterogeneities among studies. Dose-response analyses were conducted to evaluate the relationship between muscle mass and mortality risk. Forty-nine prospective studies were included in the meta-analysis. A total of 61 055 deaths were ascertained among 878 349 participants during the 2.5- to 32-year follow-up. Muscle wasting was associated with higher mortality risks of all causes (RR = 1.36, 95% CI, 1.28 to 1.44, I²  = 94.9%, 49 studies), cardiovascular disease (CVD) (RR = 1.29, 95% CI, 1.05 to 1.58, I²  = 88.1%, 8 studies), cancer (RR = 1.14, 95% CI, 1.02 to 1.27, I²  = 38.7%, 3 studies) and respiratory disease (RR = 1.36, 95% CI, 1.11 to 1.67, I²  = 62.8%, 3 studies). Subgroup analyses revealed that muscle wasting, regardless of muscle strength, was significantly associated with a higher all-cause mortality risk. Meta-regression showed that risks of muscle wasting-related all-cause mortality (P = 0.06) and CVD mortality (P = 0.09) were lower in studies with longer follow-ups. An approximately inverse linear dose-response relationship was observed between mid-arm muscle circumference and all-cause mortality risk (P < 0.01 for non-linearity). Muscle wasting was associated with higher mortality risks of all causes, CVD, cancer and respiratory disease in the general population. Early detection and treatment for muscle wasting might be crucial for reducing mortality risk and promoting healthy longevity.

Dietary assessment of 101 para-athletes from team and individual sports

Assessing the usual food intake of para-athletes enables knowledge and description of nutrient intakes, providing insight into the potential nutritional status of para-athletes and may help tailor dietary intake to their specific training needs. This study aimed to evaluate the usual intake of macronutrients and food groups and meal food patterns of athletes with a disability. We also compared dietary intake data between team and individual sport para-athletes. One hundred and one athletes with a disability from 13 Paralympic disciplines living in Brasília, Federal District, Brazil were included. Food intake was estimated from two or four non-consecutive 24-h food recalls in which para-athletes reported all food, beverages, and supplements consumed in the previous 24-h. Dietary intake analysis was performed by implementing the National Cancer Institute (NCI) method to calculate the macronutrient and food group usual intake. Macronutrient intakes were compared to Acceptable Macronutrient Distribution Ranges for the general population and food group intakes were compared to the 2008 Brazilian National Dietary Guidelines. Para-athletes consumed a low-carbohydrate, adequate protein, high-fat diet. There was no significant difference in macronutrient intake distribution between team sport and individual sport para-athletes. Most para-athletes had three main meals during the day. The prevalence of inadequate fruit servings in the middle and highest energy intake tertiles was significantly higher in team sport para-athletes (92.5% and 98.4%) than in individual sport para-athletes (90.8% and 65.5%), respectively. The prevalence of inadequate vegetable servings was significantly higher between team and individual para-athletes for the middle energy intake tertiles. Para-athletes generally consumed an imbalanced diet, which is a cause for concern given their additional physiological demands and specific training needs.

Microalgae Produce Antioxidant Molecules with Potential Preventive Effects on Mitochondrial Functions and Skeletal Muscular Oxidative Stress

In recent years, microalgae have become a source of molecules for a healthy life. Their composition of carbohydrates, peptides, lipids, vitamins and carotenoids makes them a promising new source of antioxidant molecules. Skeletal muscle is a tissue that requires constant remodeling via protein turnover, and its regular functioning consumes energy in the form of adenosine triphosphate (ATP), which is produced by mitochondria. Under conditions of traumatic exercise or muscular diseases, a high production of reactive oxygen species (ROS) at the origin of oxidative stress (OS) will lead to inflammation and muscle atrophy, with life-long consequences. In this review, we describe the potential antioxidant effects of microalgae and their biomolecules on mitochondrial functions and skeletal muscular oxidative stress during exercises or in musculoskeletal diseases, as in sarcopenia, chronic obstructive pulmonary disease (COPD) and Duchenne muscular dystrophy (DMD), through the increase in and regulation of antioxidant pathways and protein synthesis.

Are dietary intake and nutritional status of specific polyunsaturated fatty acids correlated with sarcopenia outcomes in community-dwelling older adults with sarcopenia? - Exploratory results from ENHANce

AIMS

To explore the relationship between dietary polyunsaturated fatty acids (PUFAs) intake, nutritional PUFAs status and sarcopenia outcomes in sarcopenic older adults.

METHODS

The Exercise and Nutrition for Healthy AgeiNg (ENHANce) is an ongoing 5-armed triple blinded randomized controlled trial, in sarcopenic older adults (> 65y) aiming to assess the effect of combined anabolic interventions (protein, omega-3 supplement and exercise) on physical performance in these adults, compared to single/placebo interventions. Baseline data were used for a secondary, exploratory, cross-sectional analysis. Dietary PUFAs intake was assessed with 4-day food records, status with RBC membrane fatty acids profiles. Spearman's rho(ρ) correlation coefficients were calculated to explore associations of PUFAs intake and status with sarcopenia-defining parameters (muscle strength, mass and physical performance), physical activity (step count) and quality of life (SF-36, SarQoL).

RESULTS

In total, 29 subjects (9♂/20♀, mean age 76.3 ± 5.4y) were included. Total omega-3 intake of participants (1.99 ± 0.99 g/d) was below the recommended intake (♂:2.8-5.6 g/d; ♀:2.2-4.4 g/d). Intake and status of PUFAs were not correlated. Regarding correlations with outcomes, α-linolenic acid status was inversely associated with appendicular lean mass (aLM) (ρ:-0.439; p = 0.017), whereas docosahexaenoic acid status was positively associated with aLM (ρ:0.388; p = 0.038). Some omega-3 PUFAs intake and status markers were positively associated with step count, SF-36 and SarQoL scores, whereas gamma-linolenic acid status was inversely associated with SF-36 physical component summary score (ρ = -0.426; p = 0.024).

CONCLUSIONS

Although intake of omega-3 and omega-6 was low, the present exploratory study generated new hypotheses for potential correlations of PUFAs intake and status with sarcopenia outcomes in older adults with sarcopenia.

Bioactivity of Macronutrients from Chlorella in Physical Exercise

Chlorella is a marine microalga rich in proteins and containing all the essential amino acids. Chlorella also contains fiber and other polysaccharides, as well as polyunsaturated fatty acids such as linoleic acid and alpha-linolenic acid. The proportion of the different macronutrients in Chlorella can be modulated by altering the conditions in which it is cultured. The bioactivities of these macronutrients make Chlorella a good candidate food to include in regular diets or as the basis of dietary supplements in exercise-related nutrition both for recreational exercisers and professional athletes. This paper reviews current knowledge of the effects of the macronutrients in Chlorella on physical exercise, specifically their impact on performance and recovery. In general, consuming Chlorella improves both anaerobic and aerobic exercise performance as well as physical stamina and reduces fatigue. These effects seem to be related to the antioxidant, anti-inflammatory, and metabolic activity of all its macronutrients, while each component of Chlorella contributes its bioactivity via a specific action. Chlorella is an excellent dietary source of high-quality protein in the context of physical exercise, as dietary proteins increase satiety, activation of the anabolic mTOR (mammalian Target of Rapamycin) pathway in skeletal muscle, and the thermic effects of meals. Chlorella proteins also increase intramuscular free amino acid levels and enhance the ability of the muscles to utilize them during exercise. Fiber from Chlorella increases the diversity of the gut microbiota, which helps control body weight and maintain intestinal barrier integrity, and the production of short-chain fatty acids (SCFAs), which improve physical performance. Polyunsaturated fatty acids (PUFAs) from Chlorella contribute to endothelial protection and modulate the fluidity and rigidity of cell membranes, which may improve performance. Ultimately, in contrast to several other nutritional sources, the use of Chlorella to provide high-quality protein, dietary fiber, and bioactive fatty acids may also significantly contribute to a sustainable world through the fixation of carbon dioxide and a reduction of the amount of land used to produce animal feed.

Nutrition after severe burn injury

PURPOSE OF REVIEW

Severe burn injury causes significant metabolic changes and demands that make nutritional support particularly important. Feeding the severe burn patient is a real challenge in regard to the specific needs and the clinical constraints. This review aims to challenge the existing recommendations in the light of the few recently published data on nutritional support in burn patients.

RECENT FINDINGS

Some key macro- and micro-nutrients have been recently studied in severe burn patients. Repletion, complementation or supplementation of omega-3 fatty acids, vitamin C, vitamin D, antioxidant micronutrients may be promising from a physiologic perspective, but evidence of benefits on hard outcomes is still weak due to the studies' design. On the contrary, the anticipated positive effects of glutamine on the time to discharge, mortality and bacteremias have been disproved in the largest randomized controlled trial investigating glutamine supplementation in burns. An individualized approach in term of nutrients quantity and quality may proof highly valuable and needs to be validated in adequate trials. The combination of nutrition and physical exercises is another studied strategy that could improve muscle outcomes.

SUMMARY

Due to the low number of clinical trials focused on severe burn injury, most often including limited number of patients, developing new evidence-based guidelines is challenging. More high-quality trials are needed to improve the existing recommendations in the very next future.