Lifestyle approaches to prevent and retard sarcopenia: A narrative review

Sex disparity in the association between alcohol consumption and sarcopenia: a population-based study

BACKGROUND

Previous studies have shown inconsistent findings regarding the association of alcohol consumption with sarcopenia. Therefore, this study comprehensively investigated the association of alcohol consumption with sarcopenia in a nationally representative sample of US adults.

METHODS

This population-based study included adults aged 18 years and older from the National Health and Nutrition Examination Survey (NHANES) III. Alcohol exposure was defined as daily alcohol intake, alcohol drinking history, number of drinking days per week, and frequency of binge drinking days per month. Weighted logistic regressions were used to determine associations.

RESULTS

Four cohorts were selected from the NHANES III: cohort 1 (n = 7,592), cohort 2 (n = 12,060), cohort 3 (n = 7,608), and cohort 4 (n = 7,649), corresponding to alcohol exposure categories of daily alcohol intake, drinking history, number of drinking days per week, and frequency of binge drinking days per month. In the full model, the risk of sarcopenia was significantly associated with mild (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.08-2.51), moderate (OR: 2.04; 95% CI: 1.12-3.71), and heavy drinkers (OR: 2.42; 95% CI: 1.17-4.97) compared to nondrinkers. There was an association between the development of sarcopenia and current drinkers (OR: 1.69; 95% CI: 1.12-2.56) but not former drinkers (OR: 1.21; 95% CI: 0.88-1.66). Compared to nondrinkers, an increased risk of developing sarcopenia was observed in participants who consumed alcohol 2 days (OR: 2.36; 95% CI: 1.40-3.99) or > 2 days (OR: 1.84; 95% CI: 1.10-3.07) per week, and those who engaged in binge drinking for ≤1 day per month (OR: 1.68; 95% CI: 1.09-2.60) or > 1 day per month (OR: 2.10; 95% CI: 1.10-4.01). Sensitivity analyses based on different definitions of sarcopenia yielded similar results. Stratified analyses revealed that these associations were present in females but not males.

CONCLUSION

Alcohol intake was associated with an increased risk of sarcopenia in all individuals, with this association being primarily observed in females rather than males.

Risk factors of stroke-related sarcopenia: a systematic review and meta-analysis

Background

The presence of sarcopenia at the time of stroke may deteriorate the rehabilitation and functional outcomes. There is no consensus on the factors associated with stroke-related sarcopenia because previous studies produced inconsistent and disputed results. Therefore, we screened the possible risk factors by meta-analysis.

Methods

Studies published before March 2024 on risk factors with stroke-related sarcopenia were searched through PubMed, Embase, Web of Science, CINAHL, Cochrane Library, CNKI, Wan Fang, CBM, and VIP library databases. Two researchers independently screened the articles to extract the information and to evaluate their quality. Meta-analysis was then performed using Revman 5.4 software to determine the significant risk factors for patients with stroke-related sarcopenia.

Results

A total of 14 studies (n = 3,113) were selected to determine the following factors that were statistically significant in patients with stroke-related sarcopenia: Age (OR = 1.04; 95% CI: 1.02, 1.06; P < 0.0001), tube feeding (OR = 3.98; 95% CI: 2.12, 7.47; P < 0.0001), pre-stroke sarcopenia (OR = 1.84; 95% CI: 1.39, 2.43; P < 0.0001), atrial fibrillation (OR = 1.53; 95% CI: 1.15, 2.02; P = 0.003), NIHSS score (OR = 1.48; 95% CI: 1.21, 1.81; P = 0.0001), and osteoporosis (OR = 1.801; 95% CI: 58, 2.04; P < 0.00001). BMI (P = 0.71), FOIS (P = 0.80), time since stroke (P = 0.34), and calf circumference reduction (P = 0.48) were not identified as risk or protective factors after stroke (P < 0.05).

Conclusion

Our results identified various risk factors for stroke-related sarcopenia which should be considered and studied by healthcare organizations and professionals to improve the health of stroke patients.

Systematic Review Registration

PROSPERO, Identifier CRD42024545757.

Association of triglyceride glucose-related obesity indices with sarcopenia among U.S. adults: a cross-sectional study from the National Health and Nutrition Examination Survey

The triglyceride glucose (TyG) index-related obesity indices have been proposed as reliable indicators of insulin resistance. This study aims to investigate the association between TyG index-related obesity indices and sarcopenia as well as their potential as a tool for screening sarcopenic patients. A cross-sectional study was conducted involving 7,161 participants aged 18 and above from the National Health and Nutrition Examination Survey. TyG index and TyG index-related obesity indices, including triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist circumference (TyG-WC), and triglyceride glucose-waist-to-height ratio (TyG-WHtR) were determined using standard formulas. The ratio of appendicular skeletal muscle mass to BMI were used to assess sarcopenia. The relationship between the TyG index as well as TyG index-related obesity indices and sarcopenia was investigated using restricted cubic spline analysis and multivariate logistic regression analysis. The diagnostic value of the TyG index and TyG index -related obesity indices for sarcopenia was compared using the receiver operating characteristic (ROC) curve. In the fully adjusted regression model, a positive correlation was observed between the TyG-WHtR index and sarcopenia (for each one-unit increase in TyG-WHtR index: OR = 3.57, 95% CI: 2.71-4.71, P < 0.001). Additionally, regression analyses demonstrated TyG-WHtR as a significant predictor of sarcopenia with the highest odds ratio, reaching 12.50 (95% CI: 6.13-25.70, P < 0.001) for the upper fourth quartile (Q4) compared to the first quartile, followed by followed by TyG-BMI (Q4: 3.34; 95% CI: 1.92-5.80, P < 0.001) and TyG-WC (Q4: 1.95; 95% CI: 1.04-3.68, P < 0.001). The RCS curve fitting analysis indicated a U-shaped relationship between TyG-WHtR and the diagnosis of sarcopenia, with an inflection point at 4.02. Furthermore, in the ROC analysis, the AUC for the diagnosis of sarcopenia was largest for TyG-WHtR (0.79, P < 0.001). The TyG ndex-related obesity indices, especially TyG-WHtR, have been shown to be more effective in identifying sarcopenia patients than TyG alone.

Identifying the Shared Metabolite Biomarkers and Potential Intervention Targets for Multiple Sarcopenia-Related Phenotypes

The relationship between circulating metabolites and sarcopenia-related phenotypes remains unclear. We explored the causality between circulating metabolites and sarcopenia-related phenotypes. Instrumental variables for the human metabolome were derived from the recently published GWAS, which included 690 plasma metabolites. Summary statistics for four sarcopenia phenotypes (whole-body lean mass (WBLM), usual walking pace, appendicular lean mass (ALM), and handgrip strength (HGS)) (both sexes, males and females) were obtained from relevant GWASs. We used MR to evaluate the association between circulating metabolites and sarcopenia-related phenotypes. Colocalization analysis was utilized to determine whether two associated signals were consistent with a shared causal variant rather than the confounding effect of linkage disequilibrium. Subsequently, we explored associations between modifiable risk factors and sarcopenia-related metabolites to explore which metabolites may serve as potential intervention targets through lifestyle modification. Genetically predicted plasma levels of 95 known metabolites were associated with sarcopenia-related phenotypes, and 27 metabolites were supported by robust evidence of colocalization, among which 13 metabolites had a cross-sarcopenia effect. These metabolites primarily included acyl carnitines, amino acids and their derivatives, and phospholipids. Specifically, our analyses supported causal relationships between 23, 6, and 15 metabolites and ALM, HGS, and WBLM, respectively. Seven relevant metabolites might be associated with six modifiable factors. We identified 27 metabolite biomarkers with robust causal evidence for sarcopenia-related phenotypes, highlighting 13 metabolites with a cross-sarcopenia effect, and prioritized several metabolites as the potential interventional targets of lifestyle changes. Our study provided new insight into the etiology and prevention of sarcopenia.

Sarcopenia risk in U.S. younger adults: the impact of physical activity intensity and occupational engagement-insights from a cross-sectional NHANES study

OBJECTIVE

This study aimed to investigate the associations between physical activity (PA) intensity, occupational PA engagement, and sarcopenia in younger adults.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) (from 2011 to 2018) were used for the study. PA data were extracted for the Global Physical Activity Questionnaire, and the ratio of limb muscle mass (ALM) to body mass index (BMI) was used to determine sarcopenia. Multiple logistic regression was performed, and dose-response curves were drawn to evaluate the associations.

RESULTS

Of the 8802 adults aged 20 to 59 years, 770 (8.7%) were identified as having sarcopenia. Compared to those in the reference group, the participants in the "low", "moderate", and "high" total METs groups had lower risks of sarcopenia (low: OR = 0.730, 95% CI = 0.583; 0.915; moderate: OR = 0.643, 95% CI = 0.485; 0.853; high: OR = 0.560, 95% CI = 0.457; 0.687). The risk of sarcopenia decreased in the high-intensity recreational PA group; however, such a significant association was observed only in the high-intensity occupational PA group. The relationship between total METs and sarcopenia showed a nonlinear U-shaped trend.

CONCLUSIONS

A greater intensity of PA is associated with a lower risk of sarcopenia among younger adults, regardless of whether moderate or vigorous PA is performed. Moreover, recreational PA may particularly advantageously contrast with occupational PA in lowering the risk of sarcopenia.

Cellular and transcriptomic changes by the supplementation of aged rat serum in human pluripotent stem cell-derived myogenic progenitors

Introduction

The changing composition of non-cell autonomous circulating factors in blood as humans age is believed to play a role in muscle mass and strength loss. The mechanisms through which these circulating factors act in age-related skeletal muscle changes is not fully understood. In this study, we used human myogenic progenitors derived from human pluripotent stem cells to study non-cell autonomous roles of circulating factors during the process of myogenic differentiation.

Methods

Myogenic progenitors from human embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs) were supplemented with serum samples from aged or young Fischer 344 × Brown Norway F1-hybrid rats. The effect of aged or young serum supplementation on myogenic progenitor proliferation, myotube formation capacity, differentiation, and early transcriptomic profiles were analyzed.

Results

We found that aged rat serum supplementation significantly reduced cell proliferation and increased cell death in both ESC- and iPSC-derived myogenic progenitors. Next, we found that the supplementation of aged rat serum inhibited myotube formation and maturation during terminal differentiation from progenitors to skeletal myocytes when compared to the cells treated with young adult rat serum. Lastly, we identified that gene expression profiles were affected following serum supplementation in culture.

Discussion

Together, aged serum supplementation caused cellular and transcriptomic changes in human myogenic progenitors. The current data from our in vitro model possibly simulate non-cell autonomous contributions of blood composition to age-related processes in human skeletal muscle.

Vascular Impairment, Muscle Atrophy, and Cognitive Decline: Critical Age-Related Conditions

The triad of vascular impairment, muscle atrophy, and cognitive decline represents critical age-related conditions that significantly impact health. Vascular impairment disrupts blood flow, precipitating the muscle mass reduction seen in sarcopenia and the decline in neuronal function characteristic of neurodegeneration. Our limited understanding of the intricate relationships within this triad hinders accurate diagnosis and effective treatment strategies. This review analyzes the interrelated mechanisms that contribute to these conditions, with a specific focus on oxidative stress, chronic inflammation, and impaired nutrient delivery. The aim is to understand the common pathways involved and to suggest comprehensive therapeutic approaches. Vascular dysfunctions hinder the circulation of blood and the transportation of nutrients, resulting in sarcopenia characterized by muscle atrophy and weakness. Vascular dysfunction and sarcopenia have a negative impact on physical function and quality of life. Neurodegenerative diseases exhibit comparable pathophysiological mechanisms that affect cognitive and motor functions. Preventive and therapeutic approaches encompass lifestyle adjustments, addressing oxidative stress, inflammation, and integrated therapies that focus on improving vascular and muscular well-being. Better understanding of these links can refine therapeutic strategies and yield better patient outcomes. This study emphasizes the complex interplay between vascular dysfunction, muscle degeneration, and cognitive decline, highlighting the necessity for multidisciplinary treatment approaches. Advances in this domain promise improved diagnostic accuracy, more effective therapeutic options, and enhanced preventive measures, all contributing to a higher quality of life for the elderly population.

Myoprotective whole foods, muscle health and sarcopenia in older adults

PURPOSE OF REVIEW

Sarcopenia increases in prevalence at older ages and may be exacerbated by poor diet. Whole foods rich in specific nutrients may be myoprotective and mitigate the risk of sarcopenia. Here we review recent evidence published from observational and intervention studies regarding myoprotective foods and explore their benefit for the prevention and/or treatment of sarcopenia in older adults.

RECENT FINDINGS

We found limited new evidence for the role of whole foods in sarcopenia and sarcopenia components (muscle mass, strength, physical performance). There was some evidence for higher consumption of protein-rich foods (milk and dairy) being beneficial for muscle strength in observational and intervention studies. Higher consumption of antioxidant-rich foods (fruit and vegetables) was associated with better physical performance and lower odds of sarcopenia in observational studies. Evidence for other protein- and antioxidant-rich foods were inconsistent or lacking. There remains a clear need for intervention studies designed to identify the role of whole foods for the treatment of sarcopenia.

SUMMARY

Although evidence for myoprotective roles of dairy, fruit and vegetables is emerging from observational studies, higher level evidence from intervention studies is needed for these foods to be recommended in diets of older adults to prevent and/or treat sarcopenia.

Association between nocturnal sleep duration and midday napping and the incidence of sarcopenia in middle-aged and older adults: a 4-year longitudinal study

BACKGROUND

Identifying treatment targets for sarcopenia is a public health concern. This study aimed to examine the association of nocturnal sleep duration and midday napping with the presence of sarcopenia in middle-aged and older adults, utilizing data from the China Health and Retirement Longitudinal Study in 2011 and 2015.

METHODS

A sum of 7,926 individuals (≥40 years) took part in this study. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia. A self-reported questionnaire was used to collect data on nocturnal sleep duration and midday napping. Nocturnal sleep duration was categorized into three groups: short sleepers (<6 h), normal sleepers (6-8 h), and long sleepers (>8 h). Midday napping was coded as a dichotomous outcome (yes/no).

RESULTS

The incidence of sarcopenia was 5.3% during the 4-year follow-up. Short sleep duration (<6 h) was substantially linked to an increased incidence of sarcopenia (OR: 1.50, 95% CI: 1.21-1.87) as compared to nocturnal sleep length (6-8 h). Adults with midday napping had a lower risk of developing sarcopenia than non-nappers (OR: 0.78, 95% CI: 0.63-0.95). We further found that short sleepers with midday napping did not have a significantly higher risk of subsequent diagnosis of sarcopenia compared to normal sleepers without midday napping.

CONCLUSION

These findings imply that short sleep duration in middle-aged and older persons is related to an increased incidence of sarcopenia. However, the adverse effect of short sleep duration on sarcopenia can be compensated by midday napping.

Association of dietary patterns and sarcopenia in the elderly population: a cross-sectional study

Background: Sarcopenia, defined as the loss of muscle mass and strength, has been associated with increased hospitalization and mortality. Dietary pattern analysis is a whole diet approach which in this study was used to investigate the relationship between diet and sarcopenia. This study aims to estimate the prevalence of sarcopenia and explore possible factors associated with it among a large population in Beijing, China. Methods: A cross-sectional study with 1,059 participants aged more than 50 years was performed. Sarcopenia was defined based on the guidelines of the Asian Working Group for Sarcopenia. The total score of the MNA-SF questionnaire was used to analyse nutrition status. The baseline demographic information, diet structure and eating habits were collected by clinicians trained in questionnaire data collection and anthropometric and bioimpedance measurements. Results: The overall prevalence of sarcopenia was 8.8% and increased with age: 5%, 5.8%, 10.3% and 26.2% in the 50-59, 60-69, 70-79, and ≥80 years groups, respectively. Marital status (with or without a spouse) was not an independent factor associated with sarcopenia adjusted by age and sex. However, nutritional risk or malnutrition, vegetable diet, advanced age and spicy eating habits were risk factors for sarcopenia. Meanwhile, daily fruit, dairy and nut consumption were protective factors against sarcopenia adjusted by age, sex, income status and spouse status. Conclusion: Although further studies are required to explore the association between healthy dietary patterns and the risk of sarcopenia, the present study provides basic data for identifying correlates of sarcopenia in elderly Chinese individual.

Physical Activity, Sedentary Behavior, Fruit and Vegetable Consumption, and Sarcopenia in Older Chinese Adults: A Cross-Sectional Study

PURPOSE

The purpose of this study was to investigate the association between moderate to vigorous physical activity (MVPA), sedentary behavior, fruit and vegetable intake, and the risk of sarcopenia among older Chinese adults.

METHODS

This cross-sectional study enrolled 5418 older Chinese adults who participated in the Study on Global Aging and Adult Health (SAGE). Participants reported information about their physical activity, sedentary behavior, and dietary habits (fruit and vegetable intake). Sarcopenia was defined as the presence of low skeletal muscle mass and either a slow gait speed or weak handgrip strength. A multiple logistic regression model was employed to determine the relationship between MVPA, sedentary behavior, fruit and vegetable intake, and the risk of sarcopenia.

RESULTS

Only 32.63% of participants met all three recommendations (for MVPA, sedentary behavior, and fruit and vegetable intake). Compared with meeting none of the recommendations, meeting all three recommendations was associated with a lower risk of sarcopenia (OR = 0.63, 95% CI = 0.41-0.98). Moreover, meeting the recommendation for sufficient fruit and vegetable intake (OR = 0.69, 95% CI = 0.58-0.83), MVPA and fruit/vegetable intake (OR = 0.67, 95% CI = 0.52-0.86), and sedentary behavior and fruit/vegetable intake (OR = 0.69, 95% CI = 0.48-0.98) was associated with a lower risk of sarcopenia.

CONCLUSION

Our findings indicate that in this large representative sample of older Chinese adults, meeting lifestyle recommendations for MVPA, sedentary behavior, and fruit and vegetable intake protected against sarcopenia.

Exercise Programs Combined with Diet Supplementation Improve Body Composition and Physical Function in Older Adults with Sarcopenia: A Systematic Review

Sarcopenia is a progressive and frequent syndrome among older adults highly related to physical inactivity and malnutrition. Nowadays, it is considered a pathology that triggers multiple health complications associated with the loss of muscle mass, strength, autonomy, and quality of life. The objective of the present systematic review was to evaluate the effect of exercise programs combined with dietary supplementation on body composition as the primary outcome. This systematic review was carried out in accordance with the elements considered for planning a systematic review by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the search was performed in the Scopus, EBSCO, and PubMed databases for the last 10 years. A total of 16 studies met the inclusion criteria and were included in this systematic review. Regular resistance exercise together with daily essential amino acids or whey protein and vitamin D supplementation improve the maintenance or gains in appendiceal/skeletal muscle mass and total lean mass in sarcopenic older adults. The data suggest a synergistic effect not only on the primary outcome, but also on other variables such as strength, speed, stability, and other indicators of quality of life. This systematic review was registered in PROSPERO, ID: CRD42022344284.

AI-based opportunistic CT screening of incidental cardiovascular disease, osteoporosis, and sarcopenia: cost-effectiveness analysis

PURPOSE

To assess the cost-effectiveness and clinical efficacy of AI-assisted abdominal CT-based opportunistic screening for atherosclerotic cardiovascular (CV) disease, osteoporosis, and sarcopenia using artificial intelligence (AI) body composition algorithms.

METHODS

Markov models were constructed and 10-year simulations were performed on hypothetical age- and sex-specific cohorts of 10,000 U.S. adults (base case: 55 year olds) undergoing abdominal CT. Using expected disease prevalence, transition probabilities between health states, associated healthcare costs, and treatment effectiveness related to relevant conditions (CV disease/osteoporosis/sarcopenia) were modified by three mutually exclusive screening models: (1) usual care ("treat none"; no intervention regardless of opportunistic CT findings), (2) universal statin therapy ("treat all" for CV prevention; again, no consideration of CT findings), and (3) AI-assisted abdominal CT-based opportunistic screening for CV disease, osteoporosis, and sarcopenia using automated quantitative algorithms for abdominal aortic calcification, bone mineral density, and skeletal muscle, respectively. Model validity was assessed against published clinical cohorts.

RESULTS

For the base-case scenarios of 55-year-old men and women modeled over 10 years, AI-assisted CT-based opportunistic screening was a cost-saving and more effective clinical strategy, unlike the "treat none" and "treat all" strategies that ignored incidental CT body composition data. Over a wide range of input assumptions beyond the base case, the CT-based opportunistic strategy was dominant over the other two scenarios, as it was both more clinically efficacious and more cost-effective. Cost savings and clinical improvement for opportunistic CT remained for AI tool costs up to $227/patient in men ($65 in women) from the $10/patient base-case scenario.

CONCLUSION

AI-assisted CT-based opportunistic screening appears to be a highly cost-effective and clinically efficacious strategy across a broad array of input assumptions, and was cost saving in most scenarios.

Inflammatory Profile of Older Adults in Response to Physical Activity and Diet Supplementation: A Systematic Review

Chronic, low-grade inflammation in the elderly, usually known as inflammaging, accelerates the development of age-related diseases, including cancer, obesity, sarcopenia, and cardio-metabolic diseases. Two of the most studied interventions against inflammation are diet supplementation and the regular practice of exercise. The search for this systematic review was performed in Scopus, EBSCO, and PubMed databases within the last 10 years. Only randomized controlled trials that evaluated the effect of supplementation and exercise against inflammatory markers in older adults were included. After applying eligibility criteria and risk-of-bias assessment, 11 studies were included in the systematic review. In total, 638 participants were analyzed and the main supplements evaluated were amino acid or protein supplementation from different sources. In the counterpart, the exercise applied in the evaluations included strengthening exercises or aerobic training. The interventions had a range of duration between 4 and 24 weeks, and the effects on inflammation markers in most of the studies showed a decrease in pro-inflammatory cytokines and non- or slightly significant change in anti-inflammatory cytokines. However, these results suggest that exercise and supplement interventions can contribute to diminishing the inflammation process in the elderly. We can also conclude that further well-designed randomized controlled trials are needed to confirm the possible synergistic effects of exercise and food supplementation against inflammation in the elderly due to the limited studies that currently exist. This systematic review was registered in PROSPERO, ID CRD42023387184.

Effective Use of Plant Proteins for the Development of "New" Foods

Diversity in our diet mirrors modern society. Affluent lifestyles and extended longevity have caused the prevalence of diabetes and sarcopenia, which has led to the increased demand of low-carb, high-protein foods. Expansion of the global population and Westernization of Asian diets have surged the number of meat eaters, which has eventually disrupted the supply–demand balance of meat. In contrast, some people do not eat meat for religious reasons or due to veganism. With these multiple circumstances, our society has begun to resort to obtaining protein from plant sources rather than animal origins. This “protein shift” urges food researchers to develop high-quality foods based on plant proteins. Meanwhile, patients with food allergies, especially gluten-related ones, are reported to be increasing. Additionally, growing popularity of the gluten-free diet demands development of foods without using ingredients of wheat origin. Besides, consumers prefer “clean-label” products in which products are expected to contain fewer artificial compounds. These diversified demands on foods have spurred the development of “new” foods in view of food-processing technologies as well as selection of the primary ingredients. In this short review, examples of foodstuffs that have achieved tremendous recent progress are introduced: effective use of plant protein realized low-carb, high protein, gluten-free bread/pasta. Basic manufacturing principles of plant-based vegan cheese have also been established. We will also discuss on the strategy of effective development of new foods in view of the better communication with consumers as well as efficient use of plant proteins.