Comparison of calorie and nutrient intake among elderly with and without sarcopenia: A systematic review and meta-analysis

Renin angiotensin system-induced muscle wasting: putative mechanisms and implications for clinicians

Renin angiotensin system (RAS) alters various mechanisms related to muscle wasting. The RAS system consists of classical and non-classical pathways, which mostly function differently. Classical RAS pathway, operates through angiotensin II (AngII) and angiotensin type 1 receptors, is associated with muscle wasting and sarcopenia. On the other hand, the non-classical RAS pathway, which operates through angiotensin 1-7 and Mas receptor, is protective against sarcopenia. The classical RAS pathway might induce muscle wasting by variety of mechanisms. AngII reduces body weight, via reduction in food intake, possibly by decreasing hypothalamic expression of orexin and neuropeptide Y, insulin like growth factor-1 (IGF-1) and mammalian target of rapamycin (mTOR), signaling, AngII increases skeletal muscle proteolysis by forkhead box transcription factors (FOXO), caspase activation and muscle RING-finger protein-1 transcription. Furthermore, AngII infusion in skeletal muscle reduces phospho-Bad (Ser136) expression and induces apoptosis through increased cytochrome c release and DNA fragmentation. Additionally, Renin angiotensin system activation through AT1R and AngII stimulates tumor necrosis factor-α, and interleukin-6 which induces muscle wasting, Last but not least classical RAS pathway, induce oxidative stress, disturb mitochondrial energy metabolism, and muscle satellite cells which all lead to muscle wasting and decrease muscle regeneration. On the contrary, the non-classical RAS pathway functions oppositely to mitigate these mechanisms and protects against muscle wasting. In this review, we summarize the mechanisms of RAS-induced muscle wasting and putative implications for clinical practice. We also emphasize the areas of uncertainties and suggest potential research areas.

Nutritional Strategies for Muscle Atrophy: Current Evidence and Underlying Mechanisms

Skeletal muscle can undergo detrimental changes in various diseases, leading to muscle dysfunction and atrophy, thus severely affecting people's lives. Along with exercise, there is a growing interest in the potential of nutritional support against muscle atrophy. This review provides a brief overview of the molecular mechanisms driving skeletal muscle atrophy and summarizes recent advances in nutritional interventions for preventing and treating muscle atrophy. The nutritional supplements include amino acids and their derivatives (such as leucine, β-hydroxy, β-methylbutyrate, and creatine), various antioxidant supplements (like Coenzyme Q10 and mitoquinone, resveratrol, curcumin, quercetin, Omega 3 fatty acids), minerals (such as magnesium and selenium), and vitamins (such as vitamin B, vitamin C, vitamin D, and vitamin E), as well as probiotics and prebiotics (like Lactobacillus, Bifidobacterium, and 1-kestose). Furthermore, the study discusses the impact of a combined approach involving nutritional support and physical therapy to prevent muscle atrophy, suggests appropriate multi-nutritional and multi-modal interventions based on individual conditions to optimize treatment outcomes, and enhances the recovery of muscle function for patients. By understanding the molecular mechanisms behind skeletal muscle atrophy and implementing appropriate interventions, it is possible to enhance the recovery of muscle function and improve patients' quality of life.

Association between the oxidative balance score and low muscle mass in middle-aged US adults

Background

Oxidative Balance Score (OBS) is a tool for assessing the oxidative stress-related exposures of diet and lifestyle. The study aimed to investigate the association between OBS and low muscle mass.

Methods

Overall, 6,307 individuals over the age of 18 were assessed using data from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES). Weighted logistic regression and models were used, together with adjusted models.

Results

There was a negative relationship between OBS and low muscle mass [odds ratio (OR): 0.96, 95% confidence interval (CI): 0.94-0.97, p< 0.0001] using the first OBS level as reference. The values (all 95% CI) were 0.745 (0.527-1.054) for the second level, 0.650 (0.456-0.927) for the third level, and 0.326 (0.206-0.514) for the fourth level (P for trend <0.0001). Independent links with low muscle mass were found for diet and lifestyle factors. A restricted cubic spline model indicated a non-linear association between OBS and low muscle mass risk (P for non-linearity<0.05). In addition, the inflection points of the nonlinear curves for the relationship between OBS and risk of low muscle mass were 20.

Conclusion

OBS and low muscle mass were found to be significantly negatively correlated. By modulating oxidative balance, a healthy lifestyle and antioxidant rich diet could be a preventive strategy for low muscle mass.

Implications of Protein and Sarcopenia in the Prognosis, Treatment, and Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a common cause of chronic liver disease globally, with prevalence rapidly increasing in parallel with rising rates of obesity and metabolic syndrome. MASLD is defined by the presence of excess fat in the liver, which may induce inflammatory changes and subsequent fibrosis in high-risk patients. Though MASLD occurs frequently, there is still no approved pharmacological treatment, and the mainstay of therapy remains lifestyle modification via dietary changes, enhancement of physical activity, and management of metabolic comorbidities. Most nutrition research and clinical guidance in this disease centers on the reduction in fructose and saturated fat in the diet, although the emerging literature suggests that protein supplementation is important and implicates muscle mass and sarcopenia in disease-related outcomes. This review will assess the current data on these topics, with the goal of defining best practices and identifying research gaps in care.

D-galactose might mediate some of the skeletal muscle hypertrophy-promoting effects of milk-A nutrient to consider for sarcopenia?

Sarcopenia is a process of progressive aging-associated loss of skeletal muscle mass (SMM) recognized as a serious global health issue contributing to frailty and increased all-cause mortality. Exercise and nutritional interventions (particularly intake of dairy products and milk) demonstrate good efficacy, safety, and broad applicability. Here, we propose that at least some of the well-documented favorable effects of milk and milk-derived protein supplements on SMM might be mediated by D-galactose, a monosaccharide present in large quantities in milk in the form of disaccharide lactose (milk sugar). We suggest that ingestion of dairy products results in exposure to D-galactose in concentrations metabolized primarily via the Leloir pathway with the potential to (i) promote anabolic signaling via maintenance of growth factor (e.g., insulin-like growth factor 1 [IGF-1]) receptor mature glycosylation patterns; and (ii) provide extracellular (liver glycogen) and intracellular substrates for short (muscle glycolysis) and long-term (muscle glycogen, intramyocellular lipids) energy availability. Additionally, D-galactose might optimize the metabolic function of skeletal muscles by increasing mitochondrial content and stimulating glucose and fatty acid utilization. The proposed potential of D-galactose to promote the accretion of SMM is discussed in the context of its therapeutic potential in sarcopenia.

Association of dietary fat intake with skeletal muscle mass and muscle strength in adults aged 20-59: NHANES 2011-2014

Background

Sarcopenia, a progressive loss of skeletal muscle mass and strength, needs to initially prevent in the twenties. Meanwhile, there is a lack of research on the effects of fat consumption on skeletal muscle mass and strength in adults aged 20-59. We aimed to assess associations between dietary fat intake and skeletal muscle mass, as measured by appendicular lean mass adjusted for body mass index (ALMBMI), and muscle strength, as represented by handgrip strength adjusted for body mass index (GSMAXBMI), among adults aged 20-59.

Methods

Dietary fat intake per kilogram of actual body weight was assessed using two 24h recalls, while ALM and GSMAX were measured using DXA and a handgrip dynamometer, respectively. A weighted multiple linear regression model was employed to analyze the association between dietary fat intake and skeletal muscle mass, utilizing data from the National Health and Nutrition Examination Survey spanning from 2011 to 2014. To assess the non-linear relationship and saturation value between dietary fat intake and skeletal muscle mass, a smooth curve fitting approach and a saturation effect analysis model were utilized.

Results

The study comprised a total of 5356 subjects. After adjusting for confounding factors, there was a positive association observed between dietary fat intake and ALMBMI as well as GSMAXBMI. The relationship between dietary fat intake and ALMBMI showed an inverted U-shaped curve, as did the association with GSMAXBMI. Turning points were observed at 1.88 g/kg/d for total fat intake and ALMBMI, as well as at 1.64 g/kg/d for total fat intake and GSMAXBMI. Furthermore, turning points were still evident when stratifying by gender, age, protein intake, and physical activity. The turning points were lower in individuals with low protein intake(<0.8 g/kg/d) and high levels of physical activity.

Conclusion

The moderate dietary fat intake can be beneficial for muscle mass and strength in adults aged 20-59 under specific conditions. Special attention should be directed toward the consumption of fats in individuals with low protein intake and those engaged in high levels of physical activity.

Energy and nutrient intake by people with and without sarcopenia diagnosed by the European Working Group on Sarcopenia in Older People: a systematic review and meta-analysis

CONTEXT

There is growing evidence that insufficient dietary intake is associated with sarcopenia.

OBJECTIVE

In this systematic review and meta-analysis, the energy and nutrient intakes by people with and without sarcopenia were compared using only the European Working Group on Sarcopenia in Older People 2010 (EWGSOP1) and 2019 (EWGSOP2) consensus diagnostic criteria.

DATA SOURCES

Only observational studies that compared energy and nutrient intake from food alone by individuals with and without sarcopenia were included. Studies were searched in the following databases: Embase, PubMed, Scopus, Web of Science, Lilacs, Ovid, and Scopus. The review followed the PRISMA checklist and submitted the protocol to PROSPERO.

DATA EXTRACTION

Data were extracted by 2 authors independently. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale.

DATA ANALYSIS

A total of 8648 articles were identified and 12 were selected. Among individuals with sarcopenia, lower intakes of energy and some nutrients, mainly with antioxidant properties, were observed compared with those without sarcopenia. Meta-analyses showed that individuals with sarcopenia consume fewer calories/day than individuals without sarcopenia (n = 10 studies; standardized mean difference (SMD) -0.15; 95% confidence interval: -0.29, -0.01) diagnosed by EWGSOP1 and EWGSOP2. Individuals with sarcopenia consume less omega-3, folate, magnesium, phosphorus, selenium, zinc, and vitamins C, D, and E when compared with those without sarcopenia.

CONCLUSION

The results of the present study suggest that insufficient intake of energy and nutrients with antioxidant potential may be associated with sarcopenia.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD 42020195698.

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.

Non-pharmacological interventions for older adults with postprandial hypotension: A scoping review

BACKGROUND

Older adults frequently suffer from postprandial hypotension, associated with an increased risk of falls, syncope, acute cardiovascular and cerebrovascular diseases, and even death. Researchers use non-pharmacological interventions, but related literature is dispersed and lacks a latest summary.

OBJECTIVE

The aim of this study was to map and examine non-pharmacological interventions currently employed to assist older adults with postprandial hypotension and lay a solid foundation for future studies.

METHODS

This study adhered to the JBI methodology for scoping reviews and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. PubMed, Web of Science, Embase, Cochrane Library, CINAHL, SCOPUS, Chinese Biomedical Journal, China National Knowledge Infrastructure, VIP and WAN FANG Data were retrieved from their inception to 1 August 2022.

RESULTS

Two randomized controlled trials and seven quasi-experimental studies were included. Small meals, exercise interventions, fibre with meals, green tea and water therapy have been reported to prevent postprandial hypotension effectively; however, position changes have been reported to have no impact on postprandial blood pressure decrease. Additionally, the blood pressure determination methods and test meals may affect observed trial effects.

CONCLUSION

Large samples and long-term follow-up studies are needed to prove the efficacy and safety of existing non-pharmacological interventions. Future studies should develop a BP determination method based on the postprandial BP decline trajectory induced by a given test meal to improve the reliability of study results.

RELEVANCE TO CLINICAL PRACTICE

This review broadly summarizes existing studies on developing and validating non-pharmacological interventions for older adults with postprandial hypotension. It also analyses special factors that may influence the trial effects. This may provide a useful reference for future research.

The role of zinc on nutritional status, sarcopenia, and frailty in older adults: a scoping review

BACKGROUND

Zinc (Zn) deficiency, malnutrition, sarcopenia, and frailty are prevalent among older adults and are prominent factors contributing to disability and mortality.

OBJECTIVE

This scoping review was conducted to aid understanding of the extent and types of research addressing the role of Zn in nutritional status, sarcopenia, and frailty, among older individuals.

METHOD

A systematic search was performed in August 2022 of 3 electronic databases (PubMed, Web of Science, and ProQuest) using predefined search terms. The review was conducted referring to the Arksey and O'Malley framework and PRISMA-ScR.

RESULTS

The search retrieved 16 018 records, and a total of 49 studies were included in this review after the screening. Of those, 30 were based on dietary Zn intake, 18 on tissue Zn levels, and 1 on both. Most studies were based on cross-sectional data from community-dwelling older adults. Studies addressing the associations between Zn status and individual anthropometric and sarcopenia-related variables reported inconsistent results. However, most studies reported inverse associations between malnutrition, frailty, and Zn status.

CONCLUSION

There was more consistent evidence of the relationship of Zn status with malnutrition, sarcopenia, and frailty rather than with individual nutritional parameters. Validated screening and assessment tools and criteria and prospective studies are required to elucidate the relationship of Zn with sarcopenia and frailty in the older population.

Advances in nutritional supplementation for sarcopenia management

Sarcopenia is a syndrome characterized by a decline in muscular mass, strength, and function with advancing age. The risk of falls, fragility, hospitalization, and death is considerably increased in the senior population due to sarcopenia. Although there is no conclusive evidence for drug treatment, resistance training has been unanimously recognized as a first-line treatment for managing sarcopenia, and numerous studies have also pointed to the combination of nutritional supplementation and resistance training as a more effective intervention to improve quality of life for people with sarcopenia. People with both malnutrition and sarcopenia have a higher mortality rate, so identifying people at risk of malnutrition and intervening early is extremely important to avoid sarcopenia and its associated problems. This article provides important information for dietary interventions in sarcopenia by summarizing the discoveries and developments of nutritional supplements such as protein, leucine, β-hydroxy-β-methylbutyric acid, vitamin D, vitamin C, vitamin E, omega-3 fatty acids, creatine, inorganic nitrate, probiotics, minerals, collagen peptides, and polyphenols in the management of sarcopenia.

Association between digestive diseases and sarcopenia among Chinese middle-aged and older adults: a prospective cohort study based on nationally representative survey

Objectives

Patients with digestive diseases frequently suffer from dyspepsia and malabsorption, which may lead to muscle loss due to malnutrition. However, it is not clear whether digestive diseases are associated with sarcopenia. This study aims to explore the longitudinal association between digestive diseases and sarcopenia in middle-aged and older adults based on a nationally representative survey from China.

Methods

We used a prospective cohort study including 7,025 middle-aged and older adults aged ≥45 years from the 2011 to 2015 waves China Health and Retirement Longitudinal Study (CHARLS). Digestive diseases were identified using self-report. The assessment of sarcopenia was based on the Asian Working Group for Sarcopenia 2019 Consensus and included three components of muscle strength, physical performance, and muscle mass. Cox hazards regression was used to examine the association between digestive diseases and sarcopenia.

Results

The prevalence of digestive diseases and the incidence of sarcopenia in middle-aged and older adults were 22.6% (95% CI = 21.6-23.6%) and 8.5% (95% CI = 7.8-9.1%). After adjusting for 15 covariates composed of three sets (demographic characteristics, lifestyles, and health status), digestive diseases were associated with a higher risk of sarcopenia (HR = 1.241, 95% CI = 1.034-1.490, P < 0.05). The associations were more pronounced among men, older adults aged 60-79, rural residents, and married people. In addition, the association between digestive diseases and sarcopenia was robust in the sensitivity analysis.

Conclusion

Digestive diseases were associated with an increased risk of sarcopenia in middle-aged and older adults aged ≥45 years. Early intervention of digestive diseases may help to reduce the incidence of sarcopenia in middle-aged and older adults.

Trends in Nutrition Research for Sarcopenia: A Bibliometric Analysis

Sarcopenia is age-related, pathophysiological muscle atrophy. Research regarding nutrition treatment of sarcopenia has developed rapidly, particularly as populations age. We evaluated the development of trends in this field using a bibliometric analysis. Articles up to July 2022 were searched in the Scopus database. Bibliographic information from the selected publications, such as countries, citations, world maps, institutions, authors, journals, and keywords, were converted and analyzed automatically using the “bibliometrix” package in R environment (version 4.2.0). We identified 368 Scopus articles from 1998–2021. According to citation analyses, 27 documents received more than 100 citations. Bibliometric analysis based on the literature included in this study revealed that South Korea (61 publications), United States (50), Japan (35), China (30), and Italy (20) contributed the most publications. Tehran University of Medical Science (19 records, 2.55% of articles) contributed the most publications. The most productive author was Landi, with eight articles (2.17% of articles). The publications were located in 196 journals, with Nutrients having the most publications (30, 8.15% of articles). The curves representing keywords “sarcopenia” and “aged” were the most apparent. Our analysis suggested that global nutrition and sarcopenia-related research increased rapidly from 2001 to 2021, demonstrating that this was a promising area of future research that could benefit from continued advances. Future research may focus on the effects of age and sex as well as intervention effectiveness, particularly exercise and nutrition supplementation.

Association of Micronutrients and Handgrip Strength in Korean Older Population: A Cross-Sectional Study

Sarcopenia is characterized by the loss of skeletal muscle mass, strength, and physical performance. Dynapenia and kratopenia are described as the loss of muscle strength and power. Nutritional intake status is one of the factors affecting the prevention of an age-related muscle decline such as sarcopenia, dynapenia, or kratopenia in older populations. This study aimed to investigate the association between the intake of micronutrients and handgrip strength in 1254 individuals (546 men and 708 women) of the Korean older population from the most recent dataset. They were analyzed and divided into two groups: a LHS group with low handgrip strength (<28 kg for men and <18 kg for women) and a normal group with normal handgrip strength. Logistic regression analysis was performed to estimate the odds ratios (ORs) and 95% confidence intervals (Cis) of the associations between micronutrient intakes and low handgrip strength in Korean older population by gender. Among micronutrients, insufficient potassium intake showed a significant association with low handgrip strength for men (OR: 3.159, 95% CI: 1.164−8.578) and women (OR: 2.793, 95% CI: 1.380−5.654) aged ≥65 years, respectively (p = 0.005 for men, p = 0.024 for women), as a result of adjusting for all confounding factors that could affect low handgrip strength. In conclusion, potassium intake among micronutrients in Korean older populations with low handgrip strength might need continuous monitoring for the intervention or prevention of dynapenia or sarcopenia.

The Inverse Association of Sarcopenia and Protein-Source Food and Vegetable Intakes in the Korean Elderly: The Korean Frailty and Aging Cohort Study

The aging population contributes to increasing economic and social burden worldwide. Sarcopenia, an age-related degenerative disease and progressive disorder, is characterized by a reduction in skeletal muscle mass and function. This study aims to assess the association between dietary factors and sarcopenia in the Korean elderly using nationwide data. A total of 801 subjects aged 70–84 years were included in this analysis. Subjects were divided into two groups: sarcopenic and nonsarcopenic groups according to the sarcopenia criteria established by the Asian Working Group for Sarcopenia. Nutrient and food intakes were assessed using a 24-h recall method. Logistic regression analysis was used to assess the association between sarcopenia and food group and nutrient intakes. In the multivariable models, the meat/fish/egg/legume food group, vegetable group, and total food intake were inversely associated with the prevalence of sarcopenia. The high intakes of energy, carbohydrate, protein, fiber, zinc, carotene, and vitamin B₆ were associated with the lower prevalence of sarcopenia. Therefore, consuming sufficient nutrients through various protein source foods and vegetables will help prevent sarcopenia in the Korean elderly.

Anabolic-Androgenic Steroids and Exercise Training: Breaking the Myths and Dealing With Better Outcome in Sarcopenia

Sarcopenia is an emerging clinical condition determined by the reduction in physical function and muscle mass, being a health concern since it impairs quality of life and survival. Exercise training is a well-known approach to improve physical capacities and body composition, hence managing sarcopenia progression and worsening. However, it may be an ineffective treatment for many elderly with exercise-intolerant conditions. Thus, the use of anabolic-androgenic steroids (AAS) may be a plausible strategy, since these drugs can increase physical function and muscle mass. The decision to initiate AAS treatment should be guided by an evidence-based patient-centric perspective, once the balance between risks and benefits may change depending on the clinical condition coexisting with sarcopenia. This mini-review points out a critical appraisal of evidence and limitation of exercise training and AAS to treat sarcopenia.

Relationship Between Dietary Omega-3 and Omega-6 Polyunsaturated Fatty Acids Level and Sarcopenia. A Meta-Analysis of Observational Studies

Objective: This study investigates the relationship between dietary omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) levels and sarcopenia.

Methods: A comprehensive literature search in the databases of PubMed, Web of Science, and Embase (up to July 2021) were conducted to identify the observational studies on the relationship between dietary omega-3 and omega-6 PUFAs level and sarcopenia. The pooled odds ratio (OR) of sarcopenia for the highest vs. lowest dietary omega-3 and omega-6 PUFAs level and the standard mean difference (SMD) of dietary omega-3 and omega-6 PUFAs levels for sarcopenia vs. control subjects were calculated.

Results: A total of six studies were identified in this meta-analysis. The overall multi-variable adjusted OR showed that dietary omega-3 PUFAs level was inversely associated with sarcopenia (OR = 0.41, 95% CI: 0.26–0.65; P = 0.0001). Moreover, the overall combined SMD showed that the dietary omega-3 PUFAs level in sarcopenia was lower than that in control subjects (SMD = −0.19, 95% CI: −0.32 to −0.07; P = 0.002). With regard to dietary omega-6 PUFAs level, the overall multi-variable adjusted OR suggested no significant relationship between dietary omega-6 PUFAs level and sarcopenia (OR = 0.64, 95% CI: 0.33–1.24; P = 0.19). However, the overall combined SMD showed that the dietary omega-6 PUFAs level in sarcopenia was slightly lower than that in control subjects (SMD = −0.15, 95% CI: −0.27 to −0.02; P = 0.02).

Conclusion: Our results suggested that the dietary omega-3 PUFAs level was inversely associated with sarcopenia. However, current evidence is still insufficient to demonstrate the definite relationship between dietary omega-6 PUFAs levels and sarcopenia. More well-designed prospective cohort studies with the dietary omega-3/omega-6 PUFAs ratio are still needed.

Relationship Between Protein Intake and Sarcopenia in the Elderly with Nonalcoholic Fatty Liver Disease Based on the Fourth and Fifth Korea National Health and Nutrition Examination Survey

Background: The association between sarcopenia and protein intake has been well studied. However, limited data are available on the association between sarcopenia and protein intake in people with nonalcoholic fatty liver disease (NAFLD). This study aimed to investigate the association between protein intake and sarcopenia among elderly participants with NAFLD using the Korea National Health and Nutrition Examination Survey (KNHANES). Methods: Data of 4179 participants (1576 men and 2603 women, age ≥60 years) who participated in the KNHANES during 2008-2011 were obtained. Sarcopenia was defined as appendicular skeletal muscle mass/wt (%) of 1 standard deviation below the gender-specific mean for healthy adults and NAFLD as liver fat score using the fatty liver prediction models. According to their daily protein intake, participants were grouped into the high protein intake group (>1.2 g/kg/day), middle protein intake group (0.8-1.2 g/kg/day), and low protein intake group (<0.8 g/kg/day). Generalized linear models and logistic regression models were used. Results: The overall prevalence of sarcopenia in participants with NAFLD was 16.53%. Compared with the highest protein intake group, the low protein intake group had a significantly higher risk of sarcopenia (adjustment odds ratio = 1.707; 95% confidence interval = 1.009-2.886). In the fully adjusted model, the highest protein intake group had significantly lower levels of insulin, total body fat, vitamin B, and fat intake, whereas muscle proportions, energy, carbohydrates, vitamin A, and vitamin C intake of high protein intake participants were significantly higher than other groups. Conclusion: The prevalence of sarcopenia and sarcopenia-related factors were significantly lower in NAFLD elderly participants with high protein intake. These results suggest that high protein intake can help prevent and manage sarcopenia in people with NAFLD.

Vitamin Intake and Loss of Muscle Mass in Older People with Type 2 Diabetes: A Prospective Study of the KAMOGAWA-DM Cohort

The aim of this prospective cohort study was to examine the relationships between the intakes of various vitamins and the loss of muscle mass in older people with type 2 diabetes (T2DM). The change in skeletal muscle mass index (SMI, kg/m²) (kg/m²/year) was defined as follows: (SMI at baseline (kg/m²) - SMI at follow-up (kg/m²))/follow-up period (year). The rate of SMI reduction (%) was calculated as follows (the change in SMI (kg/m²/year)/SMI at baseline (kg/m²)) × 100. The rate of SMI reduction ≥ 1.2% was considered as the loss of muscle mass. Among 197 people with T2DM, 47.2% of them experienced the loss of muscle mass at the 13.7 ± 5.2 month follow-up. Vitamin B1 (0.8 ± 0.3 vs. 0.8 ± 0.3 mg/day, p = 0.031), vitamin B12 (11.2 ± 8.3 vs. 13.4 ± 7.5 μg/day, p = 0.049), and vitamin D (16.5 ± 12.2 vs. 21.6 ± 13.0 μg/day, p = 0.004) intakes in people with the loss of muscle mass were significantly lower than those without. Vitamin D intake was related to the loss of muscle mass after adjusting for sex, age, exercise, alcohol, smoking, body mass index, SMI, glucagon-like peptide-1 agonist, sodium glucose cotransporter-2 inhibitor, insulin, HbA1c, creatinine, energy intake, and protein intake (adjusted odds ratio 0.93, 95% confidence interval: 0.88-0.97, p = 0.003). This study showed that vitamin D intake was related to the loss of muscle mass in older people with T2DM. Vitamin B12 intake tended to be related to the loss of muscle mass, although vitamin A, vitamin B2, vitamin B6, vitamin C, and vitamin E intake were not related.