From the Guidelines
To combat sarcopenia, I recommend a comprehensive approach combining resistance training and proper nutrition, prioritizing protein intake of 1.0-1.2 grams per kilogram of body weight daily, with 25-30 grams per meal for optimal muscle protein synthesis, as supported by the most recent and highest quality study 1.
Diagnosis of Sarcopenia
Sarcopenia is the progressive loss of skeletal muscle mass and strength that occurs with aging, characterized by a decline in skeletal muscle mass and function, leading to frailty, falls, and functional decline. The diagnosis of sarcopenia involves assessing muscle mass, strength, and function, with a measure of total lean mass ≥2 SD below that of a comparable young adult, distinguished by a reduction in muscle cross-sectional area 1.
Treatment of Sarcopenia
The treatment of sarcopenia involves a comprehensive approach that includes:
- Resistance training: 2-3 times weekly, focusing on major muscle groups with 2-3 sets of 8-12 repetitions at moderate intensity
- Proper nutrition: increased protein intake to 1.0-1.2 grams per kilogram of body weight daily, with 25-30 grams per meal for optimal muscle protein synthesis
- Vitamin D supplementation: 800-1000 IU daily, especially for those with deficiency
- Creatine monohydrate: 3-5 grams daily, may enhance training effects This approach works because resistance training stimulates muscle protein synthesis and improves neuromuscular function, while adequate protein provides essential amino acids needed for muscle maintenance 1.
Key Considerations
- Sarcopenia begins as early as age 30 with acceleration after 60, resulting in 3-8% muscle mass loss per decade
- Early intervention is crucial as sarcopenia contributes to frailty, falls, functional decline, and loss of independence in older adults
- For those with mobility limitations, even light resistance bands or bodyweight exercises can be effective when performed consistently
- A multidisciplinary team approach, including a registered dietician and a certified exercise physiologist, is recommended for optimal management of sarcopenia 1.
Nutrition and Sarcopenia
Nutritional interventions, including essential amino acids, have produced variable results in managing sarcopenia, with some interventions appearing effective and others of limited value 1. Selected B vitamins, such as vitamin B6 and B12, may play a role in normal and pathophysiological modes of neuromuscular function, and deficiencies in these vitamins may contribute to sarcopenia 1. However, the evidence for the use of B vitamins in the treatment of sarcopenia is limited, and further research is needed to fully understand their role.
From the Research
Diagnosis of Sarcopenia
- Sarcopenia is characterized by low muscle mass and low muscle strength and performance 2
- The Asian Working Group for Sarcopenia (AWGS) 2019 guideline proposes an algorithm for case-finding, including calf circumference measurement (cut-off <34 cm in men, <33 cm in women) or the SARC-F questionnaire (cut-off ≥4) 2
- Handgrip strength (cutoff <28 kg in men, <18 kg in women) or the 5-time chair stand test (≥12 seconds) can be used to diagnose "possible sarcopenia" 2
- The European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGS) have established diagnostic criteria for sarcopenia 3
Treatment of Sarcopenia
- Exercise and nutrition are essential for sarcopenia management, with a focus on progressive resistance (strength) training as a first-line therapy 2, 3
- Adequate protein intake (at least 1.2 g of proteins/kg/d) is recommended, with leucine-enriched balanced amino acids and possibly creatine supplementation to enhance muscle strength 4, 2
- Vitamin D replacement is necessary for individuals with low 25(OH) vitamin D levels 4
- Combination therapy, including both nutritional and exercise therapy, can improve gait speed and knee extension strength more than either exercise alone or nutrition therapy alone 3
- Resistance training combined with supplements containing amino acids is the most effective approach for preventing and treating age-related muscle wasting and weakness 5
Non-Pharmacological and Pharmacological Approaches
- Non-pharmacological approaches, including resistance exercise and adequate nutrition, are the standard treatment approaches for sarcopenia 6
- Pharmacological approaches, such as growth hormone, anabolic or androgenic steroids, and selective androgenic receptor modulators, have variable efficacy and are not currently approved by the Food and Drug Administration for the treatment of sarcopenia 6
- A comprehensive approach to sarcopenia treatment should include pharmaceutical therapies, resistance training, early ambulation, nutrition management, protein and amino acid supplementation, and non-smoking 5