What is the diagnosis and treatment of Sarcopenia (muscle wasting disease)?

From the Guidelines

To combat sarcopenia, I strongly recommend a comprehensive approach combining resistance training and proper nutrition, as supported by the most recent and highest quality study 1.

Key Recommendations

• Perform resistance exercises 2-3 times weekly, focusing on major muscle groups with 8-12 repetitions per set and gradually increasing intensity, as this has been shown to improve muscle mass, strength, and function in patients with sarcopenia 1.
• Consume adequate protein (1.0-1.5g per kg of body weight daily), with 25-30g per meal for optimal muscle protein synthesis, as recommended for patients with liver cirrhosis to prevent loss of muscle mass and reverse muscle loss in those who are sarcopenic 1.
• Consider vitamin D supplementation (800-1000 IU daily) and creatine monohydrate (3-5g daily) to enhance training effects and improve muscle function, although the evidence for these supplements is not as strong as for resistance training and proper nutrition.

Rationale

Sarcopenia is a progressive loss of skeletal muscle mass, strength, and function that occurs with aging, and it can be exacerbated by chronic diseases such as liver cirrhosis and inflammatory bowel disease. The evidence suggests that resistance training and proper nutrition are essential for preventing and treating sarcopenia, and that these interventions can improve muscle mass, strength, and function, as well as overall health and quality of life 1.

Additional Considerations

• Patients with sarcopenia should be assessed regularly to track progress and adjust interventions accordingly, as this can help to optimize treatment outcomes and improve quality of life.
• Healthcare providers should consider the individual needs and circumstances of each patient when developing a treatment plan for sarcopenia, taking into account factors such as age, sex, body composition, and underlying health conditions.
• Further research is needed to fully understand the causes and consequences of sarcopenia, and to develop effective strategies for prevention and treatment, although the current evidence supports the use of resistance training and proper nutrition as a comprehensive approach to combating sarcopenia 1.

From the Research

Definition and Causes of Sarcopenia

• Sarcopenia is defined as a loss of muscle mass coupled with functional deterioration, such as walking speed or distance, or grip strength 2.
• The condition is associated with various factors, including genetic factors, mitochondrial defects, decreased anabolic hormones, inflammatory cytokine excess, insulin resistance, and poor blood flow to muscle 2.

Treatment and Management of Sarcopenia

• Resistance exercise, protein supplementation, and vitamin D have been established as the basic treatment of sarcopenia 2.
• High-dose testosterone may increase muscle power and function, but it has potentially limiting side effects 2.
• Other potential treatments in development include selective androgen receptor molecules, ghrelin agonists, myostatin antibodies, and activin IIR antagonists 2.

Role of Physical Exercise in Sarcopenia

• Physical exercise is a therapeutic approach that has shown the best results in treating sarcopenia 3.
• High-intensity strength exercises, alone or combined with aerobic exercise, can improve muscle mass, strength, and functional test times 3.
• Strength-resistance training and multimodal programs with aerobic exercise have beneficial effects on anthropometric and muscle function parameters 3.

Nutritional Interventions for Sarcopenia

• Nutritional interventions, such as protein supplementation, can improve muscle mass, strength, and physical performance in older people 4.
• Leucine supplementation has a significant effect on muscle mass in elderly people with sarcopenia 4.
• Protein supplementation on top of resistance training is recommended to increase muscle mass and strength, particularly for obese persons and for 24 weeks or more 4.

Importance of Exercise and Nutrition in Sarcopenia

• Regular exercise programs, including resistance and endurance exercise training, can improve muscle mass, strength, and function in older persons 5.
• Nutritional supplements, such as creatine, vitamin D, and omega-3 polyunsaturated fatty acids, can support resistance training-induced adaptations and combat age-related muscle mass loss 6.