HQ10 : Do Nutritional Interventions Prevent the Onset and Progression of Sarcopenia in Older Adults?: English Translation of the Japanese Guideline for Digital Health for the Prevention and Improvement of Sarcopenia and Frailty

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There is a large body of evidence on nutritional supplementation for the prevention of the onset and progression of sarcopenia, and a relatively large number of systematic reviews and meta-analyses, in addition to RCTs, have been reported. Therefore, we conducted an umbrella review, a method that comprehensively searches for studies in systematic reviews and meta-analyses. Nineteen studies examining the effects of nutritional interventions (e.g., total energy sufficiency, protein and amino acid supplementation) alone or in combination with exercise and nutrition in older adults with pre-sarcopenia or sarcopenia, which were accepted for umbrella review and selected for systematic review or meta-analysis, were included (Figure 1) [1-20]. In three systematic reviews and meta-analyses comparing nutritional interventions to a control group of older subjects with pre-sarcopenia or sarcopenia, some nutritional interventions showed a positive effect on muscle mass, muscle strength, or physical function [21-23]. In the three studies of healthy older subjects, interventions with β-hydroxy-β-methylbutyrate (HMB), leucine, vitamin D, and omega-3 fatty acids improved muscle mass, muscle strength, or physical function. On the other hand, in three studies, interventions involving protein, leucine, or nutrition education did not improve muscle mass, strength, or physical function, yielding inconsistent results. Regarding the combined exercise and nutrition intervention, seven studies were extracted that involved healthy older adults or older adults with sarcopenia. These studies showed an additional benefit when resistance training was combined with a nutritional intervention (protein or specific nutrient supplementation) compared to resistance training alone. On the other hand, the other three studies did not show a similar effect of interventions, including whey protein and vitamin D. All of the 19 selected studies are systematic reviews or meta-analyses, mainly RCTs, and suggest that nutrition alone may contribute to the prevention of the onset and progression of sarcopenia, and that combined intervention with exercise and nutrition may also be effective. In contrast, some studies found that nutritional intervention alone or in combination with exercise did not exhibit the above effects, indicating inconsistency across the literature. Therefore, we suggest nutritional supplementation or combined nutritional supplementation with exercise to prevent the onset and progression of sarcopenia in older adults. No adverse events were reported in the included studies. There were small disadvantages related to cost, with results showing improvements in either muscle mass, strength, or physical function, which are considered to outweigh the harms. Citizen representatives participated in the meeting to formulate the healthcare questions and the vote to decide on the recommendations, and recommendations were decided based on their wishes as much as possible. Recommendations for effective interventions (nutritional approach only and combination of exercise and nutrition) to prevent the onset and progression of sarcopenia are expected to have a positive impact on patients, the public, and society, which may also provide an opportunity to improve nutritional intake and its guidance. It is expected that high-quality, generation- and sex-responsive evidence will be developed, including studies of effective nutritional content, timing of nutritional intervention, and a more detailed combination of exercise and nutritional content to prevent the onset and progression of sarcopenia. This document is the official English translation of the Japanese version published by the Japanese Association for Sarcopenia and Frailty and the National Center for Geriatrics and Gerontology in March 2025 [1]. This work was supported by the Japan Agency for Medical Research and Development (AMED) under the project “Project for Establishing Research and Development Infrastructure for the Social Implementation of Prevention and Health Promotion/Healthcare Social Implementation Infrastructure Development Project” (Management No. JP22rea522005). S.O. has disclosed financial relationships with Daiichi Sankyo Co. Ltd. and Tanabe Mitsubishi Pharma Corporation. M.A. has disclosed financial relationships with Daiichi Sankyo Co. Ltd., MSD K.K., Toa Eiyo Co. Ltd., Towa Pharmaceutical Co. Ltd., Eisai Co. Ltd., Kracie Pharmaceutical Co. Ltd., Tsumura Pharmaceutical Co. Ltd., Tanabe Mitsubishi Pharma Corporation, Chugai Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Takeda Pharmaceutical Co. Ltd., Astellas Pharma Inc., Bayer Yakuhin Ltd. The other authors declare no conflicts of interest.

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