Nutritional and Pharmacological Interventions for Sarcopenia in Older Adults: A Systematic Review and Network Meta-Analysis.

OBJECTIVES

This study aimed to compare the impacts of different nutritional supplements and drugs on older adults with sarcopenia.

DESIGN

Systematic review and network meta-analysis.

SETTING AND

PARTICIPANTS

Participants with sarcopenia receiving nutritional and pharmacological interventions targeting sarcopenia in any setting.

METHODS

We systematically searched electronic databases, including Embase, MEDLINE, the Cochrane Central Registry of Controlled Trials, Web of Science, and CINAHL up to April 2022. We included randomized controlled trials (RCTs) that examined the efficiency of nutritional and pharmacological interventions on patient-important outcomes in older adults with sarcopenia. We conducted frequent random-effects network meta-analyses to synthesize the evidence and used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework to assess the certainty of the evidence.

RESULTS

After screening 12,308 articles, we included 59 RCTs (N = 5543). Multinutrition [standardized mean difference (SMD), 0.65; 95% CI, 0.04-1.26], protein (SMD, 0.77; 95% CI, 0.38-1.17), and protein with vitamin D (SMD, 0.37; 95% CI, 0.03-0.72) probably improve the quality of life compared with usual care (moderate certainty). The combination of protein and vitamin D [mean difference (MD), 2.07 kg; 95% CI, 0.91-3.23] probably enhance handgrip strength (moderate certainty) and multinutrition (MD, 2.32 kg; 95% CI, 0.85-3.79) may improve handgrip strength (low certainty). However, the drug intervention does not yield significant improvements in handgrip strength (MD, 1.72 kg; 95% CI, -0.74 to 4.18), knee extension strength (SMD, 0.49; 95% CI: -0.05 to 1.03), or timed up and go tests (MD, 0.06; 95% CI, -0.98 to 1.11).

CONCLUSIONS AND IMPLICATIONS: Moderate evidence indicating that the combination of protein and vitamin D supplements, along with multiple nutritional intervention measures, probably enhance the quality of life, muscle strength, and muscle mass in older individuals with sarcopenia. Pharmacological therapy may increase muscle mass.