![]() ![]() ![]() Thus, sarcopenia can be considered primary if related to advanced age and with no other evident cause or associated disease. Although the incidence of sarcopenia is higher in the elderly, adults can also develop this syndrome, which can be associated with other diseases such as osteoporosis. Such progression is due to factors such as age advancement, inadequate nutrition, disuse, and endocrine dysfunction. Like any other complex syndrome, sarcopenia's onset mechanisms and progression are varied and related to the (in)balance of protein synthesis and degradation, neuromuscular integrity, and muscle fat content. Therefore, defining sarcopenia only by decreasing muscle mass could have limited clinical value. The justification for using the two factors mentioned above is that muscle strength is not dependent on muscle volume, and that strength and muscle mass ratio is not linear. ![]() The European consensus on sarcopenia recommends the inclusion of the factors that cause the decrease in skeletal muscle mass and consequent decrease in its function (strength or performance) for the diagnosis of this syndrome. Although cachexia can be a component of sarcopenia, these conditions are distinct. Its causes are multifactorial and include disuse, altered endocrine function, chronic diseases, inflammation, insulin resistance, and nutritional deficiencies. It is a complex syndrome associated with muscle mass loss alone or in conjunction with increased adipose tissue. On 18 November 2009, researchers and geriatricians defined sarcopenia as “the loss of skeletal muscle function and mass associated with age”. ![]() In addition, sarcopenia is associated with increased mortality risk in frail older adults. Sarcopenia is currently recognized as a critical geriatric problem and an important condition to predict frailty in the elderly and minimize the impact on physical activity. Later, it was used by Irwin Rosenberg, who defined this condition as age-related muscle wasting. Sarcopenia comes from the combination of two Greek words: sarx (flesh) and penia (loss) and was initially described by Evans and Campbell. In addition, the combination of nutritional strategies with training protocols is discussed to provide a better understanding of the interactions between exercise, feeding, and MPS. Thus, the objective of the present review is to analyze optimal nutritional strategies focused on the maintenance of muscle mass in older adults, discussing the protein amounts, dose per meal, and protein quality and source to achieve healthy aging. However, considering associated problems with anabolic resistance of older adults, the increased MPS provided by the RT is insufficient to sustain a positive protein net balance across the day, suggesting that the combination of AT/RT and increases in protein intake may be a better approach to preventing sarcopenia. Moreover, MPS can be stimulated by physical activities, leading to significant increases during aerobic (AT) and resistance training (RT) protocols. It has been suggested that older adults present the capacity to support and synthesize more protein (>20 g) at each meal, supporting the importance of the doses and quality of the protein ingested by older adults. Besides the minimum amount of protein intake required to optimize the MPS in older adults, other topics related to optimal doses of protein per/meal have been discussed over the decade. Recent studies suggest that older adults need to ingest 1.0–1.3 g/kg/day of protein to sustain their muscle mass and functionality, indicating that these higher doses represent 40% less muscle mass loss when compared to the lower doses previously recommended. Therefore, the previous recommendation for protein intake (0.66–0.80 g/kg/day) could be underestimated to sustain the protein net balance across the day, considering problems associated with anabolic resistance. Over the years, it has been established that an insufficient dietary protein intake is associated with loss of muscle mass in older adults due to lower muscle protein synthesis (MPS). Dietary protein intake, insulin resistance, and physical inactivity play a vital role in developing this condition. Sarcopenia is a multifactorial process associated with several risk factors (i.e., inflammatory cytokines, negative net protein balance, sedentarism, and vitamin D deficiency). One of the main problems observed in older adults is related to a relative loss of muscle mass, defined as sarcopenia, which increases risk related to falls, reduces physical capacity, and enhances problems associated with disabilities. According to the World Health Organization (WHO), until 2025, a 38% increase of individuals over 65 years old is expected, suggesting that a better understanding of that population and strategies to avoid age-related problems to achieve healthy aging are needed. The number of older adults has increased over the last decades. ![]()
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