Possible Role of Nutrition in Prevention of Sarcopenia and Falls

      ABSTRACT

      Objective: In this review, we analyze the foundation of sarcopenia as a potentially modifiable risk factor for falls, and we try to formulate practical strategies for nutritional interventions aimed at reducing the risk for sarcopenia and falls in our elderly patients.
      Methods: An extensive literature search was performed using the PubMed and the Google Scholar databases.
      Results: Falls are a common and costly source of injury and death in elderly adults. A large proportion of injurious falls are due to a trip or slip, suggesting that muscular factors are major determinants of both fall risk and the risk for fall-related injury.
      Conclusion: An increasing body of evidence links sarcopenia, the loss of muscle strength and mass that occurs with advancing age, with an increased risk for falls. Nutritional factors, as well as exercise, can help with both prevention and treatment of sarcopenia and may reduce the risk of falls in the elderly.
      Abbreviations: 25-OHD = 25-hydroxyvitamin D; EAA = essential amino acid; IGF-1 = insulin-like growth factor 1; IU = international units; MPS = muscle protein synthesis; PUFA = polyunsaturated fatty acid
      To read this article in full you will need to make a payment
      AACE Member Login
      AACE Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Zecevic A.A.
        • Salmoni A.W.
        • Speechley M.
        • Vandervoort A.A.
        Defining a fall and reasons for falling: comparisons among the views of seniors, health care providers, and the research literature.
        Gerontologist. 2006; 46: 367-376
        • Tinetti M.E.
        • Speechley M.
        • Ginter S.F.
        Risk factors for falls among elderly persons living in the community.
        N Engl J Med. 1988; 319: 1701-1707
        • Rossat A.
        • Fantino B.
        • Nitenberg C.
        • et al.
        Risk factors for falling in community-dwelling older adults: which of them are associated with the recurrence of falls?.
        J Nutr Health Aging. 2010; 14: 787-791
        • Edwards M.H.
        • Jameson K.
        • Denison H.
        • et al.
        Clinical risk factors, bone density and fall history in the prediction of incident fracture among men and women.
        Bone. 2013; 52: 541-547
      1. Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention.
        J Am Geriatr Soc. 2001; 49: 664-672
      2. K.KaufmanFalls in community-living older adults: prediction and prevention. Endo 2019. New Orleans, Louisiana.

        • Rubenstein L.Z.
        • Josephson K.R.
        Falls and their prevention in elderly people: what does the evidence show?.
        Med Clin North Am. 2006; 90: 807-824
        • Crenshaw J.R.
        • Bernhardt K.A.
        • Achenbach S.J.
        • et al.
        The circumstances, orientations, and impact locations of falls in community-dwelling older women.
        Arch Gerontol Geriatr. 2017; 73: 240-247
        • Wu G.
        The relation between age-related changes in neuromusculoskeletal system and dynamic postural responses to balance disturbance.
        J Gerontol A Biol Sci Med Sci. 1998; 53: M320-M326
        • Horlings C.G.
        • van Engelen B.G.
        • Allum J.H.
        • Bloem B.R.
        A weak balance: the contribution of muscle weakness to postural instability and falls.
        Nat Clin Pract Neurol. 2008; 4: 504-515
        • Maki B.E.
        • McIlroy W.E.
        Control of rapid limb movements for balance recovery: age-related changes and implications for fall prevention.
        Age Ageing. 2006; 35: ii12-ii18
        • Rosenberg I.H.
        Sarcopenia: origins and clinical relevance.
        J Nutr. 1997; 127: 990S-991S
        • Cruz-Jentoft A.J.
        • Bahat G.
        • Bauer J.
        • et al.
        Sarcopenia: revised European consensus on definition and diagnosis.
        Age Ageing. 2019; 48: 16-31
        • Cruz-Jentoft A.J.
        • Landi F.
        • Schneider S.M.
        • et al.
        Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS).
        Age Ageing. 2014; 43: 748-759
        • Benichou O.
        • Lord S.R.
        Rationale for strengthening muscle to prevent falls and fractures: a review of the evidence.
        Calcif Tissue Int. 2016; 98: 531-545
        • Schneider S.M.
        • Al-Jaouni R.
        • Pivot X.
        • Braulio V.B.
        • Rampal P.
        • Hebuterne X.
        Lack of adaptation to severe malnutrition in elderly patients.
        Clin Nutr. 2002; 21: 499-504
        • Lang T.
        • Streeper T.
        • Cawthon P.
        • Baldwin K.
        • Taaffe D.R.
        • Harris T.B.
        Sarcopenia: etiology, clinical consequences, intervention, and assessment.
        Osteoporos Int. 2010; 21: 543-559
        • Looker A.C.
        • Wang C.Y.
        Prevalence of reduced muscle strength in older U.S. adults: United States, 2011–2012.
        NCHS Data Brief. 2015; : 1-8
        • Szulc P.
        • Beck T.J.
        • Marchand F.
        • Delmas P.D.
        Low skeletal muscle mass is associated with poor structural parameters of bone and impaired balance in elderly men--the MINOS study.
        J Bone Miner Res. 2005; 20: 721-729
        • Pluijm S.M.
        • Smit J.H.
        • Tromp E.A.
        • et al.
        A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study.
        Osteoporos Int. 2006; 17: 417-425
        • Davies C.W.
        • Jones D.M.
        • Shearer J.R.
        Hand grip--a simple test for morbidity after fracture of the neck of femur.
        J R Soc Med. 1984; 77: 833-836
        • Cooper R.
        • Kuh D.
        • Hardy R.
        Objectively measured physical capability levels and mortality: systematic review and meta-analysis.
        BMJ. 2010; 341 (c4467)
        • Tsekoura M.
        • Kastrinis A.
        • Katsoulaki M.
        • Billis E.
        • Gliatis J.
        Sarcopenia and its impact on quality of life.
        Adv Exp Med Biol. 2017; 987: 213-218
        • Clynes M.A.
        • Edwards M.H.
        • Buehring B.
        • Dennison E.M.
        • Binkley N.
        • Cooper C.
        Definitions of sarcopenia: associations with previous falls and fracture in a population sample.
        Calcif Tissue Int. 2015; 97: 445-452
        • Landi F.
        • Liperoti R.
        • Russo A.
        • et al.
        Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study.
        Clin Nutr. 2012; 31: 652-658
        • Kaiser M.J.
        • Bauer J.M.
        • Rämsch C.
        • et al.
        Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment.
        J Am Geriatr Soc. 2010; 58: 1734-1738
        • Ahmed T.
        • Haboubi N.
        Assessment and management of nutrition in older people and its importance to health.
        Clin Interv Aging. 2010; 5: 207-216
        • Chien M.H.
        • Guo H.R.
        Nutritional status and falls in community-dwelling older people: a longitudinal study of a population-based random sample.
        PLoS One. 2014; 9 (e91044)
        • Johnson C.S.
        The association between nutritional risk and falls among frail elderly.
        J Nutr Health Aging. 2003; 7: 247-250
        • Meijers J.M.
        • Halfens R.J.
        • Neyens J.C.
        • Luiking Y.C.
        • Verlaan G.
        • Schols J.M.
        Predicting falls in elderly receiving home care: the role of malnutrition and impaired mobility.
        J Nutr Health Aging. 2012; 16: 654-658
        • Saka B.
        • Kaya O.
        • Ozturk G.B.
        • Erten N.
        • Karan M.A.
        Malnutrition in the elderly and its relationship with other geriatric syndromes.
        Clin Nutr. 2010; 29: 745-748
        • Paillaud E.
        • Belmin J.
        Dénutrition protéinoénergétique chez les personnes âgées et son traitement.
        Masson, Paris2009
        • Morley J.E.
        Pathophysiology of anorexia.
        Clin Geriatr Med. 2002; 18 (v): 661-673
        • Moriguti J.C.
        • Das S.K.
        • Saltzman E.
        • et al.
        Effects of a 6-week hypocaloric diet on changes in body composition, hunger, and subsequent weight regain in healthy young and older adults.
        J Gerontol A Biol Sci Med Sci. 2000; 55: B580-B587
        • Cruz-Jentoft A.J.
        • Kiesswetter E.
        • Drey M.
        • Sieber C.C.
        Nutrition, frailty, and sarcopenia.
        Aging Clin Exp Res. 2017; 29: 43-48
        • Robinson S.M.
        • Reginster J.Y.
        • Rizzoli R.
        • et al.
        Does nutrition play a role in the prevention and management of sarcopenia?.
        Clin Nutr. 2018; 37: 1121-1132
        • Bartali B.
        • Frongillo E.A.
        • Guralnik J.M.
        • et al.
        Serum micronutrient concentrations and decline in physical function among older persons.
        JAMA. 2008; 299: 308-315
        • Wilkes E.A.
        • Selby A.L.
        • Atherton P.J.
        • et al.
        Blunting of insulin inhibition of proteolysis in legs of older subjects may contribute to age-related sarcopenia.
        Am J Clin Nutr. 2009; 90: 1343-1350
        • Houston D.K.
        • Nicklas B.J.
        • Ding J.
        • et al.
        Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study.
        Am J Clin Nutr. 2008; 87: 150-155
        • Bauer J.
        • Biolo G.
        • Cederholm T.
        • et al.
        Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group.
        J Am Med Dir Assoc. 2013; 14: 542-559
        • Haran P.H.
        • Rivas D.A.
        • Fielding R.A.
        Role and potential mechanisms of anabolic resistance in sarcopenia.
        J Cachexia Sarcopenia Muscle. 2012; 3: 157-162
        • Bachrach-Lindström M.
        • Unosson M.
        • Ek A.C.
        • Arnqvist H.J.
        Assessment of nutritional status using biochemical and anthropometric variables in a nutritional intervention study of women with hip fracture.
        Clin Nutr. 2001; 20: 217-223
        • Rafii M.
        • Chapman K.
        • Elango R.
        • et al.
        Dietary protein requirement of men >65 years old determined by the indicator amino acid oxidation technique is higher than the current estimated average requirement.
        J Nutr. 2016; ([Epub ahead of print])
        • Bhasin S.
        • Apovian C.M.
        • Travison T.G.
        • et al.
        Effect of protein intake on lean body mass in functionally limited older men: a randomized clinical trial.
        JAMA Intern Med. 2018; 178: 530-541
        • Landi F.
        • Sieber C.
        • Fielding R.A.
        • Rolland Y.
        • Guralnik J.
        Nutritional intervention in sarcopenia: report from the International Conference on Frailty and Sarcopenia Research Task Force.
        J Frailty Aging. 2018; 7: 247-252
        • Paddon-Jones D.
        • Rasmussen B.B.
        Dietary protein recommendations and the prevention of sarcopenia.
        Curr Opin Clin Nutr Metab Care. 2009; 12: 86-90
        • Calvani R.
        • Miccheli A.
        • Landi F.
        • et al.
        Current nutritional recommendations and novel dietary strategies to manage sarcopenia.
        J Frailty Aging. 2013; 2: 38-53
        • Milne A.C.
        • Avenell A.
        • Potter J.
        Meta-analysis: protein and energy supplementation in older people.
        Ann Intern Med. 2006; 144: 37-48
        • Hector A.J.
        • Marcotte G.R.
        • Churchward-Venne T.A.
        • et al.
        Whey protein supplementation preserves postprandial myofibrillar protein synthesis during short-term energy restriction in over-weight and obese adults.
        J Nutr. 2015; 145: 246-252
        • Fiatarone M.A.
        • O'Neill E.F.
        • Ryan N.D.
        • et al.
        Exercise training and nutritional supplementation for physical frailty in very elderly people.
        N Engl J Med. 1994; 330: 1769-1775
        • Paddon-Jones D.
        • Sheffield-Moore M.
        • Katsanos C.S.
        • Zhang X.J.
        • Wolfe R.R.
        Differential stimulation of muscle protein synthesis in elderly humans following isocaloric ingestion of amino acids or whey protein.
        Exp Gerontol. 2006; 41: 215-219
        • Zanovec M.
        • O'Neil C.E.
        • Keast D.R.
        • Fulgoni V.L.
        • Nicklas T.A.
        Lean beef contributes significant amounts of key nutrients to the diets of US adults: National Health and Nutrition Examination Survey 1999–2004.
        Nutr Res. 2010; 30: 375-381
        • Phillips S.M.
        Nutritional supplements in support of resistance exercise to counter age-related sarcopenia.
        Adv Nutr. 2015; 6: 452-460
        • Wilkinson D.J.
        • Hossain T.
        • Hill D.S.
        • et al.
        Effects of leucine and its metabolite β-hydroxy-β-methylbutyrate on human skeletal muscle protein metabolism.
        J Physiol. 2013; 591: 2911-2923
        • Borack M.S.
        • Volpi E.
        Efficacy and safety of leucine supplementation in the elderly.
        J Nutr. 2016; 146: 2625S-2629S
        • Bischoff-Ferrari H.A.
        • Dawson-Hughes B.
        • Staehelin H.B.
        • et al.
        Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials.
        BMJ. 2009; 339 (b3692)
        • Bischoff-Ferrari H.
        Vitamin D: what is an adequate vitamin D level and how much supplementation is necessary?.
        Best Pract Res Clin Rheumatol. 2009; 23: 789-795
        • Bischoff-Ferrari H.A.
        • Dietrich T.
        • Orav E.J.
        • Dawson-Hughes B.
        Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults.
        Am J Med. 2004; 116: 634-639
        • Tang B.M.
        • Eslick G.D.
        • Nowson C.
        • Smith C.
        • Bensoussan A.
        Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis.
        Lancet. 2007; 370: 657-666
        • Endo I.
        • Inoue D.
        • Mitsui T.
        • et al.
        Deletion of vitamin D receptor gene in mice results in abnormal skeletal muscle development with deregulated expression of myoregulatory transcription factors.
        Endocrinology. 2003; 144: 5138-5144
        • Bischoff-Ferrari H.A.
        • Dietrich T.
        • Orav E.J.
        • et al.
        Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y.
        Am J Clin Nutr. 2004; 80: 752-758
        • Simpson R.U.
        • Thomas G.A.
        • Arnold A.J.
        Identification of 1,25-dihydroxyvitamin D3 receptors and activities in muscle.
        J Biol Chem. 1985; 260: 8882-8891
        • Dhesi J.K.
        • Bearne L.M.
        • Moniz C.
        • et al.
        Neuromuscular and psychomotor function in elderly subjects who fall and the relationship with vitamin D status.
        J Bone Miner Res. 2002; 17: 891-897
        • Wicherts I.S.
        • van Schoor N.M.
        • Boeke A.J.
        • et al.
        Vitamin D status predicts physical performance and its decline in older persons.
        Clin Endocrinol Metab. 2007; 92: 2058-2065
        • Broe K.E.
        • Chen T.C.
        • Weinberg J.
        • Bischoff-Ferrari H.A.
        • Holick M.F.
        • Kiel D.P.
        A higher dose of vitamin D reduces the risk of falls in nursing home residents: a randomized, multiple-dose study.
        J Am Geriatr Soc. 2007; 55: 234-239
        • Holick M.F.
        • Binkley N.C.
        • Bischoff-Ferrari H.A.
        • et al.
        Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.
        J Clin Endocrinol Metab. 2011; 96: 1911-1930
        • Hassan-Smith Z.K.
        • Jenkinson C.
        • Smith D.J.
        • et al.
        25-Hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 exert distinct effects on human skeletal muscle function and gene expression.
        PLoS One. 2017; 12 (e0170665)
        • Tomlinson P.B.
        • Joseph C.
        • Angioi M.
        Effects of vitamin D supplementation on upper and lower body muscle strength levels in healthy individuals. A systematic review with meta-analysis.
        J Sci Med Sport. 2015; 18: 575-580
        • Reinders I.
        • Song X.
        • Visser M.
        • et al.
        Plasma phospholipid PUFAs are associated with greater muscle and knee extension strength but not with changes in muscle parameters in older adults.
        J Nutr. 2015; 145: 105-112
        • Rodacki C.L.
        • Rodacki A.L.
        • Pereira G.
        • et al.
        Fish-oil supplementation enhances the effects of strength training in elderly women.
        Am J Clin Nutr. 2012; 95: 428-436
        • Smith G.I.
        • Julliand S.
        • Reeds D.N.
        • Sinacore D.R.
        • Klein S.
        • Mittendorfer B.
        Fish oil-derived n-3 PUFA therapy increases muscle mass and function in healthy older adults.
        Am J Clin Nutr. 2015; 102: 115-122
        • Semba R.D.
        • Blaum C.
        • Guralnik J.M.
        • Moncrief D.T.
        • Ricks M.O.
        • Fried L.P.
        Carotenoid and vitamin E status are associated with indicators of sarcopenia among older women living in the community.
        Aging Clin Exp Res. 2003; 15: 482-487
        • Robinson S.
        • Cooper C.
        • Aihie Sayer A.
        Nutrition and sarcopenia: a review of the evidence and implications for preventive strategies.
        J Aging Res. 2012; 2012 (510801)
        • Kuo H.K.
        • Liao K.C.
        • Leveille S.G.
        • et al.
        Relationship of homocysteine levels to quadriceps strength, gait speed, and late-life disability in older adults.
        J Gerontol A Biol Sci Med Sci. 2007; 62: 434-439
        • Lin R.
        • Liu W.
        • Piao M.
        • Zhu H.
        A review of the relationship between the gut microbiota and amino acid metabolism.
        Amino Acids. 2017; 49: 2083-2090
        • Dukes A.
        • Davis C.
        • El Refaey M.
        • et al.
        The aromatic amino acid tryptophan stimulates skeletal muscle IGF1/p70s6k/mTor signaling in vivo and the expression of myogenic genes in vitro.
        Nutrition. 2015; 31: 1018-1024
        • Buigues C.
        • Fernández-Garrido J.
        • Pruimboom L.
        • et al.
        Effect of a prebiotic formulation on frailty syndrome: a randomized, double-blind clinical trial.
        Int J Mol Sci. 2016; : 17
        • Curcio F.
        • Ferro G.
        • Basile C.
        • et al.
        Biomarkers in sarcopenia: a multifactorial approach.
        Exp Gerontol. 2016; 85: 1-8
        • Molfino A.
        • Amabile M.I.
        • Rossi Fanelli F.
        • Muscaritoli M.
        Novel therapeutic options for cachexia and sarcopenia.
        Expert Opin Biol Ther. 2016; 16: 1239-1244
        • Smith C.P.
        • Tarn A.C.
        • Thomas J.M.
        • et al.
        Between and within subject variation of the first phase insulin response to intravenous glucose.
        Diabetologia. 1988; 31: 123-125