Potential Nutrition Support for Age-Related Muscular Conditions

The world’s population is aging and the elderly population is living longer. This demographic change poses a challenge to public health: How can the elderly sustain health and well-being? Retention of muscle health can help older adults to preserve independence and improve their quality of life. However, there are limited data on nutrition improvement as an approach to manage age-associated loss of muscle mass and strength, also known as sarcopenia. It is unclear whether specific nutrients could be beneficial to muscle health in the ageing process. To help answer this question, we reviewed the emerging data from human Randomized Controlled Trials (RCTs) on individual nutrients and muscle health in the past decade. Nineteen RCTs reported benefits of the following nutrients, supplemented alone or in combination, on improving muscle mass or strength in the elderly: Proteins and essential amino acids, vitamin D, bovine colostrum, omega-3 fatty acids, and anti-inflammatory ingredients. Cocktail supplementation of multiple nutrients was reported to be more effective than single nutrient interventions. A systems approach integrating multi-faceted interventions may help us better understand the multifactorial etiology of sarcopenia and find effective solutions towards healthy muscle conditions with age.


Introduction
The world's population is aging.By the year 2050, 21% of the world's population, or 2 billion people, is projected to be ≥ 60 years of age.Individuals aged ≥ 80 years are estimated to triple to 392 million [1].The elderly population is living longer and this demographic change poses a challenge to public health: How can the elderly sustain good health and the highest quality of life?Mobility is an essential component of life quality, which includes muscle, joint and bone maintenance.Extensive research has been conducted on nutrients that influence age-related joint and bone deteriorations.However, there are limited data on nutritional approaches to manage loss of muscle mass and strength with age, also known as sarcopenia.It is estimated that muscle mass and strength start to decline at an annual rate of 1%-2% after the age of 50 years.After 60 years, losses in muscle mass and strength often accelerate to a higher rate, 3% per year [2,3].Retention of muscle mass and/or strength can help older adults to preserve independence and improve the quality of life [1,4,5].
Currently there is no consensus definition of sarcopenia.The most commonly used criteria to diagnose sarcopenia are from the European Working Group on Sarcopenia in Older People (EWGSOP), the International Working Group on Sarcopenia (IWGS) and Foundation for the National Institutes of Health Sarcopenia Project (FNIH).These three groups define sarcopenia as the presence of both low muscle mass (whole-body or appendicular) and low muscle function (either strength and/ or physical functioning), resulting from an increase in protein catabolism and anabolic resistance [6][7][8].However, measures of muscle mass and function are not standardized and arbitrary cut-off values and various interpretations have been applied in clinical trials.Such methodological inconsistencies have led to discrepancies in relevant literature including, but not limited to, prevalence, risk factors and efficacy of interventions.
The etiology of age-related deterioration of muscle mass or strength is yet to be fully understood.Lifestyle factors, such as reduced physical activity and an unbalanced diet, are believed to be one of the main contributors to sarcopenia.Exercise is one known factor that prevents loss of muscle mass and function.A combination of resistance and aerobic exercise with moderate intensity (20 minutes daily, 5 times per week) was reported to increase muscle strength by 38% and lower the serum concentration of a generic inflammation marker, C-Reactive Protein (CRP) (P<0.01)[9].A systematic review of 62 Progressive Resistance Training (PRT) trials (3,674 subjects) reported that PRT was effective in improving muscle strength and some aspects of functional limitations, such as gait speed, among the elderly aged 60+ years [10].A recent review confirmed most exercise interventions improved muscle strength or physical performance, but not always muscle mass among older people [11].Furthermore, risks associated with exercise could not be evaluated due to lack of data on adverse events [10].Beneficial effects of exercise training alone may not be enough to improve physical functioning or muscle mass in elderly at risk for, or with sarcopenia, suggesting a need for multifactorial interventions to achieve clinically relevant results [11,12].
The relationship between dietary patterns and sarcopenia has been examined in diverse populations.Cross-sectional data have reported high prevalence of sarcopenia is associated with alcohol intake, low dietary diversity, and insufficient intakes of fruit, vegetables and dairy food [3,[13][14][15].In particular, high adherence to a Mediterranean diet is associated with slower decline in muscle and physical functioning and a lower risk of sarcopenia among the elderly [16][17][18].Unfortunately, these findings are largely based on observational data and there are limited welldesigned Randomized Controlled Trials (RCTs) investigating the efficacy of nutrition interventions on age-related muscular conditions [11].To help better understand potential nutrition solutions to age-related loss of muscle mass and/or strength, we reviewed the emerging human data from RCTs in the past decade and summarized the evidence supporting nutrition interventions in managing sarcopenic conditions.

Literature Search Methods
We searched PubMed from January 1, 2007 to June 6, 2017, by using a combination of the following keywords: "nutrient" OR "vitamin" OR "mineral" OR "nutraceutical" AND "mobility" OR "muscle" AND "2007/01/01 to current" [Date-Completion] AND "randomized controlled trial" [Publication Type].Key words were searched in the title/abstract of articles.Once the search was implemented and the publication titles were retrieved, titles of articles were screened, and abstracts of titles determined to be potentially relevant were retrieved for screening.Then full-text articles of abstracts determined to be potentially relevant were retrieved and reviewed for inclusion or exclusion.
The focus of this review is human RCTs on individual nutrients which are published in English and show improvement in muscle mass or function among older adults.Specific dietary patterns, food groups, gene/drug-nutrient interactions, biochemical/ molecular mechanism, observational and in-vitro studies are not the focus of the present review.
Table 1 summarizes nineteen human RCTs that were published in English and reported positive effects of individual nutrients on age-related loss of muscle mass or function.In the section of "Literature Summary and Discussion", we cite additional studies, reviews and meta-analyses in order to provide a balanced point of view beyond the RCTs that are listed in Table 1.

Literature Summary and Discussion
Nineteen RCTs reported benefits of the following nutrients, either supplemented alone or with other nutrients, for improving the deterioration of muscle mass or strength due to ageing: Proteins and Essential Amino Acids (EAAs), vitamin D, bovine colostrum, omega-3 fatty acids, and select anti-inflammatory ingredients (curcumin, combination of multiple compounds).In these human trials, study populations were from North America, South America, Europe and Asia with a mean age of ≥ 55-65 years, and the duration of nutrition interventions ranged from 28 days to one year.Table 1 summarizes key characteristics of these RCTs including objectives, nutrition interventions, main outcomes and key findings.

Proteins and EAAs
Protein supplementation has been reported to have beneficial effects on muscle mass and strength among healthy adults, including the elderly.A higher protein intake than the recommended dietary allowance of 0.8 g/kg body weight (BW)/day may help preserve muscle mass and support healthy aging besides physical activity [19,20].A meta-analysis of 22 randomized trials reported protein supplementation at a dose of >1.2 g/kg BW/day during resistance exercise training increased Fat-Free Mass (FFM) by an average of 0.69 kg and leg strength among healthy adults aged 12-72 years compared to placebo (p<0.005)[20].Subgroup analysis of six studies conducted in older subjects (>50 years of age) indicated an increase of 38% in FFM and a gain of 33% in muscle strength with protein supplementation [20].These benefits were observed for protein supplementation either as supplements or through food.However, it remains unknown if such benefits could be generalized to those with sarcopenia.In a recent trial, 210 g of ricotta cheese (18 g protein) was consumed daily along with the habitual diet among Mexican older adults without sarcopenia.Based on local reference intake of dietary protein (0.9 g/kg BW/ day) in older people, the addition of ricotta cheese was estimated to increase protein intake in the intervention group from 0.9 g/kg BW/day to 1.2 g/kg BW/day for the 12-week duration of the study.It was likely that increase in protein intake via ricotta cheese contributed to improved muscle mass in the intervention group compared to placebo.In particular, at 12 weeks, the mean value of appendicular muscle mass in the intervention group was significantly increased by 0.6 kg [Standard Deviation (SD): ±3.5g], while the change from baseline values was negative in the control group (mean ± SD: -1±2.6g)[21].In contrast, the same intervention was implemented among Mexican elderly with sarcopenia but did not improve any of the outcome measures [22].More research is needed to help understand if responsiveness to protein supplementation among the elderly is influenced by muscle status (i.e.healthy, at risk, or sarcopenic).
Supplementation of EAAs alone has limited or no benefit on muscle mass and function even at a high dose (i.e. 6 g EAAs/day for 3 months) [23].When supplemented with other nutrients, favorable effects of EAAs have been reported in a number of trials.A systematic review reported EAAs in combination with 2.5-2.8g leucine were beneficial to muscle mass and function [12].Favorable effects with a smaller dose of leucine (1.2 g/day) Da Boit 2017 were reported in a trial when supplemented with EAAs, vitamin D 3 and Medium-Chain Triglycerides (MCTs), indicating a potential synergistic effect with these ingredients.In this trial, elderly people were supplemented with a combination of EAAs (leucineenriched; 40% leucine in 3 g EAAs) + vitamin D 3 (800 IU) + MCTs (6 gram) or long-chain triglycerides (LCTs, 6 g) daily for 3 months.Participants who received leucine-enriched EAAs+D 3 +MCTs had improved mid-upper arm muscle mass, right-hand grip strength (13.1% higher), walking speed (12.5% faster) and peak respiratory flow (28.2% more) compared to baseline values.These changes were significantly different from the control group who did not receive any supplementation.However, no improvements were observed in the EAAs+D 3 +LCTs group.As there was no MCTs-only group in this trial, it is not clear if the observed benefit was due to the combination (EAAs+D 3 +MCTs) or MCTs [24].
Whey protein and leucine are known to be stimulators of muscle protein synthesis and a combination of both has been reported to help preserve muscle mass and improve muscle strength among older adults with or without exercise.Supplementation on muscle function and mass without exercise was investigated in a multicenter, randomized, controlled, parallel-group trial.In this study, European elderly (≥ 65 years of age) with mobility limitations received vitamin D (800 IU), whey protein (20 g) enriched with leucine (3 g), and a mixture of other micronutrients twice per day for 13 weeks.At the end of week 13, the intervention group had greater improvements in lower-extremity function and appendicular muscle mass as compared to the control group (P<0.05)[25].Specifically, the gain in appendicular muscle mass after supplementation was 0.17 kg (~1 % total appendicular muscle mass), which would offset a couple years of muscle mass loss among the elderly aged 70 years above.Protein intakes were also increased from 0.8g/ kg/day at baseline to 1.5g/kg BW/day after supplementation [25].In a similar trial, whey protein (22 g), EAAs (10.9 g, including leucine 4 g), vitamin D 3 (100 IU/day) and minerals were supplemented daily to elderly patients with sarcopenia for 12 weeks.All subjects also participated in regular exercise and received a controlled diet (providing 300IU vitamin D 3 per day) through the course of the study.At the end of intervention, the supplemented elderly gained 1.7 kg FFM, and had significantly improved Relative Skeletal Muscle Mass (RSMM) and muscle strength compared to placebo [11].Similar benefits on skeletal muscle mass were observed in obese older adults who were on a hypocaloric diet and a resistance training program.These dieting older adults consumed a control product or a supplement containing whey protein (20.7 g/serving), leucine (2.8 g/serving) and vitamin D 3 (800 IU/serving) in a timely bolus amount (10 servings/week, 3 times immediately after exercise every week).After the 13-week intervention, both placebo and intervention groups lost weight and fat mass.However, the intervention group preserved 0.9 kg of appendicular and leg muscle mass compared to placebo (p<0.05)[26].These measurable differences in skeletal muscle mass were attributed to higher protein intakes in the supplemented group (mean ± SD: 1.11±0.28g/kg BW/ day) than in placebo (mean ± SD: 0.85±0.24g/kg BW/day) [26].Daily supplementation immediately following resistance training was further investigated among healthy, early post-menopausal women.At the end of 24-week intervention, supplemented subjects (10 g whey protein, 31 g carbohydrate, 5 µg vitamin D, and 250 mg calcium) had significant improvements in muscle strength and lean body mass compared to placebo (6 g carbohydrate + 12 mg calcium) (p<0.05)[27].These data suggest temporal additive benefits of nutrient supplementation when given immediately post exercise.

Vitamin D
The efficacy of vitamin D on physical functioning and muscle strength has been reported to vary by baseline status, dosage and dosing frequency.A single mega dose of vitamin D (300,000 IU) administered orally and muscularly was reported to improve physical functioning among the elderly 4 weeks after administration [28].In another trial, vitamin D2 (1,000 IU/day) was given to elderly women with serum 25-hydroxy vitamin D [25(OH)D] <24 ng/ml for 12 months.Both the intervention and control (calcium only) groups received 1,000 mg/day of calcium throughout the study.Only among those in the lowest tertile of functional measures at baseline did vitamin D2 supplementation improve muscle strength and mobility at 12 months compared to the calcium only group.Specifically, supplementation of vitamin D2 improved Timed Up And Go (TUG) time by 17.5% in subjects with baseline TUG time >12 seconds (the clinical cutoff point for normal mobility), hip extensor strength by 22.6% and adductor strength by 13.5% among those with the lowest tertile of baseline values (P<0.05)[29].A systematic review of 12 trials reported vitamin D supplementation at a daily dose of ≥800 IU without any exercise improved balance and muscle strength among older adults aged 60+ years (P<0.05),though the magnitude of benefit was small.Other dose intervals (i.e. a single dose, weekly, monthly) did not consistently improve these outcomes as daily doses, indicating the relevance of dosing frequency to efficacy [30].Another recent systematic review of 30 RCTs confirmed positive effects of vitamin D 3 daily supplementation ( ≥400 IU) on muscle strength (17% increase, p<0.05) [31].Supplementation was reported to be more effective in improving muscle strength among high-risk groups such as those aged ≥65 years or with vitamin D insufficiency [31,32].Supplementation of vitamin D 3 together with other nutrients (i.e.whey protein, EAAs) has been reported to improve muscle mass, strength and function in a number of trials that were previously described [11,[24][25][26].Another trial reported a potential synergy between vitamin D sufficiency and a cocktail supplementation of β-hydroxy-β-methylbutyrate, arginine, and lysine (HMB/ARG/LYS; 2.0g CaHMB, 5.0g arginine, and 1.5 g lysine) on muscle strength.In this trial, supplementation of HMB/ARG/LYS for one year was reported to increase FFM among the elderly compared to the control group regardless of serum 25(OH)D status.However, significant strength gains at the end of 12 months (21% net gain in total leg muscle strength) were observed among supplemented participants with an average of serum 25(OH)D ≥30 ng/ml (P<0.05),but not among those with serum 25(OH)D<30 ng/ml.Given elderly adults are at a high risk of vitamin D insufficiency, vitamin D status may be a factor that is worth considering when we design trials or interpret data regarding the efficacy of interventions on functional measures of sarcopenia [33].
Reversed vitamin D insufficiencies with supplementation may contribute to the retention of muscle mass and function [26,32].A human study explored vitamin D on muscle metabolism by measuring muscle Fiber Cross-Sectional Area (FCSA) in muscle biopsy tissues from mobility-limited postmenopausal women.Vitamin D 3 supplementation (4,000 IU/day) increased total muscle fiber size (type I and II) by 10% over the 4-month intervention.In a subset of subjects (n=14), intra myonuclear concentration of vitamin D receptor (VDR) increased by 30% in the supplemented group [34].However, the underlying mechanism for which vitamin D improves muscle mass and function remains unclear.

Bovine Colostrum
Bovine colostrum is known for its unique nutritional composition which includes EAAs, peptides and bioactive components (eg: immunoglobulins), and it has been reported to reduce upper respiratory tract infection among athletes and increase muscle mass during exercise training.The effects of bovine colostrum on muscle strength and bone resorption were compared to whey protein in older adults aged ≥50 years.These participants were randomized to take either 60 g of colostrum or whey protein daily during resistance training for 8 weeks.After the 8-week intervention, both groups had increased lean tissue mass, muscle thickness, upper body strength and bone mineral content, with no difference between groups (P>0.05).However, the colostrum group had a greater increase in lower body strength (leg press test) and reduction in bone resorption than the whey protein group (P<0.05).Specifically, leg press strength was increased by 21% in the colostrum supplemented group (versus 5% in the whey protein group), which may be clinically relevant to those elderly with mobility limitations due to declines in lower body strength.Further research is needed to investigate long-term benefits of bovine colostrum and the underlying mechanism of action [35].

Omega-3 Fatty Acids
Omega-3 fatty acids have been reported to have mixed results in improving muscle mass and strength in older adults, which may be due to methodological differences such as dosage, duration of intervention, sample size, exercise status, and population characteristics (i.e.gender, muscle status).Alpha-Linolenic Acid (ALA) is a precursor to other omega-3 fatty acids such as DHA and EPA.Its anti-inflammatory effect on muscle mass and strength has been investigated among in an elderly population (aged >60 years) with concomitant resistance training.After 12 weeks of flax oil supplementation (~14 g ALA/day), Interleukin 6 (IL-6) concentrations (a measure of inflammatory status) decreased significantly from baseline to 12 weeks among elderly men but not women.While resistance training improved muscle thickness, strength and lean body mass in both placebo and ALA groups, the addition of ALA did not confer an additional benefit, with the exception of an increase in knee flexor muscle thickness in male subjects [36].In contrast, supplementation with fish oil (2 g/day, providing ~0.4 g EPA and 0.3 g DHA/day) ) along with strength training for 90 days was reported to improve muscle strength and functioning in elderly women compared to the group receiving strength training only [37].Another trial further investigated gender differences in the effects of 3 g fish oil daily for 18 weeks (2.1 g EPA and 0.6 g DHA/day) on muscle functioning of older adults who participated in resistance training twice per week during the study period.Significant improvement was observed only among older women, but not men [38].These data indicate gender may be a factor that influences the efficacy of omega-3 fatty acids on muscle strength and functioning, and further exploration is needed to confirm sex-specific effects.
A few trials evaluated the effects of omega-3 fatty acids independently of exercise.A commercial supplement (Lavaza, providing a daily dose of 1.86 g EPA and 1.50 g DHA) was consumed by healthy older adults for 6 months.At the end of the intervention, supplemented elderly had significantly improved thigh muscle mass, handgrip strength and average muscle power compared to the placebo group.The benefit of omega-3 fatty acids observed in this trial was estimated to prevent 2-3 years of losses in muscle mass and function with age [39].However, null effects of omega-3 fatty acids on muscle mass and/or strength were observed in older adults with decreased muscle mass (ratio of appendicular lean mass to squared height [ALM index]: below -1 Standard Deviation [SD] of the population reference value) or frailty.In these trials, the duration of omega-3 supplementation, alone or together with other nutrients (i.e.vitamin E), varied from 3 to 6 months and the daily dosage ranged from 1.2 g (0.72 g EPA and 0.48 g DHA) to 1.3 g (0.66 g EPA, 0.44 DHA, 0.20 g other omega-3) [40,41].More research is needed to help better understand potential interactions between omega-3 fatty acids and other factors (i.e.muscle status, gender) in order to deliver relevant muscular benefit to the elderly.
While the exact mechanism remains unclear, in vitro and in vivo data suggest omega-3 fatty acids may modulate muscle protein synthesis, breakdown, mitochondrial function and lipid content [39,2,42].A recent human trial examined the effects of omega-3 fatty acids on the muscle protein synthesis rate using stable-isotope-labeled tracers among older adults aged ≥ 65 years [2].While there was no observed effect on the basal rate of muscle protein synthesis, supplementation of omega-3 fatty acids for 8 weeks doubled the muscle anabolic response to amino acid and insulin infusion compared to basal values (P<0.001), and this increase was significantly greater than the placebo group (P<0.05)[2].Furthermore, omega-3 fatty acids were reported to regulate select gene expression profiles of human mitochondrial function and muscle growth, which may help explain the anabolic resistance-countering effects of omega-3 [42].Given that the ratio of omega-3 to omega-6 in Western diets is much lower than the ancestral diet, supplementation of omega-3 may help achieve a balanced intake of polyunsaturated fatty acids and combat loss of muscle mass with age via augmenting protein metabolism in human muscle [36,2,42].

Anti-Inflammatory Ingredients
The etiology of sarcopenia is not clear, but one contributing factor is believed to be chronic systemic inflammation [36].Curcumin is known for its anti-inflammatory properties.However, a limitation for the application of curcumin is its low bioavailability.A commercial supplement, Meriva®, adopted a novel phospholipid delivery form of curcumin (Phytosome®10) [29].This supplement, Meriva®, has been investigated for the efficacy on sarcopenia parameters in healthy elderly aged 65+ years.During the 3-month intervention, all subjects received standard care including a balanced diet and exercise [43].Subjects who took 1 g curcumin/day (Meriva®), alone or in combination with vitamin C, D, isoleucine, and carnitine, had significant improvements in muscle strength (hand grip and weight lifting) and physical performance compared to baseline measures and the control group who received standard care only (P<0.05) .Furthermore, the Meriva® group reported reduced oxidative stress [43].Given the multi-faceted impact of inflammation and aging on physical function, a combination of anti-inflammatory ingredients has been investigated.Bio Charge® is a multinutrient supplement containing branched chain amino acids (taurine, L-leucine, isoleucine, valine), anti-inflammatory plant extracts (cat's claw, quercetin, green tea, biovin grape extract), and B vitamins (B 12 , B 6 , folic acid, pantothenic acid).It was taken orally by healthy and recreationally active individuals aged 40-70 years for 28 days.After supplementation, physical performance, hand grip strength, general and joint pain were improved in men, and IL-6 was reduced both in men and women compared to pre-supplementation values [44].These data indicate antiinflammatory ingredients may help manage age-related physical limitations.

Conclusion
This review provides a summary of the current evidence from human RCTs supporting a beneficial role of select nutrients, supplemented alone or in combination with other ingredients, in improving muscle mass and/or function among the elderly.These nutrients include proteins and EAAs, vitamin D, bovine colostrum, omega-3 fatty acids, and select anti-inflammatory ingredients (curcumin, combination of multiple compounds).A higher protein intake (> 0.8 g/kg BW/day) may help preserve muscle mass but more research is needed to examine the responsiveness to protein supplementation by muscle status.EAAs may be beneficial to muscle health when supplemented with other nutrients, but not alone.Favorable effects of vitamin D on muscle strength and physical functioning may be influenced by factors including, but not limited to, baseline status, dosage and dosing frequency.The improvement on body strength by bovine colostrum may be clinically relevant to mobility limitations among older people but its long-term benefit needs to be further investigated.Omega-3 fatty acids appear to be promising in combating losses of muscle mass and strength with age especially when supplemented with concurrent resistance training.Anti-inflammatory ingredients have been reported to improve physical performance among older adults.In summary, cocktail supplementation of multiple nutrients was reported to be more effective than single nutrient interventions.The underlying mechanisms are not fully understood, but may include stimulation of muscle protein synthesis, modulation of muscle protein metabolism, mitochondrial function and lipid content, and/or reduction of chronic inflammation and oxidative stress.
These trials applied various outcome measures, some of which may not be sensitive indicators of sarcopenia.As an example, the Short Physical Performance Battery (SPPB), a measure of physical function, is a categorical measure with less sensitivity to changes than numerical measures [25].This highlights a methodological challenge we are facing in nutrition research: How can we identify and choose appropriate indicators that are sensitive to changes in functional outcomes?Additionally, the efficacy of nutritional interventions on the retention of muscle mass and function can be influenced by numerous factors including, but not limited to, dosage, dosage frequency, timing, baseline status, host conditions (i.e.vitamin D sufficiency versus insufficiency, healthy versus sarcopenic), and other concomitant nutrients (i.e.synergy between nutrients).A systems approach integrating multi-faceted interventions may help us better understand the multifactorial etiology of sarcopenia and find effective solutions for muscular conditions that occur with age.
of 48 nmol/L at baseline to 73 nmol/L at week 13 (p<0.001).At baseline, habitual protein intake in both groups is >0.8 g/kg/day.At week 13, the active group achieved a total protein intake of 1.5g/ kg/day.Compliance with supplementation: 93% (median).Limitation: Primary measures, handgrip strength and SPPB, are not sensitive Data collection: June 2010 -May 2013.No exercise program in the trial.In the active group, 25(OH) D concentrations improved significantly from a median value of 48 nmol/L at baseline to 73 nmol/L at week 13 (p<0.001).At baseline, habitual protein intake in both groups is >0.8 g/ kg/day.At week 13, the active group achieved a total protein intake of 1.5g/kg/day.June 2012.Obesity definition: BMI >30 or >28 with waist circumference >88cm (women) or >102cm (men) All subjects were on a hypocaloric diet (600 kcal below Dutch estimated energy needs) and participated in a resistance exercise program (3 times/week for 1 h) throughout the 13-wk intervention period.Compliance (consumption of at least 7 products/week): no difference between groups (intervention versus placebo: 91% versus 97%) 05).High loss to follow up rate (27%).Study target subjects were 60 and 44 completed the study.Completer-analysis was employed in this study, not Intention to Treat analysis.the mean value of the ASMM of a young Mexican adult population.The addition of ricotta cheese was estimated to increase protein intake from 0.9 to 1.2 g/kg BW/day.The same nutritional intervention protocol was implemented among sarcopenic elderly prior to this trial but no improvement in measures of sarcopenia including ASMM was found.the greater increase in leg press strength in the bovine colostrum group compared to whey protein is not clear.More research is needed to confirm this benefit.No difference between groups for changes in systemic inflammation (CRP).Long-term effects of bovine colostrum need to be investigated further.Citation: Kern H, Péter S, Eggersdorfer M, Mitmesser SH (2018) Potential Nutrition Support for Age-Related Muscular Conditions.J Nutrition Health Food Sci 6(3):1-17 DOI: 10.15226/jnhfs.2018.001129Potential Nutrition Support for Age-Related Muscular Conditions OH)D at baseline was 45.8±10.8nmol/L with no difference between groups.At 4 months, the supplemented group had a greater increase in 25(OH) D level than placebo (36.4±13.6 vs 4.2±11.9nmol/L, p<0.001).Sample size was small, which might not have enough power to detect any difference in muscle strength.The dose of 4000 IU/day was high although it is below the safety limit.It is not clear if such a high dose is needed for conducted in winter-spring period.Sun exposure could not be evaluated.Citation: Kern H, Péter S, Eggersdorfer M, Mitmesser SH (2018) Potential Nutrition Support for Age-Related Muscular Conditions.J Nutrition Health Food Sci 6(3):1-17 DOI: 10.15226/jnhfs.2018.001129Potential Nutrition Support for Age-Related Muscular Conditions post hoc data analysis based on serum 25(OH)D.Serum 25(OH)D was measured at 0, 3, 6, 9, and 12 months and an average value over the yearlong study was used to stratify vitamin D status .Two strata by serum 25(OH)D within each group: <30 or ≥30 ng/ml.No beneficial effects of omega-3 fatty acids on inflammatory markers were observed probably due to low inflammatory status among these healthy subjects.Citation: Kern H, Péter S, Eggersdorfer M, Mitmesser SH (2018) Potential Nutrition Support for Age-Related Muscular Conditions.J Nutrition Health Food Sci 6(3):1-17 DOI: 10.15226/jnhfs.2018.001129Potential Nutrition Support for Age-Related Muscular Conditions OH)D at baseline: 17.7±4.2ng/ml.No difference between groups.At 12 months, vitamin D group had significantly increased vitamin D status compared to placebos (79% of subjects had 25(OH)groups were matched for gender.ALA and placebo oil were comparable in terms of color and calories.Compliance rate based on returned portions of oil: 78.2 ± 21.0% for placebos vs 83.6 ± 14.4% for ALA group Typical dietary intake was assessed by a food frequency questionnaire The Ω-6 to Ω-3 ratio for the combined dietary and supplementation sources was assessed.The ratio decreased from 11.6±0.9 to 2.3±0.8 in the ALA group while the ratio increased in placebos (11.0±0.9 to 15.9±0.7)over time (p<0.0001).Null effects might be due to a small sample size.Citation: Kern H, Péter S, Eggersdorfer M, Mitmesser SH (2018) Potential Nutrition Support for Age-Related Muscular Conditions.J Nutrition Health Food Sci 6(3):1-17 DOI: 10.15226/jnhfs.2018.001129Potential Nutrition Support for Age-Related Muscular Conditions (OH)D at baseline: Mean (range): 39.5 (20.3-68.8)nmol/l for placebos; 45.9 (20.3-84.8)nmol/l for intervention group.No difference between groups (p>0.1)By the end of the intervention, no subjects in the intervention group had serum 25(OH)D levels below 50 nmol/L, while 40% of the placebo group had insufficient vitamin D levels (<50 nmol/l) on a weightmaintaining diet for the duration of the study.Bone mineral density at the lumbar spine at 24 weeks were significantly improved at both groups.