Sarcopenia (muscle loss) and Vitamin D

To gain muscle, many studies have found that you need some of the following:
Exercise - just even walking (Intermittent high intensity exercise is much better)
Vitamin D - at least 800 IU/day,
    Loading dose will show improvements in weeks instead of 4+ months
Protein - perhaps 1gm/kg/day in a form appropriate for existing stomach acid
Calcium - 300 mg?
Omega-3

See also Bone Health   reduce falls and fractures   Fraility and Vitamin D - many studies   Overview Muscles and Vitamin D

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Sarcopenia meta-analysis (most gave too Vitamin D to make a difference) March 2022

Effect of vitamin D monotherapy on indices of sarcopenia in community-dwelling older adults: a systematic review and meta-analysis
J Cachexia Sarcopenia Muscle . 2022 Mar 8. doi: 10.1002/jcsm.12976
Konstantinos Prokopidis 1 2, Panagiotis Giannos 2 3, Konstantinos Katsikas Triantafyllidis 2 4, Konstantinos S Kechagias 2 5, Jakub Mesinovic 6 7, Oliver C Witard 8, David Scott 6 7

Most trials used small doses

Summary image from examine.com

Background: Vitamin D supplementation is proposed as a potentially effective nutritional intervention to mitigate the risk of sarcopenia. The aim of this systematic review and meta-analysis was to investigate the impact of vitamin D supplementation monotherapy on indices of sarcopenia in community-dwelling older adults.

Methods: A comprehensive search of the literature was conducted in PubMed, Web of Science, Scopus, and Cochrane Library. Eligible randomized controlled trials (RCTs) compared the effect of vitamin D supplementation (as monotherapy) with placebo on indices of sarcopenia in older (>50 years) adults. Using the random effects inverse-variance model, we calculated the mean difference (MD) in handgrip strength (HGS), short physical performance battery (SPPB), timed up and go (TUG), and appendicular lean mass (ALM) between groups. We also calculated the standardized mean difference (SMD) in general muscle strength and general physical performance (composite plot of all muscle strength and physical performance outcomes, respectively) between groups.

Results: Ten RCTs were included in the meta-analysis. A significant decrease in SPPB scores was observed with vitamin D supplementation compared with placebo (MD: -0.23; 95% CI -0.40 to -0.06; I2 = 0%; P = 0.007). Vitamin D supplementation conferred no effect on HGS (MD: -0.07 kg; 95% CI -0.70 to 0.55; I2 = 51%, P = 0.82), TUG (MD: 0.07 s; 95% CI -0.08 to 0.22; I2 = 0%, P = 0.35), ALM (MD: 0.06 kg/m2 ; 95% CI: -0.32 to 0.44; I2 = 73%, P = 0.77), general muscle strength (SMD: -0.01; 95% CI -0.17 to 0.15; I2 = 42%, P = 0.90), or general physical performance (SMD: -0.02; 95% CI -0.23 to 0.18; I2 = 71%, P = 0.83).

Conclusions: Vitamin D supplementation did not improve any sarcopenia indices in community-dwelling older adults and may compromise some aspects of physical performance. Future studies are warranted to investigate the impact of vitamin D supplementation on individual indices of SPPB, including mobility and balance, in older adults.
 Download the PDF from VitaminDWiki

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Vitamin D Deficiency and Sarcopenia in Older Persons - Nov 2019

Nutrients. 2019 Dec; 11(12): 2861 doi: 10.3390/nu11122861
Francesca Remelli, Aurora Vitali, Amedeo Zurlo, and Stefano Volpato*

 Download the PDF from VitaminDWiki
Vitamin D deficiency is a common health problem worldwide, in particular among older people. Vitamin D regulates and modulates the physiology and function of multiple human systems, including the skeletal muscle. The effect of vitamin D on the muscle has been widely investigated, suggesting that this hormone can stimulate the proliferation and differentiation of skeletal muscle fibers, maintaining and improving muscle strength and physical performance. Older persons have a higher prevalence of low Vitamin D levels as a consequence of low dietary intake and reduced ultraviolet irradiation of the skin. Therefore, older people with vitamin D deficiency might be at risk of sarcopenia, a geriatric syndrome characterized by the progressive loss of skeletal muscle mass and strength often complicated by adverse events, such as falls, disability hospitalization and death. Several randomized clinical trials have been conducted to investigate the effect of oral vitamin D supplementation in older patients to prevent or treat sarcopenia, but results are still controversial. In this narrative review we summarize the biological, clinical and epidemiological evidence supporting the hypothesis of a causal association between Vitamin D deficiency and an increased risk of sarcopenia in older people.
- - - - - -
RCTs considered generally shared one or more of the following problems

1. Too short of time
2. Too low of dose (often just 800 IU)
3. No exercise (provide the body a reason to increase muscle)
4. No protein needed to build muscle (In addition to Vitamin D

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Sarcopenia 1.8X more likely if low vitamin D (Chinese males) June 2021

The Relationship between Sarcopenia and Vitamin D Levels in Adults of Different Ethnicities: ‰‰Findings from the West China Health and Aging Trend Study
The journal of nutrition, health & aging Published: 03 June 2021, https://doi.org/10.1007/s12603-021-1645-z
S. Luo, X. Chen, L. Hou, J. Yue, X. Liu, Y. Wang, X. Xia & Birong Dong

Objectives
Sarcopenia is a condition associated with progressive loss of skeletal muscle mass and function resulting in substantial negative health outcomes and disability in older adults. It is thus important that sarcopenia-related risk factors be explored. The present study was based upon the Asian Working Group on Sarcopenia 2019 (AWGS2019) criteria to assess whether vitamin D levels are a risk factor associated with sarcopenia in various ethnic groups in western China.

Design: Cross-sectional study.

Setting: Communities in Yunnan, Guizhou, Sichuan, and Xinjiang provinces.

Participants: We included 4236 individuals that were 50 years of age or older from the West China Health and Aging Trend (WCHAT) study.

Measurements
An InBody 770 instrument was used for bioimpedance-based analyses of muscle mass, while a digital grip strength dynamometer was used for handgrip strength-based measurements of muscle strength. Physical performance was assessed based upon gait speed over 4 m. Other secondary variables were additionally analyzed as potentially relevant risk factors.

Results
Sarcopenia affected an estimated 22.45% of studied individuals who were 50 years of age or older, with respective prevalence rates in the < 60, 60–64, 65–79, and ≥80 age groups of 11.78%, 19.44%, 32.65%, and 67.97%.

Age	Rate
<60	12%
60-64	19%
65-79	33%
>80	68%

Rates in males and females were 26.66% and 20.05%, respectively. In males, a significant difference in vitamin D levels was detected when comparing individuals with and without sarcopenia, although no such relationship was detected in females. Following adjustment for confounding variables, binary logistic regression analyses revealed that inadequate vitamin D was able to independently predict sarcopenia risk only in males (OR=1.875,95%CI: 1.109–3.169, P=0.019).

Conclusions
Among middle-aged and older adults of multiple ethnicities in western China, we found that inadequate vitamin D was an independent predictor of sarcopenia risk specifically in males.

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Every trial found Scopenia to be associated with low vitamin D - Meta-analysis 2018

The association between blood concentration of 25- hydroxyvitamin D and sarcopenia: a meta-analysis.
Asia Pac J Clin Nutr. 2018;27(6):1258-1270. doi: 10.6133/apjcn.201811_27(6).0013.
Luo J1, Quan Z2, Lin S1, Cui L3.
1 Department of Public Health, Medical College of Qingdao University, Qingdao, Shandong Province, China.
2 Medical School of Yanbian University, Yanji City, Yanbian Korean Autonomous Prefecture, Jilin, China.
3 Department of Public Health, Medical College of Qingdao University, Qingdao, Shandong Province, China. qdlhcui at 163.com.
 Download the PDF from VitaminDWiki

BACKGROUND AND OBJECTIVES:
Associations between blood 25-hydroxyvitamin D (25(OH)D) concentration and sarcopenia remain controversial; thus, this meta-analysis was conducted to explore the relationship between blood 25(OH)D concentration and sarcopenia.

DESIGN:
We searched the PubMed and EMBASE databases for relevant published observational studies that investigated blood 25(OH)D concentration and sarcopenia up to June 2017.We then investigated data from these studies that compared blood 25(OH)D concentrations between the sarcopenia and healthy control groups. A random-effect model was used to calculate the pooled weighted mean difference (WMD) of blood 25(OH)D concentration with a 95% confidence interval (95% CI).

RESULTS:
Twelve studies (eight cross-sectional, two matched case-control, and two prospective cohort studies) with a total of 22,590 individuals were included. Sarcopenic individuals had lower blood 25(OH)D concentrations than healthy controls (WMD=-2.14, 95% CI: -2.81- - 1.48; I2=74.6%). Subgroup analysis showed that the methods of assessing both blood 25(OH)D concentrations and sarcopenia might be sources of heterogeneity, and further showed that studies excluding obese individuals and different sarcopenia assessment criteria enhanced the relationship. Sensitivity analysis by one-study-removed confirmed the robustness of these results.

CONCLUSIONS:
Our study shows that sarcopenic adults have lower blood 25(OH)D concentrations. Further high-quality large-scale prospective cohort studies are needed to confirm these findings.
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43+ Senior pages with STRENGTH or MUSCLE or GRIP or SARCOPENIA in title

Sarcopenia = age-related loss of muscle mass
This list is automatically updated

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Sarcopenia if total of the following is >4

 Download the PDF from VitaminDWiki

See also VitaminDWiki

• Overview Muscles and Vitamin D
• Osteosarcopenic obesity (obese with low bone and muscle mass) twice as likely if low vitamin D – Oct 2016
• NASA thinks spacestation personnel only need 800 IU of vitamin D – Sept 2012 Loss of muscle strength while in space
• Adding just a little vitamin D does not help (muscle mass in this case) – meta-analysis Jan 2021
• Low Vitamin D breaks down muscle by interferring with protein - Editorial Nov 2013
• Resistance exercise combined with Vitamin D is great for seniors – meta-analysis July 2017
• Muscle strength of senior women increased 25 percent with vitamin D, decreased 6 percent with placebo – Oct 2016
• Muscular Dystrophies – low vitamin D might be associated with all 9 types – Aug 2018
• Sarcopenia: Nutrition and physical activity – systematic review – Jan 2017 has the following summary
  37 Randomized Controlled Trials of healthy seniors (those not already having Sarcopenia)
  Exercise helped in every trial
  Creatine was good too
  Protein did not help - but they failed to look at stomach acid being able to digest the protein
  400 IU of vitamin D did NOT help (need at least 800 IU after a Vitamin D loading dose)

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Sarcopenia statistics - 2014

Sample statistics from http://sarcopeniacure.com/statistics/ Note- protein and vitamin D are among their cures

• >50 % loss of muscle mass by 90 years
• Healthcare expenditures due to sarcopenia cost roughly $900 per person per year
• In the United States, an estimated 53 % of men and 43 % of women over 80 are sarcopenic.
• People who are physically inactive can lose as much as 3 to 5 % of their muscle mass per decade after age 30

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Added 1 lb of muscle mass with 800 IU Vitamin D - RCT 2017

Added 1 lb of muscle to sarcopenia adults in 13 weeks with just 800 IU vitamin D and protein – RCT Jan 2017

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Pedometer + reminder to increase steps 10%/month - RCT with Vitamin D Aug 2015

J Am Med Dir Assoc. 2015 Aug 1;16(8):654-60. doi: 10.1016/j.jamda.2015.02.017. Epub 2015 Apr 7.
Mail-Based Intervention for Sarcopenia Prevention Increased Anabolic Hormone and Skeletal Muscle Mass in Community-Dwelling Japanese Older Adults: The INE (Intervention by Nutrition and Exercise) Study.
Yamada M1, Nishiguchi S2, Fukutani N2, Aoyama T2, Arai H3.

 Download the PDF from VitaminDWiki

OBJECTIVE: The aim of the Intervention by Nutrition and Exercise (INE) study was to investigate the effects of a mail-based intervention for sarcopenia prevention on muscle mass and anabolic hormones in community-dwelling older adults.
DESIGN: A cluster-randomized controlled trial.
SETTING AND PARTICIPANTS: This trial recruited community-dwelling adults aged 65 years and older in Japan. The 227 participants were cluster randomized into a walking and nutrition (W/N) group (n = 79), a walking (W) group (n = 71), and a control (C) group (n = 77). We analyzed the physical and biochemical measurements in this substudy.
INTERVENTION: Six months of mail-based intervention (a pedometer-based walking program and nutritional supplementation).
MEASUREMENTS: The skeletal muscle mass index (SMI) using the bioelectrical impedance data acquisition system, biochemical measurements, such as those of insulinlike growth factor (IGF-1), dehydroepiandrosterone sulfate (DHEA-S), and 25-hydroxy vitamin D (25OHD), as well as frailty, were assessed by the Cardiovascular Health Study criteria.
RESULTS: Participants in the W/N and W groups had significantly greater improvements in SMI, IGF-1, and 25(OH)D (P < .05) than those in the C group. Participants in the W/N group had significantly greater improvements in DHEA-S (P < .05) than in the other groups. These effects were more pronounced in frail, older adults.
CONCLUSION: These results suggest that the mail-based walking intervention of the remote monitoring type for sarcopenia prevention can increase anabolic hormone levels and SMI in community-dwelling older adults, particularly in those who are frail.

PMID: 25858281 DOI: 10.1016/j.jamda.2015.02.017

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Hypothesis: Sarcopenia and other senior problems are related to low gastric acid

Hypothesis: Sarcopenia and other senior problems are related to low gastric acid
   Hypothesis by VitaminDWiki Feb 2015

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From muscle wasting to sarcopenia and myopenia: update 2012.

J Cachexia Sarcopenia Muscle. 2012 Nov 17
von Haehling S, Morley JE, Anker SD.
Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany, stephan.von.haehling at charite.de.

Human muscle undergoes constant changes.
After about age 50, muscle mass decreases at an annual rate of 1-2 %.
Muscle strength declines by 1.5 % between ages 50 and 60 and by 3 % thereafter.

The reasons for these changes include denervation of motor units and a net conversion of fast type II muscle fibers into slow type I fibers with resulting loss in muscle power necessary for activities of daily living. In addition, lipids are deposited in the muscle, but these changes do not usually lead to a loss in body weight.

Once muscle mass in elderly subjects falls below 2 standard deviations of the mean of a young control cohort and the gait speed falls below 0.8 m/s, a clinical diagnosis of sarcopenia can be reached. Assessment of muscle strength using tests such as the short physical performance battery test, the timed get-up-and-go test, or the stair climb power test may also be helpful in establishing the diagnosis. Serum markers may be useful when sarcopenia presence is suspected and may prompt further investigations.

Indeed, sarcopenia is one of the four main reasons for loss of muscle mass.

On average, it is estimated that 5-13 % of elderly people aged 60-70 years are affected by
sarcopenia. The numbers increase to 11-50 % for those aged 80 or above.

Sarcopenia may lead to frailty, but not all patients with sarcopenia are frail-sarcopenia is about twice as common as frailty. Several studies have shown that the risk of falls is significantly elevated in subjects with reduced muscle strength.

Treatment of sarcopenia remains challenging, but promising results have been obtained using

• progressive resistance training,
• testosterone,
• estrogens,
• growth hormone,
• vitamin D, and
• angiotensin-converting enzyme inhibitors.

Interesting nutritional interventions include

• high-caloric nutritional supplements and
• essential amino acids that support muscle fiber synthesis.
  (= protein: note by VitaminDWiki)

PMID: 23160774

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Elderly need >1 grams of protein /kg of weight and correction of vitamin D deficiency - Jan 2015

Treating Sarcopenia In Older And Oldest Old.
Curr Pharm Des. 2015 Jan 30. [Epub ahead of print]
Martone AM, Lattanzio F, Abbatecola AM, La Carpia D, Tosato M, Marzetti E, Calvani R, Onder G, Landi F1.

The presence of sarcopenia is not only rapidly rising in geriatric clinical practice and research, but is also becoming a significant concept in numerous medical specialties. This rapidly rising concept has encouraged the need to identify methods on how to treat sarcopenia. For example, physical activity measures using resistance training exercise, combined with nutritional interventions (protein and amino acid supplementation) have shown to significantly improve muscle mass and strength in older persons. Resistance training may improve muscle strength and mass by improving protein synthesis in skeletal muscle cells. Aerobic exercise has also shown to hold beneficial impacts on sarcopenia by improving insulin sensitivity. At the moment, the literature indicates that most significant improvement on sarcopenia is based on exercise programs. Thus, this type of intervention should be implemented in a persistent manner over time in elders, with or at risk of muscle loss. At the same time, physical training exercise should include correcting nutritional deficits with supplementation methods.
For example, in older sarcopenic patients with adequate renal function, daily protein intake should be increased to >1. 0 grams of protein per kilogram of body weight. In particular, leucine, β-hydroxy β-methylbutyrate (HMB), creatine and some milk-based proteins have been have shown to improve skeletal muscle protein balance.
In addition, it is also recommended to correct for vitamin D deficiency, if present, considering the crucial role of vitamin D in skeletal muscle. In this present paper, we will provide evidence regarding the effects of different physical exercise protocols, specific nutritional intervention, and some new metabolic agents (HMB, citrulline malate, ornithine, and others) on clinical outcomes related to sarcopenia in older adults.

PMID: 2563311  Download the ResearchGate PDF from VitaminDWiki

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Interventions against sarcopenia in older persons - Dec 2014

Curr Pharm Des. 2014;20(38):5983-6006.
Valeria Z, Renato G, Luisa C, Bruno V, Mauro Z, Matteo C1.

The term "sarcopenia" describes the age-related loss of skeletal muscle mass and function. It represents a major risk factor for functional loss and disability in older persons. Multiple underlying pathophysiological mechanisms have been posed at the basis of the sarcopenia phenomenon, including intrinsic (e.g., age-related modifications of the skeletal muscle, the central nervous system, and hormones) and extrinsic (e.g., sedentariness, poor protein dietary intake) factors.
Several interventions have been explored in the last years to counteract the age-related muscle decline.
These include

• protein supplementations,
• physical exercise,
• testosterone replacement (as well as other anabolic androgens) in men,
• estrogen replacement in women,
• growth hormone replacement, and
• treatment of vitamin D deficiency.

To date, adequate protein intake and resistance training are the most promising interventions able to prevent and/or delay the decline of muscle mass and function. An intense debate is currently ongoing about the best operational definition able to capture the complexity of this aging condition. In the context of identifying the optimal treatment for a specific condition, this is not a trivial issue because it sets the target of the intervention as well as the population at risk. Nevertheless, despite the current methodological issues, it is important to preliminarily test the possible strategies that might be implemented in the future, when the sarcopenia condition will finally be more univocally defined and its clinical relevance recognized. Aim of the present review is to describe and discuss available evidence about the possible interventions potentially serving at acting against sarcopenia. Pharmacological as well as non-pharmacological interventions are presented.

PMID: 24641222

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From sarcopenia to frailty: a road less traveled - March 2014

J Cachexia Sarcopenia Muscle. 2014 Mar;5(1):5-8. doi: 10.1007/s13539-014-0132-3. Epub 2014 Feb 14.
Morley JE1, von Haehling S, Anker SD, Vellas B.

The physical frailty phenotype consists of fatigue, weight loss, and loss of muscle power. Sarcopenia has been shown to be a major cause of frailty. Six societies including SCWD published a consensus suggesting that all persons older than 70 years of age should be screened for frailty when seeing health professionals.
Simple screening tests such as the FRAIL (fatigue, resistance, aerobic, illness, and loss of weight) scale can be used.
It is felt that frailty can be treated by

• exercise (resistance and aerobic),
• high quality protein,
• vitamin D, and
• treatment of the common causes of fatigue.

It is expected that this approach will decrease disability in older persons.

PMID: 24526568
 Download the PDF from VitaminDWiki.

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Improved muscle function in postmenopausal women with just 1,000 IU of vitamin D daily – RCT May 2015

Improved muscle function in postmenopausal women with just 1,000 IU of vitamin D daily – RCT May 2015
postmenopausal women with a history of falls (associated with low vitamin D)
1,000 IU daily for 9 months

	Vitamin D	Placebo
Vitamin D at start	15 ng	17 ng
Vitamin D after 9 months	28 ng	14 ng
Muscle strength lower limbs	+25 %
Loss of lean muscle mass		-7 %

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Vitamin D is one of 3 basic options to treat Sarcopenia - June 2015

Pharmacologic Options for the Treatment of Sarcopenia
Calcified Tissue International, June 2015 Publisher wants $40 for PDF
John E. Morley

Sarcopenia is now clinically defined as a loss of muscle mass coupled with functional deterioration (either walking speed or distance or grip strength). Based on the FRAX studies suggesting that the questions without bone mineral density can be used to screen for osteoporosis, there is now a valid simple questionnaire to screen for sarcopenia, i.e., the SARC-F. Numerous factors have been implicated in the pathophysiology of sarcopenia. These include genetic factors, mitochondrial defects, decreased anabolic hormones (e.g., testosterone, vitamin D, growth hormone and insulin growth hormone-1), inflammatory cytokine excess, insulin resistance, decreased protein intake and activity, poor blood flow to muscle and deficiency of growth derived factor-11. Over the last decade, there has been a remarkable increase in our understanding of the molecular biology of muscle, resulting in a marked increase in potential future targets for the treatment of sarcopenia.
At present,

• resistance exercise,
• protein supplementation, and
• vitamin D

have been established as the basic treatment of sarcopenia. High-dose testosterone increases muscle power and function, but has a number of potentially limiting side effects. Other drugs in clinical development include selective androgen receptor molecules, ghrelin agonists, myostatin antibodies, activin IIR antagonists, angiotensin converting enzyme inhibitors, beta antagonists, and fast skeletal muscle troponin activators. As sarcopenia is a major predictor of frailty, hip fracture, disability, and mortality in older persons, the development of drugs to treat it is eagerly awaited.

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Sarcopenia overview including Vitamin D - Life Extension Foundation - Nov 2018

 Download the PDF from VitaminDWiki

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See also web

• Effects of nutrition supplementation and physical exercise on muscle mass, muscle strength and fat mass among sarcopenic elderly RCT Nov 2020, PDF $30, DOI: 10.1139/apnm-2020-0643
• The most effective factors to offset sarcopenia and obesity in the older Korean: Physical activity, vitamin D, and protein intake Nutrition Jan 2017 doi: 10.1016/j.nut.2016.06.004
• Longitudinal Associations Between Vitamin D Metabolites and Sarcopenia in Older Australian men: The Concord Health and Aging in Men Project
  Sarcopenia 2.5X more likely if low Vitamin D (5 years earlier)
• Search Cinical Trials for SARCOPENIA and "VITAMIN D" 33 trials as of Feb 2021
• Prevalence, incidence, and clinical impact of sarcopenia: facts, numbers, and epidemiology-update 2014. Dec 2014
• Improved muscle function in postmenopausal women with just 1,000 IU of vitamin D daily – RCT May 2015
• Vitamin D supplementation improves muscle strength in healthy adults – meta-analysis of 6 RCT Aug 2014
   Download the PDF from VitaminDWiki.